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Transcript
Phentermine hydrochloride (F EN-ter-m een) CLASSIFICATION(S): Anorexiant PREGNANCY CATEGORY: C Rx: Adipex-P, Ionamin, C-IV USES Short-term (few weeks) treatment for weight reduction with exercise, behavioral modification, and caloric restriction in the management of exogenous obesity in clients with an initial body mass of 30 kg/m2 or more or 27 mg/m2 or more in the presence of other risk factors (e.g., hypertension, diabetes, hyperlipidemia). ACTION/KINETICS Action Phentermine is a sympathomimetic amine with similar actions as amphetamine, including increase in BP and CNS stimulation. Tachyphylaxis and tolerance can occur. CONTRAINDICATIONS Advanced arteriosclerosis, CV disease, moderate to severe hypertension, hyperthyroidism, glaucoma, or known hypersensitivity to sympathomimetic amines. Also, agitated states, those with a history of drug abuse, during or within 14 days following the administration of MAO inhibitors (hypertensive crisis may occur). Use with other drugs for weight loss, as well as with selective serotonin reuptake inhibitors is not recommended. Lactation. Use in children less than 16 years of age. SPECIAL CONCERNS • Abuse of phentermine and development of intense psychological dependence and severe social dysfunction are possible. • Abrupt discontinuation following high doses results in extreme fatigue and mental depression. • Use with caution even in those with mild hypertension. • Insulin requirements in diabetes mellitus may be altered. C = see color insert H = Herbal • Safety and efficacy not determined in children. SIDE EFFECTS Most Common Dizziness, constipation, dry mouth, headache, false sense of well being, N&V, nervousness, insomnia, tremors. CNS: Overstimulation, restlessness, nervousness, dizziness, insomnia, euphoria, dysphoria, tremor, headache, exaggerated feelings of depression or elation, false sense of well being, psychotic episodes (rare). GI: Dry mouth, unpleasant taste, diarrhea, constipation, GI disturbances. CV: Palpitation, tachycardia, throbbing heartbeat, increased BP, primary pulmonary hypertension, regurgitant cardiac valvular disease. Miscellaneous: Urticaria, impotence, changes in libido, tremors. OD OVERDOSE MANAGEMENT Symptoms: Acute overdose: CNS: Restlessness, tremor, hyperreflexia, rapid respiration, confusion, assaultiveness, hallucinations, panic states. Fatigue and depression follow the central stimulation. CV: Arrhythmias, hypertension or hypotension, circulatory collapse. GI: N&V, diarrhea, abdominal cramps. Fatal poisoning usually terminates in convulsions and coma. Chronic intoxication: Severe dermatoses, marked insomnia, irritability, hyperactivity, personality changes, psychosis (indistinguishable from schizophrenia). Treatment: Acute overdose: • Largely symptomatic. • Gastric lavage. • Sedation with a barbiturate. • Acidification of the urine (increases phentermine excretion). • Phentolamine, IV for acute, severe hypertension. DRUG INTERACTIONS Alcohol / Adverse drug reaction possible Dexfenfluramine / Possible primary pulmonary hypertension (rare); also, possible serious regurgitant cardiac valvular disease (primarily affecting the mitral, aortic, and/or tricuspid valves) Fenfluramine / Possible primary pulmonary hypertension (rare); also, possible serious regurgitant cardiac valvular disease (primarily affecting the mitral, aorIV = Intravenous E = sound alike drug tic, and/or tricuspid valves) Guanethidine /앗 Guanethidine hypotensive effect MAO inhibitors / Possible significant 앖 BP; do not use together. Allow at least 2 weeks to elapse between the use of an MAOI and phentermine HOW SUPPLIED Capsules: 18.75 mg, 30 mg, 37.5 mg; Capsules (resin): 15 mg, 30 mg; Tablets: 8 mg, 37.5 mg. DOSAGE • CAPSULES; TABLETS Exogenous obesity. Adipex-P: One capsule or tablet (37.5 mg) once daily, given before breakfast 1 or 1–2 hr after breakfast. For some, /2 tablet (i.e., 18.75 mg) daily may be ade1 quate. Or, for some, give /2 tablet two times/day. Ionamin: One capsule or tablet (various doses) once daily, given before breakfast or 2 hr after breakfast. 1 For some, /2 tablet may be adequate Take capsules 10–14 hr before bedtime. NURSING CONSIDERATIONS ADMINISTRATION/STORAGE 1. Tolerance to the anorectic effect usually occurs within a few weeks. Do not exceed the recommended dose in an attempt to increase the effect; rather, discontinue the drug. 2. Store at room temperature. ASSESSMENT 1. List reasons for therapy, risk factors, BMI, other agents trialed, outcome. 2. List medical conditions that may require weight loss. Identify those that preclude therapy: advanced arteriosclerosis/CAD, hyperthyroidism, glaucoma, drug abuse history, extreme agitation. Bold Italic = life threatening side effect 3. Monitor VS, renal and LFTs, BMI. Assess for tolerance, anorectic effect usually develops within a few weeks. CLIENT/FAMILY TEACHING 1. Take only as directed. Avoid late evening administration due to the possibility of insomnia. Swallow Ionamin capsules whole. 2. If a dose is missed, skip the missed dose completely; take the next dose at the regularly scheduled time. Continue to remain in and follow medically supervised weight loss program. 3. Do not perform activities that require mental alertness until drug effects realized; may experience cognitive impairment. 4. Continue calorie restrictions and regular daily exercise to ensure weight loss. 5. Drug may cause pulmonary hypertension which is fatal. Shortness of breath is the first symptom but other symptoms include: chest pain (angina pectoris), syncope, or lower extremity edema. Report immediately any S&S or deterioration in exercise tolerance and stop therapy. 6. Drug may cause psychological dependence and social isolation. Do not increase dose and do not stop abruptly after prolonged therapy. Severe side effects may occur. Store safely out of the reach of children. 7. Monitor FS. Insulin requirements may be altered with the use of Ionamin and the recommended dietary regimen. 8. With hypertension, monitor BP closely. Drug may cause significant increases in BP. 9. Keep all F/U to assess response, VS, labs, and for adverse SE. OUTCOMES/EVALUATE Desired weight loss ■ = black box warning W = Available in Canada