Phentermine Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Dizziness, dry mouth, difficulty sleeping, irritability, nausea, vomiting, diarrhea, or constipation may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.

Tell your doctor right away if you have any serious side effects, including: fast/irregular/pounding heartbeat, mental/mood changes (e.g., agitation, uncontrolled anger, hallucinations, nervousness), uncontrolled muscle movements, change in sexual ability/interest.

Stop taking this medication and get medical help right away if you have any very serious side effects, including: severe headache, trouble speaking, seizure, weakness on one side of the body, vision changes (e. g., blurred vision).

This drug may rarely cause serious (sometimes fatal) lung or heart problems (pulmonary hypertension, heart valve problems). The risk may increase with longer use of this medication and use of this drug along with other appetite-suppressant drugs/herbal products. Stop taking this medication and get medical help right away if you have any very serious side effects, including: chest pain, difficulty breathing with exercise, decreased ability to exercise, fainting, swelling of the legs/ankles/feet.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US –

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Is It Safe To Use Phentermine If You Have High Blood Pressure?

Published on March 13, 2019

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If you have never used Phentermine before, tons of questions are probably going through your mind. Even current users of this drug wonder about its impact on other aspects of their health. Like many other medications, phentermine can also induce some side effects or interact with certain drugs. So, it’s natural to wonder whether it’s safe to take the drug if you have some health problem such as high blood pressure.

Throughout this post, we’re going to focus on phentermine and discuss whether you can take it if you have high blood pressure or not. Scroll down to learn more.

How does phentermine work?

Phentermine is one of the most frequently prescribed drugs for weight loss. Yes, the drug is available with a doctor’s prescription only due to its strength. This is not a dietary supplement or some other weight loss product you can buy in drugstore or order online. Phentermine is a generic form of drugs that are sold under brand names such as Adipex-P and Suprenza (1).

This is a psychostimulant medication that belongs to drugs called substituted amphetamine which is a chemical class of medications similar to amphetamine. Phentermine was specifically formulated to suppress appetite in order to reduce calorie intake and help kick-start weight loss in persons whose BMI is 30 (or 27 in the presence of cardiovascular risk factors and other problems associated with obesity).

Phentermine is used as an adjunct to doctor-approved exercise, calorie restriction, and lifestyle changes to help men and women lose weight (2). As a short-term solution (up to 12 weeks or three months), phentermine works when you make an effort. It’s a huge mistake to take the pill hoping it would magically work without exercising or making any changes in your diet.

The drug works by stimulating your brain to decrease appetite, but also it helps burn calories faster. Phentermine stimulates the release of certain neurotransmitters such as dopamine, epinephrine (adrenalin), and norepinephrine (noradrenaline) to boost energy levels, increase alertness, and minimize cravings. It’s a well-known fact that cravings (usually for unhealthy food) are one of the biggest enemies for successful weight loss and effective weight management. This way, phentermine allows users to slim down and maintain their results.

Approved since 1959, phentermine is thanks to its efficacy and reasonable price one of the drugs with the oldest seal of approval from FDA (3). Not only it promotes weight loss on its own, but the drug also works well in combination with other medications such as topiramate (4, 5).

High blood pressure causes and risk factors

Hypertension or high blood pressure occurs when the force of blood pushing against blood vessel walls is higher than normal (6). Millions of people have hypertension. More precisely, an estimated 103 million US adults have high blood pressure, according to the American Heart Association, which is nearly half of all adults in the country. The death rate caused by hypertension increased by 11% in a period between 2005 and 2015. On a global level, about a third of the adult population worldwide has high blood pressure, and with the aging population alongside increased life expectancy those numbers are bound to rise (7).

Most people with hypertension don’t have any symptoms which only depicts the severity of this problem. However, in some cases, a person can have a headache, nosebleeds, shortness of breath, but none of them are specific symptoms that affect everyone with high blood pressure. It’s highly important to monitor your blood pressure regularly in order to manage it effectively.

As far as the causes of hypertension are concerned, it’s important to differentiate between primary and secondary high blood pressure. Primary hypertension does not have a specific cause, and it tends to develop over many years. On the flip side, secondary hypertension involves some underlying cause such as obstructive sleep apnea, adrenal gland tumors, kidney problems, thyroid-related problems, and certain medications (8). In most instances, hypertension is a result of some health problem or a consequence of some unhealthy lifestyle habit.

Everyone can develop high blood pressure, but some people are at a higher risk than others. Some risk factors are out of your control, such as:

• The family history of hypertension
• Ethnicity and race
• Aging
• Gender (being a man)
• Having a disease (sleep apnea, kidney problems, etc.)

On the other hand, some risk factors associated with hypertension are modifiable. These include:

• Sedentary lifestyle
• Smoking and exposure to secondhand smoke
• Diabetes
• Overweight and obesity
• Alcohol consumption
• High cholesterol
• Unhealthy diet
• Eating too much salt
• Some medications

Phentermine and hypertension

Overweight and obese individuals are at a higher risk of hypertension, so it’s natural to wonder whether weight loss drug could make their blood pressure even worse. Some weight loss medications do increase the risk of hypertension, but when it comes to phentermine that may not be the case. Kim et al. found in their study that while phentermine promoted weight loss and induced adverse reactions in some participants, there were no significant differences in systolic and diastolic blood pressure between control and placebo group (4).

A separate study, published in the Obesity journal, confirmed that phentermine treatment for obesity doesn’t result in increased systolic blood pressure, diastolic blood pressure, and heart rate. Phentermine-assisted weight loss is linked with favorable shifts in blood pressure as well as slowed progression to hypertension in obese individuals (9).

