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

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
  • Starting: 3.75/23 mg once daily for 14 days
  • Maintenance: 7.5/46 mg once daily
  • Max: 15/92 mg once daily
  • May be taken without regard to food. Take in the morning.
  • Evaluate weight loss after 12 weeks on 7.5/46 mg dose. If patient has not lost ≥ 3% of baseline body weight, discontinue or increase to next highest dose by giving 11.25/69 mg for 14 days, then 15/92 mg once daily.
  • If patients have not lost ≥ 5% of baseline body weight after 12 weeks on 15/92 mg dose, then discontinue
  • When discontinuing 15/92 mg dose, take every other day for 1 week to avoid precipitating seizure
  • 3.75/23 mg and 11.25/69 mg doses are for titration purposes only

Generic / Price

- NO/$$$$

Other

  • DEA Schedule IV
  • Topiramate is a seizure medication. See topiramate for more.
  • Providers and pharmacies must register in the Qsymia REMS program in order to prescribe


Kidney disease
Benzphetamine
  • Pharmacokinetics are not well-defined
  • Manufacturer makes no specific recommendations [14]
Diethylpropion
  • Diethylpropion is excreted in the urine
  • Kidney disease would be expected to affect diethylpropion clearance
  • The manufacturer recommends caution in kidney disease, but makes no specific dosage recommendations [7]
Phendimetrazine
  • Major route of elimination is by the kidneys
  • Kidney disease would be expected to affect phendimetrazine clearance
  • The manufacturer makes no specific dosage recommendations in kidney disease [15]
Phentermine
  • Phentermine is excreted in the urine
  • Kidney disease would be expected to affect phentermine clearance
  • The manufacturer makes no specific dosage recommendations in kidney disease [12]


Liver disease
Benzphetamine
  • Pharmacokinetics are not well-defined
  • Manufacturer makes no specific recommendations [14]
Diethylpropion
  • The metabolism of diethylpropion is not well-defined
  • Diethylpropion has not been studied in patients with significant liver disease
  • The manufacturer makes no specific dosage recommendations in liver disease [7]
Phendimetrazine
  • The metabolism of phendimetrazine is not well-defined
  • Phendimetrazine has not been studied in patients with significant liver disease
  • The manufacturer makes no specific dosage recommendations in liver disease [15]
Phentermine
  • The metabolism of phentermine is not well-defined
  • Phentermine has not been studied in patients with significant liver disease
  • The manufacturer makes no specific dosage recommendations in liver disease [12]


Drug Interactions

All sympathomimetic amines

  • MAO inhibitors - MAO inhibitors should not be taken within 14 days of sympathomimetic amines. When taken together, severe hypertension may occur.
  • Medications that work in the central nervous system - any medication that works in the central nervous system (ex. antidepressants, antipsychotics, seizure medications, insomnia drugs, bipolar medications, etc.) may potentially be affected by the stimulant properties of sympathomimetic amines
  • Serotonergic medications - Case reports of serotonin syndrome have been reported in patients taking stimulants with other serotonergic medications

Metabolism and clearance


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