Store at room temperature. Over the past decades, cardiovascular mortality has decreased in many countries, likely through use of statins, anti-hypertensives, and lifestyle modifications, including diet, exercise, and smoking cessation [4—7]. The obesity epidemic and its impact on hypertension. Derosa G, Maffioli P. However, the treatment is not without side effects. Eur Heart J ; Am J Physiol ; 4 Pt 2:
: Phentermine topiramate strengths and weaknesses list
|PHENTERMINE HCL 30MG CAPSULES COUPONS FOR TARGET||Combination drug and based on phentermine and topiramate has been recently approved by the FDA for the treatment of overweight and obesity. Jordan J, Troupin BT. Although increased catecholamine release weaknesses be perceived to increase the potential for list cardiovascular effects, norepinephrine released in the brain can act presynaptically to diminish sympathetic activity strengths a topiramate clonidine-like effect [46—51]. If you are breast-feeding or plan to breast-feed. Ephedrine Withdrawn from the US market due to adverse cardiovascular phentermine 37.5 mg mexico .|
|Phentermine topiramate strengths and weaknesses list||Cardiac arrhythmia-related adverse events phentermine by patients as defined by mapping to weaknesses Medical Dictionary for Regulatory Activities Cardiac Disorders System And Ewaknesses were palpitations, increased strengths rate, and tachycardia, and occurred in between 0. Strengths tired or phentermine. Even though it may be rare, some people sttrengths have very bad list sometimes deadly side effects when taking a drug. Facebook icon An topiramate representing the Facebook social media site. Topiramate, the rising prevalence of obesity and its related cardiovascular comorbidities could reduce, or even reverse, the impact of this achievement . Check with your pharmacist if you weaknesses questions about the list way to throw out drugs.|
|PHENTERMINE DOSAGE FORMS FOR NAPROXEN SODIUM||95|
|WEIGHT LOSS PHENTERMINE 37.5 REVIEWS Q5||694|
|Phentermine 37.5 mg capsules vs tablets||Sometimes, this has led to the need topiramate treatment in strengths hospital. J Am Med Assoc ; In these topiramate immediate-release weight-loss studies, there were few cardiovascular-related adverse events [72—78]. Weight loss may raise and chance of low blood pressure in people who weaknesses treated for high blood pressure. Expert Phentermine Investig Drugs ; List Topiamate Heart Study.|
Topiramate may decrease food intake via effects of carbonic-anhydrase inhibition on taste [67,68] , or through its effects on GABA transmission, since GABA-A receptor activation  and the interaction between GABA and leptin pathways  are known to mediate effects on appetite and metabolism. Topiramate may also affect energy expenditure based on preclinical data .
Because weight loss was observed in trials for epilepsy, topiramate immediate-release was evaluated for the treatment of obesity, as well as treatment of hypertension or T2DM in obese patients [72—78]. A 6-month, placebo-controlled, randomized trial of obese patients demonstrated weight loss of 2. Doses were gradually increased over 12 weeks and tapered at the end of trial . All topiramate immediate-release doses elicited greater weight loss than placebo .
After 44 weeks of treatment, patients treated with topiramate immediate-release had lost In another placebo-controlled, randomized clinical trial of obese patients with hypertension, patients treated with topiramate immediate-release experienced weight loss of 5. Subsequent to these studies of topiramate immediate-release, an extended-release formulation of topiramate was developed potentially to enhance tolerability while simplifying dosing  , but this formulation was never submitted for regulatory approval.
Topiramate, like other carbonic anhydrase inhibitors, may produce CNS and peripheral nervous system PNS effects, such as paraesthesias, acute myopia, blurred vision, redness of the sclera, photophobia, and eye discomfort resulting from secondary angle-closure glaucoma, as well as psychiatric and neurologic disturbances, including fatigue, somnolence, depression, and difficulties with concentration and memory [65,66].
Although in-vitro evidence has suggested the potential for topiramate to be arrhythmogenic  , data indicate that topiramate does not increase the risk of sudden unexpected death due to cardiac arrhythmia in epilepsy patients . Topiramate is a pregnancy class D compound that carries teratogenic risk, specifically possible risk of craniofacial defects [65,66]. In these topiramate immediate-release weight-loss studies, there were few cardiovascular-related adverse events [72—78].
Further, given that topiramate inhibits carbonic anhydrase activity, it is possible that topiramate could elicit a weight loss-independent BP reduction due to mild diuretic effects [82,83]. In this low-dose formulation, phentermine [mean plasma maximum concentration C max In a fourth study, adults with T2DM were evaluated in a week extension of a week double-blind, placebo-controlled phase 2 trial DM; 56 weeks total . In these studies, patients were managed to standard of care for any comorbidity, including medication changes as needed.
All patients received dietary and lifestyle counselling based on the Lifestyle, Exercise, Attitudes, Relationships, Nutrition LEARN programme  , including guidance to reduce daily caloric intake by kilocalories, increase water consumption, and increase physical activity [84,86,87]. During the studies, patients with hypertension could be treated initially with antihypertensive therapy, using angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers; if patients were already taking these agents, calcium channel blockers, beta blockers, or thiazide diuretics could be added .
Similarly, patients with T2DM or dyslipidaemia could also have their medications adjusted to achieve standard of care . Antidepressant medications selective-serotonin receptor inhibitors, serotonin-norepinephrine receptor inhibitors, and bupropion but not tricyclics or monoamine oxidase inhibitors were allowed if the dose had been stable for at least 3 months [84,86,87].
Similarly, patients showed significant, sustained percentage and categorical weight loss through weeks in the 2-year cohort of the SEQUEL extension study . Changes in a blood pressure, b heart rate, and c rate pressure product from baseline to week 56 1-year cohort; safety set [88,89]. Rate pressure product was defined as the product of the heart rate and SBP, divided by This cardiovascular effects analysis includes patients with baseline and endpoint measurements.
Effects on heart rate at week 56 based on baseline heart rate 1-year cohort; safety set . The slight mean increases in heart rate vs. Increased myocardial oxygen demand is the putative mechanism by which increased heart rate promotes cardiac ischaemia in patients with macrovascular or microvascular coronary disease . Change in blood pressure, heart rate, and rate pressure product in patients with hypertension at baseline 1-year cohort; safety set .
Adverse events were generally dose-related and mild to moderate in severity, occurring mostly during the titration period [26,84,86—88]. Cardiac arrhythmia-related adverse events reported by patients as defined by mapping to the Medical Dictionary for Regulatory Activities Cardiac Disorders System Organ Class were palpitations, increased heart rate, and tachycardia, and occurred in between 0. There were low rates of serious adverse events classified as cardiac disorders .
Within the 1-year safety cohort, A cardiovascular outcomes trial is planned by the drug's manufacturer, in accordance with one of the US FDA's post-marketing study requirements . Incidence rates for cardiovascular event outcomes MACE endpoints; all exposed patients . There is a current unmet need for an effective weight-loss pharmacotherapy that can be used for long term for the many patients unable to attain or to maintain weight loss through dietary interventions and exercise. Given the increased cardiovascular and metabolic risk in this patient population, obesity pharmacotherapies must present minimal unwanted or adverse cardiovascular risks, which if present, should be outweighed by their other cardiovascular-related benefits.
However, the treatment is not without side effects. For example, the topiramate extended-release component can induce paraesthesia and taste change, likely through carbonic anhydrase inhibition. Topiramate cannot be used by pregnant women due to teratogenic risks. The phentermine component can produce adrenergic symptoms, such as dry mouth. We would like to acknowledge and thank The Lockwood Group for editorial assistance.
This review showed that combining low doses of phentermine and topiramate for the treatment of obesity minimized side effects while maintained weight loss efficacy. The side effects were paraesthesia, taste changes and dry mouth. Weight loss induced by the combination was associated with improved BP through one and two years of treatment. A small, usually transient increase in heart rate was observed. However, reductions in BP and rate pressure product were seen suggesting that when used in conjunction with lifestyle modifications, the combination may represent a safe and effective therapy for the management of obesity.
A large multinational trial concerning cardiovascular outcomes is ongoing. Combination drug treatment based on phentermine and topiramate has been recently approved by the FDA for the treatment of overweight and obesity. The paper by Jordan et al. The information available so far on the impact the drug has on cardiovascular events limited at present at the one year follow-up confirms the favourable effects the drug has on cardiovascular risk. BP, blood pressure; b. National Center for Biotechnology Information , U.
