Phentermine 30mg, 37.5 mg Informed Consent
Phentermine (FEN-ter-meen) is an appetite suppressant / anorectic prescribed adjunct to diet, exercise, and behavior changes to aid weight loss. Phentermine should be taken on an empty stomach, before breakfast, or 2 hours after a meal. Because Phen
termine may disrupt standard sleep patterns, it should always be taken at least 8 hours before sleeping.
BEFORE TAKING PHENTERMINE, inform us of any medications you are currently taking (e.g., medicines to treat high blood pressure, including Guanadrel (Hylorel) and guanethidine (Ismelin); insulin or diabetes medication you take by mouth) or have any medication allergies. Taking Phentermine with medicines used during surgery, dental, or emergency treatments may cause serious side effects. Please let us know if you are planning a surgical/medical procedure.
YOU ARE NOT A CANDIDATE FOR THIS PROGRAM IF THE FOLLOWING APPLY TO YOU:
Extreme agitation
Currently taking any ADD/ADHD meds
Uncontrolled B/P
Taking Med Suboxone
Over age 68
Glaucoma (pressure)
Tourettes (Tics)
History of stroke
Heart disease
Hyper(FAST)thyroid
Under age 18
History of heart attack
Alcohol abuse
Breastfeeding
Seizure disorder
Heart disease
Drug abuse
DO NOT TAKE PHENTERMINE IF YOU ARE USING OR HAVE USED ANTIDEPRESSANTS IN THE DRUG CLASS OF MONOAMINE OXIDASE (MAO) INHIBITORS (see list below) in the last 14 days; this may suddenly provoke highly high blood pressures. These include:
- furazolidone (Furoxone)
- phenelzine (Nardil)
- selegiline (Eldepryl)
Isocarboxazid (Marplan
Procarbazine (Matulane)
- Tranylcypromine (Parnate)
SOME ANTIDEPRESSANTS MAY NEED TO BE ADJUSTED OR TAKEN AT BEDTIME WHEN TAKEN CONGRUENT WITH PHENTERMINE TO MINIMIZE OVERSTIMULATION. Phentermine may increase these medicines’ central nervous system (CNS) stimulant effects, such as irritability, nervousness, trembling or shaking, or trouble sleeping. Examples:
- Citalopram (Celexa)
- Fluoxetine (Prozac, Seraphim)
- escitalopram (Lexapro)
- Fluvoxamine (Luvox)
- sertraline (Zoloft)
- Some antidepressants, when taken congruent with Phentermine, may increase the risk of hypertension and or irregular heartbeat. **Extreme caution must be taken when combining these medications. EXAMPLES INCLUDE:
- protriptyline (Vivactil)
- trimipramine (Surmontil)
- amitriptyline (Elavil)
- Amoxapine (Ascending)
- desipramine (Norpramin)
- mipramine (Tofranil)
- Doxepin (Sinequan)
- nortriptyline (Pamelor)
ALSO, PLEASE TELL US IF YOU TAKE ANY MEDS FOR ATTENTION DEFICIT (ADD, ADHD): amantadine (Symmetrel), Amphetamines, Caffeine, i.e. NoDoz, chlophedianol (Ulone), Cocaine; medicines for asthma or other breathing problems, medication for colds, sinus problems, or hay fever or other allergies (including nose drops or sprays), methylphenidate (Ritalin), nabilone (Cesamet.) Taking Phentermine together with other diet medications such as dexfenfluramine (Redux) can be very dangerous; do not take Phentermine with any other diet medications.
SIDE EFFECT: Get immediate emergency medical help if you have any signs of an allergic reaction: hives, difficulty breathing, swelling of your face, lips, tongue, or throat.
STOP USING PHENTERMINE AND CALL US AT ONCE IF YOU HAVE ANY OF THESE SYMPTOMS: · Feeling short of breath, even with mild exertion · Feeling like you may pass out · Swelling of feet or lower legs, rapid weight gain · Chest pain, uneven heartbeat, chest “tightness or pressure,” · Swift heart beat (palpitations) · Unusual thoughts or behavior, feeling restless or confused;
Dangerously high blood pressure (symptoms include severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, and seizure).
LESS SERIOUS SIDE EFFECTS THAT YOU MAY EXPERIENCE INCLUDE: · Feeling nervous or anxious · Itching.· Headache, dizziness, tremors · Trouble sleeping (insomnia) · Faster heartbeat · Dry mouth or an unpleasant taste in your mouth · Mild elevation in blood pressure · Diarrhea or constipation;
IMPORTANT NOTES CONCERNING PHENTERMINE AND WEIGHT LOSS: Phentermine will NOT be used as a substitute for proper diet or exercise. It must be used in conjunction with a reduced-calorie diet and exercise for maximum effects. Any diet, activity level, and behavior modifications must be developed and continued long-term to maintain weight loss and prevent the lost weight from returning. As Phentermine is similar chemically to amphetamines, taking Phentermine may cause a positive result in urine screening tests for amphetamines and can be habit-forming. Do NOT share your Phentermine prescription with others.