In 2017 one study found that phentermine treatment for weight loss can lower blood pressure, thus making the drug actually helpful for persons with hypertension. Obese adults who were treated with phentermine for six months experienced weight loss and decrease in both diastolic and systolic blood pressure. That being said, blood pressure numbers didn’t improve in persons who had diabetes (10).

While the above-mentioned studies found that phentermine doesn’t aggravate blood pressure, it’s still important to carry out further research on this topic. After all, it’s important to elucidate all the mechanisms of action associated with phentermine in order to uncover whether it could affect blood pressure, particularly in persons with hypertension, in the long run.

So, I can take phentermine with hypertension?

Despite the fact that evidence points out phentermine could be safe for persons with high blood pressure, you should still be cautious. In fact, the best thing to do is to consult your doctor about the problem. Your physician will inform you about the safety of the drug and potential risks that may occur. The doctor may want to monitor you closely if you have high blood pressure and are taking phentermine, but also if you have problems affecting heart valves and reduced kidney function.

Various sources include hypertension or high blood pressure on the list of serious side effects of phentermine (11, 12). Phentermine could lead to pulmonary hypertension, high blood pressure in the arteries of your lungs. Patients who have hypertension or some other cardiovascular problem that could be aggravated by higher blood pressure or accelerated heart rate should take the drug with caution (13).

Always trust your doctor as he or she can evaluate your cardiovascular health and determine whether phentermine is safe for you. If you’ve changed your doctor recently, then make sure you inform them about high blood pressure or some cardiovascular disease you may have before they hand the phentermine prescription.

You should never, under any circumstances, seek for a doctor who will prescribe phentermine if your physician doesn’t do so due to assessment that it could have a negative impact on your blood pressure or some other aspect of health. In other words, while generally, you should be okay when using phentermine with hypertension it doesn’t mean you should avoid consulting doctor and following their instructions or recommendations on the matter.

Phentermine tips you need to know

Phentermine is not the most frequently prescribed weight loss drug just because of its convenient price, it also works. Getting the most out of phentermine requires following dosage instructions and other orders issued by your doctor. There’s a lot you can do to get the most out of phentermine while minimizing the risk of side effects. Here are a few suggestions you need to know if you’re considering using phentermine (or you’re already are):

• Avoid increasing or decreasing dosage on your own. The doctor usually prescribes the lowest dosage first and adjusts it if or when necessary. Taking more than necessary could increase the risk of side effects, overdose, dependence, and other negative effects
• Take the drug before breakfast or one to two hours after it. Ideally, you should avoid taking phentermine in the late evening because it could make it difficult for you to fall asleep. Remember, phentermine is a stimulant, and it keeps you aware and alert.
• Exercise regularly and increase physical activity levels in addition to eating a healthier diet and reducing calorie intake. As mentioned above, phentermine is prescribed as a conjunction to lifestyle changes. It works only when you make some modifications in your lifestyle too. That way, you’re equipped to achieve a healthy weight loss and are more likely to maintain weight in healthy range effectively .
• If the drug impairs your judgment avoid operating heavy machinery or drive when taking it
• Avoid drinking alcohol when taking phentermine. Alcohol could increase the risk of side effects associated with this drug
• Never, under any circumstances, should you use phentermine together with other weight loss drugs
• Your meals should consist of controlled portions of protein, whole grains, and vegetables

Tips to control high blood pressure

Hypertension is a serious problem due to the fact it can contribute to the higher risk of other cardiovascular issues. Fortunately, this is a modifiable problem that you can control with a few wise decisions, such as the following:

• Lose weight – since being overweight or obese puts you at a higher risk of hypertension the first and the most important thing you can do is to slim down. Start by making some changes in your diet and physical activity levels, stay motivated, and stick to your schedule, and you’ll get there
• Try to exercise about 150 minutes a week which is about 30 minutes on most days during the week
• Avoid trans fats and other unhealthy foods and ingredients in favor of fruits, vegetables, whole grains, and other healthy alternatives
• Decrease salt intake
• Quit smoking and drinking
• Reduce caffeine intake
• Manage stress
• Get enough sleep

Conclusion

Phentermine is a common weight loss drug that doctors prescribe to their patients whose BMI is 30. Studies show that the drug doesn’t cause high blood pressure, but you should still be cautious and consult your doctor about the subject.

References

(1) https://www.everydayhealth.com/drugs/phentermine
(2) https://www.webmd.com/drugs/2/drug-4151/phentermine-oral/details
(3) https://www.sciencedirect.com/topics/neuroscience/phentermine
(4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687747/
(5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623549/
(6) https://www.heart.org/-/media/data-import/downloadables/pe-abh-what-is-high-blood-pressure-ucm_300310.pdf
(7) https://www.heart.org/en/news/2018/05/01/more-than-100-million-americans-have-high-blood-pressure-aha-says
(8) https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410
(9) https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2011.94
(10) https://www.healio.com/endocrinology/obesity/news/online/%7Be0ec386f-62f7-4d88-94f1-ebbe47ff604b%7D/phentermine-lowers-weight-systolic-bp-in-adults-with-obesity
(11) https://www. rxlist.com/consumer_phentermine-hydrochloride/drugs-condition.htm#what_are_side_effects_of_phentermine
(12) https://www.drugs.com/sfx/adipex-p-side-effects.html
(13) https://www.livestrong.com/article/482412-can-you-take-diet-pills-with-high-blood-pressure/

Phentermine for weight loss seems safe, effective longer term :: KPWHRI

Dr. Arterburn discusses reassuring news from his PCORnet study of the most widely used anti-obesity drug in the United States.

