Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Current Obesity Reports
Published in: Current Obesity Reports 1/2024

03-01-2024 | Obesity | REVIEW

Phentermine in the Modern Era of Obesity Pharmacotherapy: Does It Still Have a Role in Treatment?

Authors: Kristina H. Lewis, Kimberly A. Gudzune, Jamy D. Ard

Published in: Current Obesity Reports | Issue 1/2024

Login to get access

Abstract

Purpose of Review

This review provides an overview of the history, mechanism of action, and expected treatment effects of the anti-obesity medication (AOM), phentermine. It also includes a summary of recent research and practical guidance for prescribing clinicians.

Recent Findings

Recent research on phentermine is sparse and consists primarily of observational studies with methodologic limitations. These studies suggest that phentermine use is associated with clinically significant weight loss in adults and that the medication is generally well tolerated. Large-scale observational studies evaluating phentermine’s safety have not identified an increased risk of cardiovascular events or elevations in blood pressure. There is no data to support the notion that phentermine is addictive.

Summary

Although it remains the most commonly prescribed AOM in the USA, phentermine has little rigorous research to support its efficacy and safety in long-term treatment, which creates a dilemma with guideline-recommended chronic use of AOMs. While we await forthcoming conclusive data on this front, clinicians may consider using phentermine long-term in selected patients, if such prescribing is consistent with local regulatory statutes.
Literature
1.
Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989.PubMed
2.
Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205–16.PubMed
3.
Zoler M. Wegovy U.S. Supply shortage strikes again. WebMD Health News. 2023 May 5 2023.
4.
Colman E. Anorectics on trial: a half century of federal regulation of prescription appetite suppressants. Ann Intern Med. 2005;143(5):380–5.PubMed
5.
Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342–62.PubMed
6.
Patel D. Pharmacotherapy for the management of obesity. Metabolism. 2015;64(11):1376–85.PubMed
7.
Bray GA, Greenway FL. Pharmacological treatment of the overweight patient. Pharmacol Rev. 2007;59(2):151–84.PubMed
8.
Nelson DL, Gehlert DR. Central nervous system biogenic amine targets for control of appetite and energy expenditure. Endocrine. 2006;29(1):49–60.PubMed
9.
Introduction WM. Clin Pharmacol Ther. 1992;51(5):581–5.
10.
Weintraub M. Long-term weight control study: conclusions. Clin Pharmacol Ther. 1992;51(5):642–6.PubMed
11.
Weintraub M, Sundaresan PR, Madan M, Schuster B, Balder A, Lasagna L, et al. Long-term weight control study I (weeks 0 to 34). Clin Pharmacol Ther. 1992;51(5):586–94.PubMed
12.
Murali S. Knowledge gaps in long-term phentermine use: making the case for maintenance. Obesity (Silver Spring). 2019;27(8):1219.PubMed
13.
Bray GA, Heisel WE, Afshin A, Jensen MD, Dietz WH, Long M, et al. The science of obesity management: an Endocrine Society scientific statement. Endocr Rev. 2018;39(2):79–132.PubMedPubMedCentral
14.
Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. American Association Of Clinical Endocrinologists and American College Of Endocrinology Comprehensive Clinical Practice Guidelines for medical care of patients with obesity. Executive Summary Complete Guidelines available at https://​www.​aace.​com/​publications/​guidelines. Endocr Pract. 2016;22(7):842–84.
15.
Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2013.
16.
Grunvald E, Shah R, Hernaez R, Chandar AK, Pickett-Blakely O, Teigen LM, et al. AGA clinical practice guideline on pharmacological interventions for adults with obesity. Gastroenterology. 2022;163(5):1198–225.PubMed
17.
Wharton S, Lau DCW, Vallis M, Sharma AM, Biertho L, Campbell-Scherer D, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020;192(31):E875–91.PubMedPubMedCentral
18.
Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief. 2020;360:1–8.
19.
