Summer Banks, Director of Content at Dietspotlight, has researched over weight-loss programs, pills, shakes and diet plans. Anonymous December 20, A 6-month randomized, placebo-controlled, dose-ranging trial of topiramate for weight loss in obesity. You may experience symptoms including tiredness, depression, restlessness, blurred vision and many more. At plasma concentrations associated with low doses of phentermine e. Obesity Silver Spring ; 20 7: I would actually get up to one mg a day, plus mg tabs each day.
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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: Ann Med Interne Paris ; Cardiovascular responses to weight management and sibutramine in high-risk subjects: Eur Heart J ; Diabetes Metab J ; 3: Medicines and Healthcare Products Regulatory Agency.
Department of Health and Human Services. Food and Drug Administration. Committee for Medicinal Products for Human Use. Guideline on clinical investigation of medicinal products in the treatment or prevention of diabetes mellitus WWW document ; Concept paper on the need for revision of the guideline of medical products used in weight control WWW document ; Aminorex, fenfluramine, and chlorphentermine are serotonin transporter substrates.
Implications for primary pulmonary hypertension. Amphetamine-type central nervous system stimulants release norepinephrine more potently than they release dopamine and serotonin. Amphetamine analogs increase plasma serotonin: J Pharmacol Exp Ther ; Paradoxical effect of sibutramine on autonomic cardiovascular regulation. Central sympathoinhibition and peripheral neuronal uptake blockade after desipramine in rabbits.
Am J Physiol ; 4 Pt 2: R—R [ PubMed ]. Influence of sibutramine on blood pressure: Int J Obes ; Selective norepinephrine reuptake inhibition as a human model of orthostatic intolerance. Selective impairment in sympathetic vasomotor control with norepinephrine transporter inhibition. Effects of desipramine on sympathetic nerve firing and norepinephrine spillover to plasma in humans. Am J Physiol ; How physician obesity specialists use drugs to treat obesity.
Obesity Silver Spring ; Randomized controlled trial to investigate the effects of a newly developed formulation of phentermine diffuse-controlled release for obesity. Effects on weight reduction and safety of short-term phentermine administration in Korean obese people. Maybe a snack bar or yogurt for a snack.
I usually eat every 3 hours. I'm a severe asthmatic, have been since forever. I had to take steroid pills and shots because I couldn't breathe. It caused me to gain so much weight it never went away. At the age of 14 I was lbs. It was about July that I looked in the mirror and saw that I was horrified with what I saw. I had let myself go and to me I looked very fat. A week later I was put on Bontril. It absolutely changed my life. It's now May of and I way pounds. The weight is still coming off and I barely have anything that fits cause its too BIG.
I've never been happier and it keeps getting better. Anonymous May 13, Bontril Slow Release phendimetrazine: I gained 25 pounds in 4 weeks. Lost 11 pounds when I could exercise. I started Bontril on March 11 and stopped for 9 days because I could not get to the doctor. I have lost 10 pounds. No withdrawal symptoms while off. SandraLA April 29, I am not hungry at all and I love it so far.
Really haven't had any side effects. Anonymous April 13, The first day I was a little jittery and could not eat anything then I developed a very bad headache but after my body getting over the initial shock it has adjusted to the medicine. I weighed in on Sunday at lbs, today Thursday I am I have lost a whooping 10lbs I am so excited about this. I started to take the medicine because I was doing all that exercise and my weight was not going down but now the combination of the pill and exercise I am seeing changes.
I am 34 and 5'1. EYT March 31, I have lost 15 pounds so far. No side effects for me with the exception of the sweet taste in my mouth. I love to eat Anonymous March 22, I am a full-time student and makes me much less active than normal. I have done little exercise and have lost 15 pounds in 6 weeks! Medication is great, I don't even have to drink coffee, and I forget to eat because my appetite just disappears.
Once the medication kicks in and makes me lose the cravings, it's also much easier to eat well when I'm not taking it. I have saved hundreds of dollars on impulse food alone! I wanted to feel healthier and reach my goal of being lbs, and I am very healthy to begin with so why not? Anonymous February 26, You are either taking too much or you might have already a tendency to anxiety and as a stimulant, this medication will increase symptoms of anxiety.
Taking it with a full glass or skim, soy or almond milk will be also soothing of negative symptoms. MarinaBella February 24, I have not started exercising yet, but intend to, so the weight loss is all diet. This medicine is excellent and gives you the ability to turn down food you know is not helpful to your goals.
It has also wiped out all my cravings. I have been taking this medicine for 5 weeks and have lost 21 pounds and have four to go to reach my goal. The only side effect I had was a couple of bouts of dizziness, but they would only last for 30 seconds or so. I have more energy to go to the gym and actually miss going if I can't make it that day.
The cravings were bad for about a week, but then just disappeared. Now I look at chocolate at the grocery store and have no desire to eat it. Anonymous February 10, I am pleased to say that I have lost 7 pounds the first week and 6 pounds the second week and tomorrow will be 3 weeks and I have lost 3 this week. In total I have lost 16 pounds so far. I have experienced the dry mouth, suppressed appetite, and headaches. However, none of them bad enough to make me stop yet.
When I look in the mirror I am so pleased. I started out at pounds and now am at pounds. Everyday I am excited to see what my scale says once I get up. I would recommend this to anyone that needs to lose weight. I haven't been able to exercise yet due to an injury in back. Best Weight Loss Pill January 17, I am a 30 year old male and 6 weeks ago I weighed lbs. I have taken Phendimetrazine 35mg 3 times a day for 6 weeks now.
I have dropped almost 40 lbs and look and feel the best ever. I exercise 30 minutes a day -nothing major, just a light jog. I eat 4 small meals which are: I don't drink alcohol or soda. Anonymous December 20, A year on, a year off. I would actually get up to one mg a day, plus mg tabs each day. I am 49 years old. My last experience with Bontril has not been good. I have tried to cut back on the dosage to no avail.
I will have to go off it completely. I'm disappointed, because I do think it is a great medicine to manage your weight. I guess the moral to this story is you eventually will reach a point where your body can no longer tolerate it. I Guess Weight Watchers is my next step. Anonymous November 23, The 1st week I lost 7lbs and the 2nd week I lost 3 lbs and none since. The 1st week I had tons of energy and a significant decrease in appetite. The 2nd week my appetite started to come back and the energy was gone.
I now have almost the same appetite as before, although I do get full a little quicker. Went to Doctor today to get refill. Going to try 1 more month. I did follow the calorie diet and drank lots of water the 1st 2 weeks. It is hard to restrict calories now that the hunger is back. As far as side effects, I did experience headaches, insomnia and dry mouth for a few days, but that has gone away. I was also irritable that 1st week. Now the only side effect is dizziness if I don't drink enough water.
Anonymous October 20, I have tried every diet possible with little success. Been the the doctor and my thyroid is working well. I was working out 5 days a week P90X lost inches but no weight and still with little to show for all my hard work. My plan is part doctor prescribed and part learning portion control.