By David Arterburn, MD, MPH, a senior investigator at Kaiser Permanente Washington Health Research Institute and an internal medicine physician at Washington Permanente Medical Group

As time goes by, we’re recognizing more and more how chronic and tenacious obesity can be. Comprehensive, intensive interventions to achieve lifelong changes in lifestyle — including diet and exercise — are the cornerstone of treatment, with long-term follow-up. But such programs don’t work for up to one in three patients. And weight regain is common after 6 months, the point when such programs can yield weight loss of 5 percent to 10 percent.

Weight-loss medications are one way to help more people to have larger, and potentially longer lasting, responses to lifestyle interventions, as placebo-controlled trials have shown. But these medications tend not to be used broadly, mainly because of lack of insurance coverage, leading to high out-of-pocket costs for patients, but also because of concerns about side effects.

Phentermine is the most commonly used anti-obesity medication in the United States. Back when it was approved for weight loss in 1959, the chronic nature of obesity wasn’t understood as well. The Food and Drug Administration (FDA) limited treatment to 12 weeks or less. By contrast, when the FDA approved a new brand-named combination medication, Phentermine/Topiramate-CR (Qsymia), in 2012, it was for long-term use for a year or more.

Many doctors prescribe phentermine, on its own, to patients for more than 12 weeks. And anecdotal reports from many of my colleagues suggested that it was helpful for many patients long-term. But there’s a lack of research on its longer-term safety and efficacy. Phentermine is available as an inexpensive generic medication, but concerns have been raised about addiction and, because of how it acts, cardiovascular side effects. The medication is a stimulant, so it’s possible that it could raise blood pressure. We clearly needed more research to understand the benefits and risk of longer-term phentermine use.

Filling this knowledge gap

In our new study, “Safety and Effectiveness of Longer-Term Phentermine Use: Clinical Outcomes from an Electronic Health Record Cohort,” published today in Obesity, my colleagues and I found evidence of better weight loss with longer-term use of phentermine — up to 2 years’ follow-up. And we didn’t find any link between longer-term use and risk of cardiovascular disease or death up to 3 years from starting phentermine.

To accomplish this study, we used electronic health records from the Patient Outcomes Research to Advance Learning (PORTAL) cohort, part of the National Patient-Centered Clinical Research Network (PCORnet) initiative funded by the Patient-Centered Outcomes Research Institute (PCORI). This cohort included information from 8 health systems in the United States, including Kaiser Permanente (Southern California, Colorado, Northwest, Washington, Hawaii, and Mid-Atlantic) and Denver Health and HealthPartners (in Minnesota). The study was led by my long-time collaborator, Kristina Lewis, MD, MPH, SM, at Wake Forest School of Medicine in Winston-Salem, NC.

We studied nearly 14,000 phentermine users, 8 in 10 of whom were women. Their mean BMI was 38, which is 235 pounds for a 5’6” person. But they included people with a BMI as low as 27, which is 168 pounds for a 5’ 6” person. (Obesity starts at a BMI of 30.) Three in 10 of them were prescribed phentermine for more than 3 months. At 6 months, a year, and 2 years after starting phentermine, weight loss was clinically significantly greater among people who used the medication longer-term (more than a year) or medium-term (more than112 days but less than a year) than in people who used it for only 3 months. The 144 people who used phentermine continuously for more than a year had kept off more than 7 percent of their baseline weight at 2 years.

It’s important to monitor patients for their response to phentermine treatment. About a third of people prescribed phentermine lost less than 3 percent of their weight within the first 3 months of starting the drug. These “non-responders” should not continue phentermine treatment, as they are unlikely to experience clinical benefit from it. By contrast, people who had an early response to the medication — losing at least 3 percent of their weight by 3 months — tended to have greater overall long-term success at weight loss with the aid of the medication.

As far as safety goes, we expected to see an increase in blood pressure, but instead found that systolic blood pressure was reduced at 24 months in long-term users of phentermine relative to short-term users. It’s possible that this decrease in blood pressure was due to sustained weight loss in the longer-term users of phentermine. Forty-one (0.3 percent) of 13,972 phentermine users experienced a major adverse event (36 cardiovascular events; 5 deaths), but none of these was among the long-term users.

Impact on obesity treatment

Our study is limited by being observational, by not being a randomized controlled trial, and by having a relatively small sample of long-term users — and it didn’t address the issue of possible addiction. But because of phentermine’s wide availability and low cost, our findings could have a significant impact on obesity treatment in people at low risk for heart disease.

Similar to what we have seen in studies of the combination medication Qsymia, it appears that some patients can safely maintain long-term weight loss with phentermine alone. Still, until we have a change in FDA policy, off-label longer-term prescribing of phentermine should be done cautiously with full consideration of the legal and medical licensure implications, which can vary from state to state.

More importantly, given the low cost of phentermine relative to other weight-loss drugs, this study should motivate a future randomized trial to establish more definitively phentermine’s long-term efficacy and safety.

Phentermine and Topiramate | Memorial Sloan Kettering Cancer Center

This information from Lexicomp^® explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider.

Brand Names: US

Qsymia

What is this drug used for?

• It is used to help with weight loss in certain people.

What do I need to tell my doctor BEFORE I take this drug?

