no amphetamine-like withdrawal after long-term phentermine pharmacotherapy for obesity
DESCRIPTION
Slide presentation at ECO2013 Liverpool, May 2013TRANSCRIPT
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Long-term Phentermine Pharmacotherapy – An
Investigation for Amphetamine-like Withdrawal
Ed J. Hendricks, MD, FASBP ECO 2013
May 15, 2013 Liverpool, U.K.
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Phenethylamine
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Phenethylamine Derivatives
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Phentermine
• Phentermine is presumed addicting • No human evidence of addiction • Obesity treatment specialists have seen neither
addiction nor withdrawal • Patients taking phentermine can cease abruptly
without symptoms other than hunger • Some patients experience lower energy levels
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Withdrawal Study Rationale
• Amphetamine addiction, abuse and withdrawal syndromes now well described.
• If phentermine is addicting, abrupt cessation should induce amphetamine-like withdrawal.
• Use addiction metrics to assess symptoms in phentermine-treated patients.
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Research Setting
• Private, Fee-for-service, Obesity Medicine specialty practice
• Metropolitan Sacramento, California, USA • In operation, with same MD 24 years • Treatment modalities:
– Low carbohydrate, optimum protein: 100% – Behavior, Lifestyle modification: 100% – Pharmacotherapy: 95% – Phentermine: 90%
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Research Plan
• Prospective Interventional Clinical trial • Patients phentermine-treated for > 1 year. • Consent to cease phentermine ~ 48 hours • Examine for signs of Abuse, Addiction,
Phentermine cravings. • Examine for withdrawal symptoms while on
drug (D0) and at ~ 24 hours (D1) and ~ 48 hours (D2) after abrupt cessation.
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Study Demographics Subjects 72 Male 7 (9.7%) Female 65 (90.3%) W/H/B/A 63/7/2/0 Age, Years 50.9 (19.4) Age Range, Years 29 – 86 Rx Duration, Years 8.3 (5.0) Time Range, Years 1.1 – 21.5 Dose mg/d 53.6 (21.3) Dose Range, mg/day 18.75 – 112.5
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PWQ
• Phentermine Withdrawal Questionnaire • from Amphetamine Withdrawal Questionnaire • Assessment of major 10 symptoms occurring
in Amphetamine-addicted subjects after abrupt amphetamine cessation
• Likert scale scoring 0 – 4, total range 0 – 40
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AWQ Total Scores
McGregor, Addiction 2005; 100(9): 1320-9.
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AWQ Item Scores
McGregor, Addiction 2005; 100(9): 1320-9.
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AWQ Item Scores
McGregor, Addiction 2005; 100(9): 1320-9.
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AWQ Item Scores
McGregor, Addiction 2005; 100(9): 1320-9.
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AWQ vs PWQ 10-item Scores
0
5
10
15
20
0 1 2
McGregor AA McG. Controls Study Subjects
Day of Abstinence
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Hunger Scores
0
0.5
1
1.5
2
2.5
0 1 2
McGregor AA Study Subjects
Day of Abstinence
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9-Item Scores
0 2 4 6 8
10 12 14 16
0 1 2
McGregor AA Study Subjects
Day of Abstinence
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PWQ Data
Measure D0 D1 D2 FriedmanTest, df=2
10-Item 3.39 (3.5) 3.55 (3.1) 2.99 (2.7) p = 0.046 Hunger 0.77 (0.97) 1.02 (1.0) 1.03 (1.1) p = 0.027 9-Item 2.65 (3.0) 2.35 (2.6) 1.95 (2.4) p = 0.084
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Conclusions
• Abrupt cessation of phentermine treatment does not produce amphetamine-like withdrawal.
• Fear of inducing addiction is an inappropriate justification for withholding phentermine treatment for obesity.
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WITH THANKS TO: Frank Greenway, MD
Pennington Biomedical Research Center Baton rouge, Louisiana, USA
Manit Srisurapanont, MD, PhD
Chang Mai University Chang Mai, Thailand
Richard Atkinson, MD
Editor, International Journal of Obesity
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Phentermine Rx Weight Loss 1 Year
Mean Wt. Loss = 18.7 % Mean Wt. Loss = 17.7 Kg
Hendricks, Obesity 2011; 19(12):2351-60.
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Phentermine & Weight Loss
Hendricks, Obesity 2011; 19(12):2351-60.
No phentermine Rx
Phentermine Rx