Saxon DR, Iwamoto SJ, Mettenbrink CJ, McCormick E, Arterburn D, Daley MF, et al. Antiobesity medication use in 2.2 million adults across eight large health care organizations: 2009–2015. Obesity (Silver Spring). 2019;27(12):1975–81.
20.
Almazan E, Schwartz JL, Gudzune KA. Use of medications associated with weight change among participants in the All of Us research programme. Clin Obes. 2023:e12609.
21.
Elangovan A, Shah R, Smith ZL. Pharmacotherapy for obesity-trends using a population level national database. Obes Surg. 2021;31(3):1105–12.PubMed
22.
Lewis KH, Fischer H, Ard J, Barton L, Bessesen DH, Daley MF, et al. Safety and effectiveness of longer-term phentermine use: clinical outcomes from an electronic health record cohort. Obesity (Silver Spring). 2019;27(4):591–602.PubMed
23.
Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553–64.PubMedPubMedCentral
24.
Rubino D, Abrahamsson N, Davies M, Hesse D, Greenway FL, Jensen C, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA. 2021;325(14):1414–25.PubMed
25.
Shibuya K, Ali KF, Ji X, Milinoivh A, Bauman J, Kattan MW, et al. The benefit of short-term weight loss with anti-obesity medications in real-world clinical practice. Endocr Pract. 2019;25(10):1022–8.PubMed
26.
Grabarczyk TR. Observational comparative effectiveness of pharmaceutical treatments for obesity within the veterans health administration. Pharmacotherapy. 2018;38(1):19–28.PubMed
27.
Tchang BG, Aras M, Wu A, Aronne LJ, Shukla AP. Long-term weight loss maintenance with obesity pharmacotherapy: a retrospective cohort study. Obes Sci Pract. 2022;8(3):320–7.PubMed
28.
Cunningham JG, Szoka N, Tabone LE, Cox S, Aylward L, Abunnaja S. Preoperative and early adjuvant weight loss medications in bariatric surgery patients with body mass index over 60 or suboptimal initial response to surgery. Surg Obes Relat Dis: official journal of the American Society for Bariatric Surgery. 2023.
29.
Griebeler ML, Butsch WS, Rodriguez P, Lomeli L, Kampert M, Makin V, et al. The use of virtual visits for obesity pharmacotherapy in patients with overweight or obesity compared with in-person encounters. Obesity (Silver Spring). 2022;30(11):2194–203.PubMed
30.
Rocha-Gonzalez HI, De la Cruz-Alvarez LE, Kammar-Garcia A, Canizales-Quinteros S, Huerta-Cruz JC, Barranco-Garduno LM, et al. Weight loss at first month and development of tolerance as possible predictors of 30 mg phentermine efficacy at 6 months. J Pers Med. 2021;11(12).
31.
Moldovan CP, Weldon AJ, Daher NS, Schneider LE, Bellinger DL, Berk LS, et al. Effects of a meal replacement system alone or in combination with phentermine on weight loss and food cravings. Obesity (Silver Spring). 2016;24(11):2344–50.PubMed
32.
Thomas DD, Waring ME, Ameli O, Reisman JI, Vimalananda VG. Patient characteristics associated with receipt of prescription weight-management medications among veterans participating in MOVE! Obesity (Silver Spring). 2019;27(7):1168–76.PubMed
33.
Acosta A, Camilleri M, Abu Dayyeh B, Calderon G, Gonzalez D, McRae A, et al. Selection of antiobesity medications based on phenotypes enhances weight loss: a pragmatic trial in an obesity clinic. Obesity (Silver Spring). 2021;29(4):662–71.PubMed
34.
U.S. Department of Health and Human Services FaDA, Center for drug evaluation and research. Guidance for industry: developing products for weight management. 2007.
35.
Marquez-Cruz M, Kammar-Garcia A, Huerta-Cruz JC, Carrasco-Portugal MDC, Barranco-Garduno LM, Rodriguez-Silverio J, et al. Three- and six-month efficacy and safety of phentermine in a Mexican obese population. Int J Clin Pharmacol Ther. 2021;59(8):539–48.PubMedPubMedCentral
36.
Perez-Cruz E, Guevara-Cruz M, Ortiz-Gutierrez S, Luna-Camacho Y, Guzman-Aguilar R, Briceno-Saenz G, et al. Effect of phentermine on hepatic steatosis in bariatric surgery: a pilot study. Med Princ Pract. 2022;31(3):254–61.PubMedPubMedCentral
37.
Kim HO, Lee JA, Suh HW, Kim YS, Kim BS, Ahn ES, et al. Postmarketing surveillance study of the efficacy and safety of phentermine in patients with obesity. Korean J Fam Med. 2013;34(5):298–306.PubMedPubMedCentral