Long-term use of amphetamines may lead to Pulmonary Hypertension (PH), a severe medical condition in which the blood pressure in the lungs becomes dangerously higher than usual; this condition can progressively lead to heart failure. PH is diagnosed with symptoms of progressive shortness of breath, dizziness and fatigue, progressive weakness, and fainting spells. While other lung conditions may present with symptoms similar to those of Pulmonary Hypertension, such as asthma and COPD, Phentermine MUST be stopped immediately if these symptoms arise.
To be started on this Phentermine program, all candidates must have a BMI >25.0 kg/m, be older than 18 years, and be younger than 68. Transfers patients with a prior history of taking Phentermine with another practitioner who presents with a current BMI less than <25.0 kg/m2 may be considered at the NP’s discretion. We will NOT prescribe Phentermine to minors (less than age 18).
Of course, Phentermine will NOT be prescribed to patrons with NO history of ever taking the drug that currently has a BMI less than 25.0. These patients are better candidates for our Lipo or hCG programs that target specific fat regions.
When drug therapy is discontinued, in some cases, weight may be regained unless the patient continues with implemented behavioral changes. When stopping Phentermine, your body may need time to adjust. This length of time depends on how much medicine you were using and how long you used it. Symptoms you may experience include changes in personality, irritability, extreme tiredness or weakness, mental depression or illness (severe), nausea or vomiting, skin disease, stomach cramps, trembling, or trouble sleeping.
PHENTERMINE REFILL
Phentermine prescriptions may be refilled once a month (not before 30 days) –
Bi-monthly prescription refills (not before 60 days) may also be dispensed at the NP’s discretion to evaluate progressive healthy weight loss.
A patient is considered responsive to the treatment plan when evidence supports that the patient is making positive behavioral modifications and decreasing in weight after initiating the Phentermine prescription.
We ask that all patients maintain relationships with their “primary care” doctor to whom they can be referred for evaluation and management of blood pressure, diabetes, hypertension, and other medical problems. Please be advised that WHEN INDICATED, you may be prescribed a controlled substance in the form of an appetite suppressant that may raise your blood pressure. We accept patients with high blood pressure if they are on medication and their blood pressure is controlled. Patients are advised not to take any controlled substance, such as Phentermine or Adipex if their blood pressure is higher than 140/90. If a patient has a high reading and a blood pressure over 140/90, you will NOT be prescribed Phentermine, Adipex, or SR Combo.
ADDITIONAL GOALS OF THERAPY—Success will be measured by the degree of weight loss and improvement in associated risk factors. All patients must be re-evaluated after 12 weeks to determine if the treatment is working. If the weight loss at that point is not at least 5% of the starting weight, the prescribed appetite suppressant should be stopped, according to the FDA, as it is not likely to work adequately.
Phentermine is currently FDA-approved for short-term weight loss (12 weeks). GOAL– Again, If at least 5% weight loss after three months of continued use of Phentermine is not achieved, the drug will be discontinued.
When the patient is actively losing healthy weight with no signs of medication tolerance or ill drug effects, Phentermine may be continued as “non-label” use at the patient’s consent and the NP’s discretion. It must be apparent to the patient that medical risks associated with “off label” usage (taking Phentermine longer than 12 weeks) have been less systematically evaluated and, thus, maybe with increased medical risk over the risks seen with usage in compliance with labeled suggestions. These patients may intermittently wean on and off Phentermine as long as the blood pressure remains well controlled and the medication seems to offer still some benefit over risk.
If Phentermine can help a patient maintain at least 10% of their initial weight loss, the patient is still considered a success and may continue on therapy. Med continuation will always be conditional based on the Nurse Practitioner’s review of the patient’s current weight loss trends and a benefit-to-risk ratio assessment.
Phentermine is an appetite suppressant that has been taken safely by millions, but as with any medication, there is a possibility of side effects or an adverse reaction. In case of severe side effects, stop taking the Phentermine and seek immediate medical attention at your local ER. Phentermine should be taken 1 hour BEFORE breakfast during the adjustment phases to prevent insomnia; also, you should try breaking the tablet in half to help with possible sleeping disturbances. When breaking the tablet, taking the Phentermine 2 hours after breakfast is okay to help with medication longevity throughout the day. Depending on the individual patient, it may take 4-7 days to adjust to possible sleeping disturbances associated with the medications.
By Purchasing , I acknowledge that I have read and agree with the Phentermine program described in this informed consent and its potential side effects and risks. I have disclosed my past and current medical history. I know the possible benefits, risks, alternatives, and adverse reactions. I’ve had the opportunity to ask questions and express concerns. At this moment, I release Indian Lake Medical and its associates from any liability associated with this phentermine weight loss program. I understand that any medical treatment may involve risks and the proposed benefits. I also understand that there are certain health risks associated with remaining overweight or obese. Risks of this medical weight loss program and some of its proposed treatment plans may include but are not limited to nervousness, sleeplessness, headaches, dry mouth, gastrointestinal disturbances, weakness, tiredness, psychological problems, high blood pressure, rapid heartbeat, and heart irregularities. These and other possible risks could occasionally be serious or even fatal when left untreated.
I am not pregnant, and I am not attempting to become pregnant.
By Purchasing, I acknowledge that I have read and understand Phentermine Informed Consent.