• If you are allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had.
• If you have any of these health problems: Glaucoma or overactive thyroid disease.
• If you have or have ever had depression or thoughts of suicide.
• If you have any of these health problems: Kidney disease or liver disease.
• If you are taking any of these drugs: Acetazolamide, dichlorphenamide, methazolamide, or zonisamide.
• If you have taken certain drugs for depression or Parkinson’s disease in the last 14 days. This includes isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. Very high blood pressure may happen.
• If you are taking any of these drugs: Linezolid or methylene blue.
• If you are pregnant or may be pregnant. Do not take this drug if you are pregnant.
• If you are breast-feeding. Do not breast-feed while you take this drug.
• 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.
• Have blood work checked as you have been told by the doctor. Talk with the doctor.
• Avoid drinking alcohol while taking this drug.
• Talk with your doctor before you use marijuana, other forms of cannabis, or prescription or OTC drugs that may 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 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.
• 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.
• A pregnancy test will be done to show that you are NOT pregnant before starting this drug and while taking it.
• If you may become pregnant, you must use birth control while taking this drug. If you get pregnant, call your doctor right away.

What are some side effects that I need to call my doctor about right away?

WARNING/CAUTION: 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 that 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.
• Feeling confused, not able to focus, or change in behavior.
• Memory problems or loss.
• Trouble speaking.
• Trouble sleeping.
• 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.
• This drug may cause very bad eye problems. If left untreated, this can lead to lasting eyesight loss. Call your doctor right away if you have new eye signs like blurred eyesight or other changes in eyesight, eye pain, or eye redness.

What are some other side effects of this drug?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Headache.
• Diarrhea or constipation.
• Dry mouth.
• Numbness or tingling.
• Feeling dizzy, tired, or weak.
• Change in taste.
• Upset stomach.
• Signs of a common cold.
• Nose or throat irritation.
• Back pain.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to your national health agency.

You may report side effects to the FDA at 1-800-332-1088. You may also report side effects at https://www.fda.gov/medwatch.

How is this drug best taken?

Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely.

• Take this drug early in the day to prevent sleep problems.
• Take with or without food.
• Drink lots of noncaffeine liquids unless told to drink less liquid by your doctor.

What do I do if I miss a dose?

• Skip the missed dose and go back to your normal time.
• Do not take 2 doses at the same time or extra doses.

How do I store and/or throw out this drug?

• Store at room temperature in a dry place. Do not store in a bathroom.
• Keep lid tightly closed.
• Store this drug in a safe place where children cannot see or reach it, and where other people cannot get to it. A locked box or area may help keep this drug safe. Keep all drugs away from pets.
• Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

General drug facts

• If your symptoms or health problems do not get better or if they become worse, call your doctor.
• Do not share your drugs with others and do not take anyone else’s drugs.
• Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider.
• This drug comes with an extra patient fact sheet called a Medication Guide. Read it with care. Read it again each time this drug is refilled. If you have any questions about this drug, please talk with the doctor, pharmacist, or other health care provider.
• If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Consumer Information Use and Disclaimer

This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider’s examination and assessment of a patient’s specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

Last Reviewed Date

2020-11-16

Copyright

© 2021 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.

Phendimetrazine vs Phentermine: Main Differences and Similarities

Phendimetrazine and phentermine are two medications that can be used for obesity. They can also treat those who are overweight with high blood pressure, diabetes, or high cholesterol. Both phendimetrazine and phentermine are only recommended for a short duration with an appropriate diet and exercise regimen. As sympathomimetics, phendimetrazine and phentermine work similarly to amphetamines.

Phendimetrazine

Phendimetrazine (What is Phendimetrazine?) is the generic name for Bontril PDM. It is recommended for those who are 17 years old or older with obesity. Although its mechanism of action is not entirely clear, it may help suppress appetite as a CNS stimulant.

Phendimetrazine is taken as a 35 mg oral tablet 1 hour before meals. An extended-release 105 mg oral capsule is also available. The extended-release form is taken 30 to 60 minutes before breakfast.

Phentermine

Phentermine (What is Phentermine?) is the generic name for Adipex P and Lomaira. Like Phendimetrazine, it is prescribed to treat obesity in combination with an appropriate diet and exercise plan. It is only recommended to be taken in those who are older than 16 years of age.

Phentermine is available as a general 37.5 mg oral tablet. It also comes in a 15 mg, 30 mg, or 37.5 mg oral capsule. The brand name, Lomaira, comes as an 8 mg tablet. Dosing ultimately depends on your doctor’s instruction. Still, it is usually taken before or after breakfast.

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Phendimetrazine vs Phentermine Side by Side Comparison

Phendimetrazine and phentermine are similarly acting medications. As prescription medications for obesity, they share several similarities and differences. These features can be found below.

Summary

Both phendimetrazine and phentermine are medications prescribed for obesity. The exact mechanism of action of both medications is unknown. However, they are believed to play a role in suppressing appetite.

As CNS stimulants that are similar to amphetamines, they carry similar side effects and drug interactions. Both medications can cause increased heart rate, increased blood pressure, and heart palpitations. They can even cause insomnia in some people. Therefore, they should not be taken at night before bedtime

Phendimetrazine and phentermine should also not be used during or within 14 days of using monoamine oxidase inhibitors. Otherwise, there is a higher risk of increased blood pressure.

While phendimetrazine is restricted to those age 17 years or older, phentermine is limited to those aged 16 years or older. Phendimetrazine also comes in an extended release form which may have different dosing instructions.

Phendimetrazine and phentermine should only be used under the guidance of a doctor. Because they both have similar side effects and drug interactions, it is important to discuss your options with your doctor. Both medications are also contraindicated during pregnancy because of fetal risks.

Do medicines for weight loss affect blood pressure, and reduce the effects of high blood pressure (hypertension)?

What is high blood pressure (hypertension)?

Blood pressure is a measure of the force that your heart uses to pump blood around your body. It is usually given as two figures: the pressure when your heart pushes blood out (systolic pressure), and the pressure when your heart rests between beats (diastolic pressure). Blood pressure is considered to be high when systolic pressure is over 140 and/or diastolic pressure is over 90, often written as ‘140 over 90’ and measured in millimetres of mercury (mm Hg). The risk of developing high blood pressure increases as you get older.

Hypertension can increase people’s risk of developing serious long-term health problems, such as heart attack or stroke. Lowering blood pressure in people with hypertension reduces the number of people who develop diseases of the heart and blood vessels (cardiovascular disease), which leads to fewer deaths and cardiovascular problems.    

Weight and hypertension

Hypertension treatment guidelines recommend keeping to a healthy weight and losing weight when needed. Some people may take medicines to help reduce their weight.        

Why we did this Cochrane Review 

Medicines licensed for use in weight loss in the USA and Europe include orlistat and naltrexone combined with bupropion. Another combination, phentermine with topiramate, is licensed in the USA only. We wanted to find out if weight-loss medicines have long-lasting effects on blood pressure, and whether they could reduce the unwanted effects of high blood pressure on people’s health.  

What did we do?

We searched for studies about the effects of taking weight-loss medicines in people with high blood pressure. We were interested in how these medicines affected blood pressure and body weight.  We also wanted to know how many people experienced any unwanted effects, how many people developed cardiovascular disease, and if any people died.  

We looked for randomised controlled studies, in which the treatments people received were decided at random. This type of study usually gives the most reliable evidence about the effects of a treatment. 

We assessed the reliability of the evidence we found. We considered factors such as: how the studies were conducted, how many people they involved, and whether their findings were consistent across studies. 

Search date: we included evidence published up to March 2020. 

What we found

We found six studies in 12,724 people with high blood pressure (average age 46 to 62 years). The studies were conducted in the USA (3 studies) and Europe (3 studies), and lasted from 6 months to 28 months. 

All studies compared the effects of taking a weight-loss medicine with effects of taking a dummy medicine (placebo).  

What are the results of our review?

Orlistat may reduce weight and probably reduces blood pressure (4 studies; 2058 people).

Phentermine plus topiramate may reduce weight and may reduce blood pressure (1 study; 1305 people).

Naltrexone plus bupropion probably reduces weight but probably does not reduce blood pressure (1 study; 8283 people).

One study looked at the risk of death and major unwanted cardiovascular effects; it showed no differences between naltrexone plus bupropion treatment and a placebo after two years. 

People taking weight-loss medicines reported more unwanted effects than those taking a placebo. The most common unwanted effects were digestive problems (for orlistat, and phentermine plus topiramate), dry mouth and skin tingling or numbness (for naltrexone plus bupropion). 

How reliable are these results? 

Results are from a small number of studies. In some studies, there were few events for some measures we were interested in.   

We are moderately confident about how orlistat and naltrexone plus bupropion affected weight loss and blood pressure. However, results might change if more evidence becomes available. 

We are less confident about the effects of phentermine plus topiramate; the unwanted effects of orlistat, and the risk of unwanted cardiovascular events associated with naltrexone plus bupropion. Results are likely to change if more evidence becomes available. 

Conclusions

Some weight-loss medicines reduce weight and blood pressure in people with high blood pressure, but may cause unwanted effects. We did not find enough evidence about whether taking weight-loss medicines to lose weight could reduce death and cardiovascular disease.  

Weight Loss Pill Also Lowers Blood Pressure

An experimental weight loss/blood pressure pill may pack a one-two punch against hunger and high blood pressure, one of the main health consequences of obesity, according to new research presented at the American Society of Hypertension’s 25th annual meeting in New York.

Taken once a day, Qnexa combines the appetite suppressant phentermine with the anti-seizure drug topiramate in a unique formulation. Data on this drug are slated to be reviewed this summer by a Food and Drug Administration advisory panel. The FDA is not obligated to follow the advice of its expert panels, but it usually does.

Phentermine quickly suppresses appetite while the controlled-release topiramate decreases appetite and increases satiety throughout the day.

“When the hunger comes back, the topiramate kicks in,” says study author Dr. Suzanne Oparil, a professor of medicine, physiology and biophysics and director of the vascular biology and hypertension program at the University of Alabama at Birmingham.

Topiramate also has blood pressure-lowering effects, she says. Oparil is a consultant for Qnexa manufacturer Vivus.

The new analysis of three separate studies included more than 4,500 people. Researchers compared several doses of the new pill with placebo among severely obese adults as well as overweight, non-obese people who had other health problems related to their weight, such as high blood pressure or metabolic syndrome, a cluster of risk factors that increase risk for diabetes and heart disease.

Overall, people who took the combination pill lost more weight than their counterparts who were given a placebo. The higher the dose, the more substantial the weight loss, and the more likely it was to be maintained over time, the study shows.

At six months, people who took the full dose of Qnexa once daily lost nearly 10 percent of their body weight; by one year, it was up to 10.4 percent. Those who took the medium dose of the pill lost 8 percent of their body weight at six months and 8.2 percent by one year. The people who took the lowest dose of the drug dropped about 5.1 percent of body weight at six months, and, on average, gained some back by one year.

The new drug also resulted in drops in systolic blood pressure – the upper number in a blood pressure reading – at one year.

A sub-analysis of people with high blood pressure showed that the new pill also helped reduce blood pressure in this group and allowed them to reduce the number of other blood pressure medications they were taking.

The new pill did have some side effects, including altered taste, constipation, dizziness, dry mouth and headache. But “there were no surprises,” Oparil says.

“It was safe and efficacious across a broad patient population – some who were very obese and some who were less obese but had metabolic syndrome or high blood pressure,” she says.

Not Another Fen-Phen

Phentermine was once widely prescribed as the “phen” part of the fen-phen weight loss combo that shot to fame in the mid-1990s and then fell from grace after its use was linked to pulmonary hypertension – high blood pressure in the lungs – and heart valve disease. The problems were found to be related to the “fen” or fenfluramine part of the combination, not the phentermine.

Dr. Louis Aronne, founder and director of the Comprehensive Weight Control Program at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York, believes that combination drugs such as Qnexa hold promise in the battle of the bulge.

“Instead of using single agents, we need to use combination drugs to break through the [weight loss] plateaus,” says Aronne, who was not involved in the trials but has been an adviser to Vivus and other companies developing weight loss drugs.

“This is a breakthrough in that we have something that we know is effective and we can use it at lower doses,” which improves the safety profile, he says.

Although both pills are independently FDA-pproved, the new combination pill can’t be used simply by combining the two drugs as the dosages in Qnexa are unique and lower than what is commercially available, he says.

If approved, candidates for Qnexa may include people with a body-mass index (BMI) of 27 to 30 and other conditions related to being overweight, and people with a BMI of 30 or higher. A BMI takes height and weight into account to measure body fat. If your BMI is greater than 25, you are considered overweight. If it is over 30, you are considered obese.

Some people are candidates for weight loss surgery, and others who are just slightly overweight may be able get by with proper diet and exercise, Aronne says.

“The one-third of people who fall in the middle and have all the risks and complications of obesity, that is where I see this drug having an application,” he says.

Dr. George Bakris, president of the American Society of Hypertension and a professor of medicine and the director of the Hypertension Center at the University of Chicago, is cautiously optimistic about the potential benefits of this new drug.

“I would like to see a 24-hour blood pressure reading to see if blood pressure levels really are down,” he says. “If true, that would be huge.”

He tells WebMD that blood pressure may look good in the office but may rise at night, for example, which is why the 24-hour reading would be more telling, he says.
By Denise Mann
Reviewed by Laura Martin
©2005-2010 WebMD, LLC. All rights reserved

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90,000 Hypertension tablet tested 4 in 1

Scientists from the University of Sydney have invented a combination drug for lowering blood pressure, which consists of four known drugs for hypertension in low doses and works more effectively than either drug alone. The results of a clinical trial of the combination drug are published in The Lancet and presented at the ESC Congress 2021.

High blood pressure causes heart attacks and strokes. Moreover, it is found in most people after 50 years. While not many of them measure their blood pressure on a daily basis, they are correct and know the new gold standard for normal blood pressure.

Lead author of the new study, Clara Chow of the University of Sydney, believes that hypertension control is not perfect anywhere in the world, and in Africa, hypertension is under control in less than one in ten.

“Global statistics show that over the past 30 years, the number of cases of hypertension has doubled, and hypertension has become the leading cause of death from heart attack and stroke,” says Chow.

As a result, people often go to the doctor with very high blood pressure readings. In such cases, doctors prescribe one or two drugs in high doses, from which the liver and kidneys suffer. If these drugs do not relieve blood pressure, experiment with the following. But often, such patients, experiencing the side effects of the drug – pain due to high doses of the drug, stop taking the drugs altogether and, therefore, live with a constant risk of heart attack or stroke.

“We wanted to see if people who have severe side effects from treatment would benefit from switching to a drug in the form of a combination of ultra-low doses [drugs],” explains Professor Chou.

To reduce the toxic effects of strong drugs on the body and effectively lower blood pressure, Australian scientists combined four well-known drugs in one tablet – irbesartan at a dose of 37.5 mg, amlodipine at a dose of 1.25 mg, indapamide at a dose of 0.625 mg and bisoprolol at a dose 2.5 mg. Typically, these drugs are prescribed in minimum doses of 75 mg, 5 mg, 1.5 mg, and 2.5 mg, respectively.

The combination drug was tested on two groups of 591 adults in Australia.The first group received a new 4-in-1 pill. The second group, the control group, took only one medication for hypertension, which is usually prescribed by doctors.

As a result, after 12 weeks of testing, blood pressure decreased in 80% of patients from the first group and 60% of patients from the control group.

After 12 months, the decrease in blood pressure in the first group of patients turned out to be even more stable than in the control group of patients with a standard approach to the treatment of hypertension.However, no differences in side effects were observed.

“This was the first study to show that the benefits persisted in the long term without any decrease over time,” Chou emphasizes. drugs for blood pressure, they have not caught up [in terms of effectiveness] the group with the drug 4 in 1 “.

However, it is not enough to create an effective drug.It also needs to be made affordable for the majority of patients who need it, scientists say. Only in this case will the medicine have a serious impact on the global health of the planet’s inhabitants.

“When we find such an effective, simple and safe treatment, we must do everything we can to get it to those who will benefit the most,” Chou says.

Earlier, we wrote about five-minute breathing exercises, which will lower blood pressure without pills, and exercises that will help lower blood pressure as well as medication.We also said that “high” and “low” pressure have the same effect on the risk of heart attack and stroke.

More interesting news of science and medicine can be found in the sections “Science” and “Medicine” on the media platform “Look”.