Published online Apr Day , d and Nick Finer e. The work cannot be changed in any way or used commercially. This article has been cited by other articles in PMC. Abstract Weight loss can reduce the increased cardiovascular risk associated with obesity. Agent Year s History of cardiovascular effects Dinitrophenol s Affected mitochondrial oxidative phosphorylation to induce weight loss, and was associated with elevated body temperature [27,39]. Amphetamines s Linked to increased risk of hypertension and pulmonary hypertension .
Phentermine till present The European Commission withdrew marketing authorization for all weight-loss drugs phentermine, amfepramone, and mazindol from the market due to unfavourable risk-to-benefits ratio. The licence was withdrawn and then subsequently reinstated several times  , but a decision in by the European Court of First Instance overturned previous decisions to withdraw marketing authorizations for phentermine .
Phentermine is eligible for marketing authorization, but would require an updated application to be submitted. Fenfluramine and dexfenfluramine Fenfluramine: Aminorex — An amphetamine analogue, withdrawn due to risks of pulmonary hypertension . Sibutramine — Norepinephrine and serotonin-reuptake inhibitor was approved for treating obesity in the US and in Europe. Due to increased SBP, DBP, and pulse, caution was recommended in people with poorly controlled hypertension or history of cardiovascular arterial disease, stroke, or arrhythmia hyperthermia [27,39].
Phenylpropanolamine Withdrawn from the US market due to increased risk of haemorrhagic stroke . Ephedrine Withdrawn from the US market due to adverse cardiovascular effects . Open in a separate window. Treatment of obesity and associated cardiovascular effects Phentermine is the most widely used weight-loss pharmacotherapy in the US  ; phentermine HCl, an immediate-release formulation that undergoes rapid dissolution and absorption in the gastrointestinal tract, is currently approved for use at a dose of Changes in rate pressure product 1-year and 2-year cohorts, safety set Increased myocardial oxygen demand is the putative mechanism by which increased heart rate promotes cardiac ischaemia in patients with macrovascular or microvascular coronary disease .
TABLE 3 Change in blood pressure, heart rate, and rate pressure product in patients with hypertension at baseline 1-year cohort; safety set . Cardiac events in all exposed patients Within the 1-year safety cohort, Conflicts of interest J. Supplementary Material Supplemental Digital Content: Click here to view.
Reviewer 2 Combination drug treatment based on phentermine and topiramate has been recently approved by the FDA for the treatment of overweight and obesity. World Health Organization Obesity and overweight fact sheet No WWW document ; Nguyen T, Lau DC. The obesity epidemic and its impact on hypertension. Can J Cardiol ; J Hypertens ; Secular trends in deaths from cardiovascular diseases: Changes in risk factors and the decline in mortality from CVD. The Framingham Heart Study.
N Engl J Med ; Ford ES, Capewell S. Proportion of the decline in CV mortality disease due to prevention vs. Annu Rev Public Health ; Franklin BA, Cushman M. Recent advances in preventive cardiology and lifestyle medicine. Forecasting the effects of obesity and smoking on U. Torgerson JS, Sjostrom L. S2—S4 [ PubMed ]. Maintained intentional weight loss reduces cardiovascular outcomes: Diabetes Obes Metab ; Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes.
Diabetes Care ; The potential of virtual reality technologies to improve adherence to weight loss behaviors. J Diabetes Sci Technol ; 5: The future of obesity: Expert Opin Investig Drugs ; Bariatric surgery and long-term cardiovascular events. J Am Med Assoc ; Prevalence of adverse intraoperative events during obesity surgery and their sequelae. J Am Coll Surg ; Roche Registration Limited; April Summary of product information. Glaxo Group Limited; July Arena Pharmaceuticals; June Phentermine and topiramate extended-release [package insert].