38.
39.
40.
41.
Lee M, Lauren BN, Zhan T, Choi J, Klebanoff M, Abu Dayyeh B, et al. The cost-effectiveness of pharmacotherapy and lifestyle intervention in the treatment of obesity. Obes Sci Pract. 2020;6(2):162–70.PubMed
42.
Elhag W, El Ansari W, Abdulrazzaq S, Elsherif M, Mustafa I. Lorcaserin vs. Phentermine among non-surgical and surgical obese patients: anthropometric, glycemic, lipid, safety and cost outcomes. Ann Med Surg (Lond). 2019;45:75–81.
43.
Gorelik E, Gorelik B, Masarwa R, Perlman A, Hirsh-Raccah B, Matok I. The cardiovascular safety of antiobesity drugs-analysis of signals in the FDA Adverse Event Report System Database. Int J Obes (Lond). 2020;44(5):1021–7.PubMed
44.
Thomas EA, McNair B, Bechtell JL, Ferland A, Cornier MA, Eckel RH. Greater hunger and less restraint predict weight loss success with phentermine treatment. Obesity (Silver Spring). 2016;24(1):37–43.PubMed
45.
Rothman RB, Elmer GI, Shippenberg TS, Rea W, Baumann MH. Phentermine and fenfluramine: preclinical studies in animal models of cocaine addiction. Ann N Y Acad Sci. 2006;844(1):59–74.
46.
Hendricks EJ, Srisurapanont M, Schmidt SL, Haggard M, Souter S, Mitchell CL, et al. Addiction potential of phentermine prescribed during long-term treatment of obesity. Int J Obes (Lond). 2014;38(2):292–8.PubMed
47.
Force USPST, Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, et al. Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US preventive services task force recommendation statement. JAMA. 2018;320(11):1163–71.
48.
O’Malley PG. What does off-label prescribing really mean? Arch Intern Med. 2012;172(10):759–60.PubMed
49.
Eguale T, Buckeridge DL, Winslade NE, Benedetti A, Hanley JA, Tamblyn R. Drug, patient, and physician characteristics associated with off-label prescribing in primary care. Arch Intern Med. 2012;172(10):781–8.PubMed
50.
Radley DC, Finkelstein SN, Stafford RS. Off-label prescribing among office-based physicians. Arch Intern Med. 2006;166(9):1021–6.PubMed
51.
Good CB, Gellad WF. Off-label drug use and adverse drug events: turning up the heat on off-label prescribing. JAMA Intern Med. 2016;176(1):63–4.PubMed
52.
53.
54.
55.
56.
57.
58.
59.
Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014;311(1):74–86.PubMedPubMedCentral
60.
Munro JF, MacCuish AC, Wilson EM, Duncan LJ. Comparison of continuous and intermittent anorectic therapy in obesity. Br Med J. 1968;1(5588):352–4.PubMedPubMedCentral
61.
Chai ST MN. SAT-LB022 Effects of intermittent versus continuous phentermine therapy on weight reduction and inflammatory markers in obese non-diabetic patients. J Endocr Soc. 2019;3(Suppl 1).
62.
Busetto L, Bettini S, Makaronidis J, Roberts CA, Halford JCG, Batterham RL. Mechanisms of weight regain. Eur J Intern Med. 2021;93:3–7.PubMed
63.
Smith SR, Weissman NJ, Anderson CM, Sanchez M, Chuang E, Stubbe S, et al. Multicenter, placebo-controlled trial of lorcaserin for weight management. N Engl J Med. 2010;363(3):245–56.PubMed
64.
Jastreboff AM, Kaplan LM, Frias JP, Wu Q, Du Y, Gurbuz S, et al. Triple-hormone-receptor agonist retatrutide for obesity - a phase 2 trial. N Engl J Med. 2023.
65.
Metadata
Title
Phentermine in the Modern Era of Obesity Pharmacotherapy: Does It Still Have a Role in Treatment?
Authors
Kristina H. Lewis
Kimberly A. Gudzune
Jamy D. Ard
Publication date
03-01-2024
Publisher
Springer US
Keywords
Obesity
Obesity
Published in
Current Obesity Reports / Issue 1/2024
Electronic ISSN: 2162-4968
DOI
https://doi.org/10.1007/s13679-023-00546-9

Other articles of this Issue 1/2024

Current Obesity Reports 1/2024 Go to the issue

Review

Obesity and leukemia: Biological mechanisms, perspectives, and challenges

REVIEW

Weight Loss Diets, Fads, and Trends

Letter to the Editor

Is Endoscopic Surveillance Needed After Laparoscopic Sleeve Gastrectomy?

Review

The H-P-O axis and adiposity-related alterations in PCOS

REVIEW

The Role of Racism in Childhood Obesity

REVIEW

Bioavailability of Orally Administered Drugs After Bariatric Surgery
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits