APPETITE SUPPRESSANT DOSING








Benzphetamine IR (Didrex®)

Dosage forms

Tablet
  • 50 mg

Dosing

Weight loss
  • Starting: 25 - 50 mg once daily
  • Maintenance: 25 - 50 mg one to three times a day
  • Max: 150 mg/day
  • Take midmorning

Generic / Price

- YES/$

Other

  • DEA Schedule III
  • Tablets are scored so they may be cut in two

Diethylpropion IR (Tenuate®)

Dosage forms

Tablet
  • 25 mg

Dosing

Weight loss
  • Dosing: 25 mg three times a day
  • Max: 100 mg/day
  • Take one hour before meals
  • A midevening dose may be added to overcome night hunger

Generic / Price

- YES/$

Other

  • DEA Schedule IV
  • Usual starting dose is 25 mg three times a day before meals
  • May take a fourth dose midevening to overcome night hunger

Diethylpropion ER (Tenuate Dospan®)

Dosage forms

Tablet, extended-release
  • 75 mg

Dosing

Weight loss
  • Dosing: 75 mg once daily
  • Max: 75 mg once daily
  • Take midmorning

Generic / Price

- YES/$

Other

  • DEA Schedule IV
  • Do not cut, chew, or crush tablet

Phendimetrazine IR (Bontril® PDM)

Dosage forms

Tablet
  • 35 mg

Dosing

Weight loss
  • Dosing: 35 mg two to three times a day
  • Max: 210 mg/day (2 tablets 3 times a day)
  • Take one hour before meals

Generic / Price

- YES/$

Other

  • DEA Schedule III
  • In some cases, half a tablet (17.5 mg) per dose may be adequate
  • Tablets are scored so they may be cut in two

Phendimetrazine ER (Bontril®)

Dosage forms

Capsule, extended-release
  • 105 mg

Dosing

Weight loss
  • Dosing: 105 mg once daily
  • Max: 105 mg once daily
  • Take 30 - 60 minutes before morning meal

Generic / Price

- YES/$

Other

  • DEA Schedule III

Phentermine IR (Adipex-P®)

Dosage forms

Tablet
  • 37.5 mg
Capsule
  • 15 mg
  • 30 mg
  • 37.5 mg

Dosing

Weight loss
  • Dosing: 37.5 mg once daily
  • Max: 37.5 mg once daily
  • Tablet can be split and given twice a day
  • May take before breakfast or 1-2 hours after breakfast
  • Phentermine patient handout

Generic / Price

- YES/$

Other

  • DEA Schedule IV
  • For some patients, half tablet (18.75 mg) daily may be adequate
  • In some cases, it may be desirable to give half tablets (18.75 mg) two times a day
  • Tablets are scored so that they may be cut in two

Phentermine IR (Lomaira™)

Dosage forms

Tablet
  • 8 mg

Dosing

Weight loss
  • Dosing: 1 tablet three times a day 30 minutes before meals
  • Max: 8 mg three times a day
  • Take 30 minutes before meals
  • Tablet may be halved for 4 mg dose

Generic / Price

- NO/$

Other

  • DEA Schedule IV
  • Tablets are scored so that they may be halved

Phentermine (Suprenza™)

Dosage forms

Tablet, orally-disintegrating
  • 15 mg
  • 30 mg
  • 37.5 mg

Dosing

Weight loss
  • Dosing: 15 - 37.5 mg once daily
  • Max: 37.5 mg once daily
  • May be taken without regard to food

Generic / Price

- NO/$$$$

Other

  • DEA Schedule IV
  • Place tablet on tongue where it will dissolve, then swallow with or without water

Qsymia® (phentermine + topiramate)

Dosage forms

Capsule
  • Phentermine : Topiramate
    • 3.75 : 23 mg
    • 7.5 : 46 mg
    • 11.25 : 69 mg
    • 15 : 92 mg

Dosing

Weight loss (pediatric patients ≥ 12 years and adults)
  • Criteria
    • Adults: BMI ≥ 30 or ≥ 27 + one weight-related comorbidity
    • Children ≥ 12 years: BMI in the ≥ 95th percentile
  • Starting: 3.75/23 mg once daily for 14 days then 7.5/46 mg once daily. Take in the morning with or without food.
  • Maintenance: 7.5/46 - 15/92 mg once daily
  • Max: 15/92 mg once daily
  • Evaluate weight loss after 12 weeks on 7.5/46 mg dose. If the patient has not lost ≥ 3% of baseline body weight (or 3% of baseline BMI for children), discontinue or increase to the next highest dose by giving 11.25/69 mg for 14 days, then 15/92 mg once daily.
  • After 12 weeks on 15/92 mg, if the patient has not lost ≥ 5% of baseline body weight (or 5% of baseline BMI for children) dose, discontinue Qsymia
  • If weight loss exceeds 2 lbs (0.9 kg)/week in children, consider dosage reduction
  • When discontinuing the 15/92 mg dose, take every other day for 1 week to avoid precipitating seizures
  • The 3.75/23 mg and 11.25/69 mg doses are for titration purposes only
Kidney disease dosing
  • CrCl ≥ 50 ml/min: no dose adjustment necessary
  • CrCl < 50 ml/min: maximum dose is 7.5/46 mg once daily
  • Dialysis: DO NOT USE
Liver disease dosing
  • Child-Pugh A: no dose adjustment necessary
  • Child-Pugh B: maximum dose is 7.5/46 mg once daily
  • Child-Pugh C: DO NOT USE

Lab monitoring

  • Pregnancy testing: topiramate has been associated with an increased risk of birth defects, and Qsymia should not be given to pregnant women or women who are trying to become pregnant. Pregnancy testing is recommended before therapy and monthly during treatment, along with effective contraception. Pharmacies must register with the Qsymia REMS program to dispense Qsymia.
  • BMP - topiramate inhibits carbonic anhydrase and has been associated with non-anion gap metabolic acidosis in some patients (see topiramate acidosis). Check electrolytes before starting therapy and periodically thereafter. In Qsymia trials, the peak reduction in serum bicarbonate typically occurred within 4 weeks of titration to the assigned dose.

Efficacy

Weight loss in adults Weight loss in adolescents

Generic / Price

- NO/$$$$

Other

  • DEA Schedule IV
  • Topiramate is a seizure medication. See topiramate for more.







Pricing legend
  • $ = 0 - $50
  • $$ = $51 - $100
  • $$$ = $101 - $150
  • $$$$ = > $151
  • Pricing based on one month of therapy at standard dosing in an adult
  • Pricing based on information from GoodRX.com®
  • Pricing may vary by region and availability