90,000 FENTERMINE CAUSES HEART PROBLEMS – MEDICAL

Content:

Phentermine hydrochloride affects the cardiovascular system in much the same way as fear, excitement and anger. Essentially amphetamine, phentermine stimulates the part of the central nervous system that regulates the heart and blood pressure. Doctors prescribe phentermine hydrochloride as part of a weight loss program because of its ability to increase metabolism and suppress appetite. The cardiovascular effects of phentermine can cause serious heart problems.

Is this an emergency?

Seek emergency help immediately if you experience severe medical symptoms.

Hypertension

Phentermine causes the blood vessels in the body to narrow and constrict. This process, called vasoconstriction, increases systemic blood pressure. Blood pressure is the sum of the systolic blood pressure — the top number or more — in a reading that reflects the pressure in the body as the heart contracts. The lower number, called diastolic pressure, reflects the pressure when the heart is resting between beats. The National Institutes of Health reports that phentermine increases systolic and diastolic blood pressure 1.Increased pressure affects how well the heart can fill with blood during the resting phase. Less blood filling the chambers of the heart means less blood is available for pumping out of the body. Narrow and narrow blood vessels and, as a result, high blood pressure make the heart work harder to pump blood to the body. The lungs are affected by high blood pressure and a condition called pulmonary hypertension occurs. Patients develop coughing, shortness of breath, and chest pain.If left untreated, pulmonary hypertension can lead to heart failure.

• Phentermine causes the blood vessels in the body to narrow and constrict.
• Less blood filling the heart chambers means less blood is available for pumping out of the body.

Irregular heart rhythms

Irregular heart rhythms, called arrhythmias, reduce the efficiency of the heart. The stimulating effects of phentermine make heart cells more responsive to electrical impulses.This is called hyperexcitability, in which the heart has extra heartbeats. You may feel these extra heart beats or palpitations. Billy Ann Wilson, Ph. reference :: Nurse Pearson’s Guide to Drugs 2010.”; Wilson, B. Reason:

• Billy Ann Wilson
• PhD.
• Margaret Shannon
• Ph.D.,
• Kelly Shields
• Pharm.D.
• The authors of Pearson Nurse’s Drug Guide 2010 report that one of the common heart problems caused by phentermine is tachycardia [2] (# ‘inline-reference :: Pearson Nurse’s Drug Guide 2010; Wilson
• B

A., Shannon, T. M., and Shields, K. M .; 2010 “). Tachycardia with a heart rate of more than 100 beats per minute can cause shortness of breath, dizziness, and fainting. Prolonged tachycardia lowers blood pressure. If left untreated, it can lead to cardiovascular collapse.

• Irregular heart rhythms, called arrhythmias, reduce the efficiency of the heart.
• D., authors of Pearson Nurse’s Drug Guide 2010, report that one of the common heart problems caused by phentermine is tachycardia [2] (# ‘inline-reference :: Pearson Nurse’s Drug Guide 2010 ; Wilson, B.Reason: * Billy Ann Wilson
  * Ph.

Acute cardiovascular disease

High blood pressure and vasoconstriction, also known as narrowing of the blood vessels, creates the conditions for a heart attack. If you have a history of coronary artery disease, you have an increased risk of heart attack. If you are taking phentermine, tell your doctor right away if you have chest pain, shortness of breath, or dizziness.

Chronic heart failure

Heart failure can occur at any time during use because your underlying health condition determines how well your heart can tolerate the effects of phentermine.High blood pressure, vasoconstriction and arrhythmias damage the heart. Tell your doctor about fluid retention, chest pain, and shortness of breath.

90,000 This woman was addicted to a weight loss drug phentermine for 15 years

Every time I walked into a medical weight loss clinic, the experience was the same: tabloids with curled ears, subtle reminders of what a perfect body should look like, were strewn alongside antiquated table lamps with pleated lampshades.Dirty mini-blinds (were they beige or white and just really dusty?) Stayed closed, letting me hide in plain sight, praying that no one would see me for who I really was – an alcoholic addicted to prescription diet pills.

I didn’t grow up around alcohol or drugs. My upbringing was conservative, in a stable loving atmosphere in South Louisiana. It wasn’t until I had a painful breakup in my first year of college that I started looking for something to drown out the constant hum of fear and anxiety running through my body.I found it in food, sex, drugs, and finally at the bottom of the bottle.

The quiet struggle with PTSD looked like a quarter-life crisis to everyone, and my already low self-esteem was in shit. My weight has increased dramatically; I dropped out of college one semester before graduation. Alcohol made me forget about all my problems, but I didn’t want to keep gaining weight. So when a friend recommended diet pills, I was immediately interested.

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How easy, I thought, to just take a pill and not get hungry? For an emotional eater like me, this seemed like the perfect solution. I found the nearest weight loss clinic and made my first appointment. It was 2001, and I chose the clinic with the most beautiful advertisement in the phone book. I didn’t know that I would eventually visit them all.

When I got on the scales at the clinic, they showed 170.I was told that my BMI matches my height exactly. I am 5 feet 6 inches, so a normal weight for someone my height would be between 118 and 148 pounds. The doctor spoke to me briefly about healthy habits and prescribed phentermine, a commonly prescribed amphetamine-like drug used to suppress appetite.

Phentermine is one of four FDA-approved weight loss drugs for short-term use only. (Five other drugs are approved for long-term use.) Possible side effects include increased heart rate and blood pressure, insomnia, constipation, and nervousness. More than once I woke up with my heart pounding from my chest, damn scary, but not enough to make me stop.