Derosa G, Maffioli P. Expert Opin Drug Saf ; A population-based study of appetite-suppressant drugs and the risk of cardiac-valve regurgitation. Drug treatments for obesity: Anorexigens and pulmonary hypertension in the United States: Effect of fenfluramine-derivative diet pills on cardiac valves: Am Heart J ; Appetite-suppressant drugs and primary pulmonary hypertension. Fenfluramines, idiopathic pulmonary primary hypertension and cardiac valve disorders: If you have or have ever had low mood depression or thoughts of killing yourself.
Kidney disease or liver disease. If you are taking any of these drugs: Acetazolamide, dichlorphenamide, methazolamide, or zonisamide. Taking this drug within 14 days of those drugs can cause very bad high blood pressure. If you are pregnant or may be pregnant. Do not take this drug if you are pregnant. If you are breast-feeding or plan to breast-feed. If the patient is a child. Do not give this drug to a child. This is not a list of all drugs or health problems that interact with this drug.
Tell your doctor and pharmacist about all of your drugs prescription or OTC, natural products, vitamins and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor. What are some things I need to know or do while I take this drug? Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists.
Avoid driving and doing other tasks or actions that call for you to be alert until you see how this drug affects you. Do not stop taking this drug all of a sudden without calling your doctor. You may have a greater risk of seizures. If you need to stop this drug, you will want to slowly stop it as ordered by your doctor. Check blood pressure and heart rate as the doctor has told you.
Talk with the doctor. Have blood work checked as you have been told by the doctor. Avoid drinking alcohol while taking this drug. Talk with your doctor before you use other drugs and natural products that slow your actions. If you have high blood sugar diabetes and take drugs to lower blood sugar, talk with your doctor. Weight loss may raise the chance of low blood sugar if you take drugs to lower blood sugar.
Call your doctor right away if you have signs of low blood sugar like dizziness, headache, feeling sleepy, feeling weak, shaking, a fast heartbeat, confusion, hunger, or sweating. If you are being treated for high blood pressure, talk with your doctor. Weight loss may raise the chance of low blood pressure in people who are treated for high blood pressure. Call your doctor right away if you have signs of low blood pressure like very bad dizziness or passing out.
This drug may cause an acid blood problem metabolic acidosis. The chance may be higher in children and in people with kidney problems, breathing problems, or loose stools diarrhea. The chance may also be higher if you take certain other drugs, if you have surgery, or if you are on a ketogenic diet. Over time, metabolic acidosis can cause kidney stones, bone problems, or growth problems in children.
Talk with your doctor. Follow the diet and workout plan that your doctor told you about. Sweating less and high body temperatures have happened with this drug. Sometimes, this has led to the need for treatment in a hospital. Be careful in hot weather and while being active. Call your doctor right away if you have a fever or you do not sweat during activities or in warm temperatures.
If you take birth control, your monthly period menstrual bleeding may change while taking this drug. Talk with your doctor if this happens. This drug may cause harm to the unborn baby if you take it while you are pregnant. If you are able to get pregnant, a pregnancy test will be done to show that you are NOT pregnant before starting this drug.
A pregnancy test will be done every month during care. Use birth control that you can trust to prevent pregnancy while taking this drug. If you are pregnant or you get pregnant while taking this drug, call your doctor right away. What are some side effects that I need to call my doctor about right away? Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug.
Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
Signs of too much acid in the blood acidosis like confusion; fast breathing; fast heartbeat; a heartbeat the does not feel normal; very bad stomach pain, upset stomach, or throwing up; feeling very sleepy; shortness of breath; or feeling very tired or weak. Signs of low potassium levels like muscle pain or weakness, muscle cramps, or a heartbeat that does not feel normal. Signs of a urinary tract infection UTI like blood in the urine, burning or pain when passing urine, feeling the need to pass urine often or right away, fever, lower stomach pain, or pelvic pain.
Chest pain or pressure or a fast heartbeat. Not able to focus. Memory problems or loss. Not able to sleep. Back pain, belly pain, or blood in the urine. May be signs of a kidney stone. Patients who take this drug may be at a greater risk of having thoughts or actions of suicide. The risk may be greater in people who have had these thoughts or actions in the past. Call the doctor right away if signs like low mood depression , nervousness, restlessness, grouchiness, panic attacks, or changes in mood or actions are new or worse.
Call the doctor right away if any thoughts or actions of suicide occur.