The documents accompanying the medicine explain that it should not be taken for more than three months at a time; it is intended to support the diet and exercise of an overweight person. Once my weight falls below the number considered to be overweight, they will no longer be able to prescribe medication.I was delighted to lose 22 pounds and fall back to the normal range for my height.

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I had no idea what was going to happen to me.

There is something about phentermine that made me feel invincible. Not everyone has the same response, and not everyone has the same response to alcohol or opioids. But the first time I was hooked. Tingling in the limbs, numbness of my face and gums, weight loss from not eating or sleeping – I don’t talk about that much because the very thought of one of these blue and white pills makes me salivate.Thirty days later, I returned for a new one.

The medicine can also be obtained from a general practitioner or obstetrician-gynecologist, according to my friends who were fans of this medicine. I personally have never had the courage to ask a doctor I know to prescribe phentermine; the likelihood of questions was too high, and why risk it when I knew I could waltz in and out of a weight loss clinic and skip the interrogation?

In 2015, the New York Times reported the amazing persistence of a weight loss drug that hit the market in 1959.One reason: Phentermine is widely prescribed in commercial dietary clinics across the country.

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I continued to take phentermine from time to time for the next 15 years.

“It’s kind of a cheap speed,” Richard Allen, then director of the Georgia Drug and Drug Administration, which oversees the use of controlled substances like phentermine, told The Times.

These pills are what I used every morning to get rid of a hangover to raise my three young children. A diseased part of my brain told me that phentermine made me more desirable to my husband, more fun and interesting at parties, and improved my job. Outwardly, I won during my lifetime. The amphetamines helped mask my alcoholism for many, many years. This is what I used to fuel my creativity and thus my livelihood as a freelance writer.Although I’ve been sober for over two years, I miss this maximum; especially during the summer months, when the feeling of clumping thighs warms up my already rampant self-loathing.

There will always be a small part of me that wants to try again. This is the destructive power of addiction.

Over the years, in various cities in the South, I have sat staring at purple or brown carpets in the waiting room, wishing to be a naturally thin person who would not have to resort to such nonsense to get another bottle.another month of feeling on top of the world. Of course, now that I’m sober, I know that even if I were naturally thin, I would still be a drug addict.

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No one in the waiting room looked you in the eye. Our shame was palpable. It seemed to me that overweight patients were embarrassed that they had allowed themselves to go so far as to end up in a clinic dedicated to helping overweight people get smaller.Thin women were also ashamed because they suffered from body dysmorphia or were drug addicts. Anyway, nobody wanted to be there.

During my career in the field of prescription pills, I ended up in both the fat and the skinny camp. There was a time when I was in my 20s, just before my husband and I got married, my weight almost dropped below the limit that would allow a doctor to write me a prescription. The fear of living without phentermine from now on led me to try to eat well and wear my heaviest shoes before returning for more.

The problem was that, as is always the case with any addiction, after years of taking a drug intended for short-term use only, it stopped working. I started combining the pill with Red Bull or adding other tops, trying to achieve the same effect. I had to accept it in order to function normally, to feel normal.

Sometimes I took a vacation for several months. “I’ll give my body a break,” I told myself, because it makes the addict feel like she’s not really an addict.Real addicts don’t take breaks, right? They can’t because they’re too busy blowing a random stranger in a windowless van for drug money. Real addicts don’t have families or the right size, if any, underwear.

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I have all my teeth left. I still had the right size underwear.I did not provide sexual favors to strangers. I was fine.

“You have perfect blood pressure!” The nurse tore off the Velcro to remove the blood pressure cuff from my arm. “There will be a doctor soon.”

The doctor was usually a man who looked like he had seen much better days; I don’t know what the rules are, but they all carry deep sadness. The day I sat down opposite him or her, I was grateful. I smiled, I tried to look like a person who tried to be healthy, but could not.I would say that genetics or motherhood prevented me from realizing my true potential. The Libra didn’t lie: I was overweight most of the time. I deliberately kept myself in a certain range because I would rather be a little fat at speed than skinny without access to it.

Every summer since my recovery there has been an internal struggle.

Nobody will know.

I can go for them anytime.

It’s legal.

I’m 20 pounds overweight – that would be that easy.

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And it would be. As easy as grabbing a bottle of vodka or whiskey from the grocery store and stashing it somewhere in your home. As easy as having a drink when no one is looking, except I have to steal money from the bank account I share with my husband, figure out where to put the kids, make an appointment, get the pills, and then hide them.

I’ve had to lie over and over again.

Towards the end, when I was constantly bloated from drinking too much the night before and gaining weight instead of losing weight, no matter how many pills I took, I began to worry about my health. The doctors — all of them — began to stare at me curiously, because my weight never dropped; he has always remained the same. I went in, took 30 pills and left. When I ran out of the hospital, I went to another clinic, possibly on the other side of town. I changed appointments to appointments, so I rarely saw the same doctor for two months in a row.

“What are you doing here?” – the paramedic once asked me, having measured the pressure. “You don’t belong here.” I suspect he may have meant that I don’t look like I’m from that part of town, which was questionable, or maybe he was making a general comment that I don’t look fat. In any case, he was right in every way. I didn’t feel like I belonged to anyone, including my own skin.

My last visit to a weight loss medical clinic was in December 2016.When I finally made the decision to sober up in 2017, it was out of desperation. I was trapped in a dark place of deep unhappiness and depression, and no matter what I put down my throat to fight these feelings, I never felt good. This is the essence of addiction.

As a 39-year-old recovering drug addict and alcoholic, I can now say that I am more comfortable with myself than ever before because of the intense, life-changing work that sobriety requires.