Anorexiants include- Phenetermine Hcl, Benzphentamine Hcl, phenetrazine Hcl, Phendimetrazine tartarate, Diethylpropion Hcl, Mazindol, Fenfluramine, Sibutramine Refer - Dexfenfluramine HCl

Interacting drugs- summary 

Anorexiants + Guanethidine

 anorexiants decrease the hypotensive effects of guanithidine

Insulin 

hypoglycemic effects increased due to increased skeletal muscle  Monitor blood glucose and adjust the insulin or sulfonylureas dose as necessary

MAO inhibitors

 increase the pressor response to the anorexiants .Possible hypertensive crisis and intracranial hemorrhage occur. This reaction also occur with furazolidone , an antimicrobial with MAO inhibitors activity. Avoid this combination, if given inadvertantly and hypotension ocurs,administer phenotolamine

Tricyclic antidepressants 

decrease the effects of anorexiants. An increased dose necessary

Anorexiants include-

Phenetermine Hcl, Benzphentamine Hcl, phenetrazine Hcl, Phendimetrazine tartarate, Diethylpropion Hcl, Mazindol, Fenfluramine, Sibutramine Refer - Dexfenfluramine HCl

Body as a whole- headache, asthenia, chills, accidental injury, rash, thirst GI- diarrhea, vomiting

CNS- insomnia, dry mouth, somnolence, dizziness, depression, vertigo, emotional lability, abnormal dreams, thinking abnormal

Respiratory - pharyngitis, cough increased, bronchitis

GU- urinary frequency, polyuria,menstrual disorder, urinary tract infection, nocturia, dysmenorrhea, amenorrhea, dysuria, oliguria, albumineruria, breast pain, kidney calculus.

Body as whole- Flu syndrome,pain,back ache, fever, allergic reaction, malaise,neck pain, chest pain, generalized edema, strees, face edema, meoplasam, pelvic pain, adenoma, immune system disorder, neck rigidity, sicide attempt

Cardiovascular-Hypotension,angina, palpitations, vasodilatation, migraine, cardiovascular disorder, tachcardia, postural hypotension, peripheral vascular disorder, syncope, arrhythmia,extrasystole, hemorrhage, thrombophlebitis, varicose vein, heart block, pulmonary embolus,thrombosis

GI- Constipation, nausea, dyspepsia, increased appetite, rectal disorder, gastritis, peptic ulcer, hepatitis, mouth ulceration Endocrine, goiter, diabetes mellitus, thyroid disorder, hypothyroidism

Metabolic/nutrional -edema, gout, hypoglycemia, hypokalemia, hyperglycemia, hyperkalemia, hyperlipemia, hyperuricemia

Diagnosed pulmonary hypertension,patients receiving monoamine oxidase inhibitors, hypersensitivity to dexfenfluramine, fenfluramine, or rlated compounds.

Special precautions:

Drowsiness,patient developing intolerance such as nausea and vomiting, discontinue the drug. Intolerance- if the patients developds any syptoms of intolerance (eg nause, and vomiting) reduce the dosage and discontinue the drug

Misuse potential- potential exists for any misuseof dexfenfluramine in inappropiate patient populations (eg patients with anorexia nervosa or bulimia ) Combination therapy with other weight loss agents not established.

Special risks patients- weight loss has been associated with a reduction in hyperglycemia in obese patients, a reduction in blood pressure in obese hypertensive patients. Therefore when dexfenfluraramine is used in the management of obesicity associated with hypertension diabetes or dyslipeidemia- there may be changes in these conditions and medications used to treat them should be monitored, and adjusted if necessary.

Warnings-

Primary pulmonary hypertension- patients should be evaluated for the etiology of the symptoms and possible presence of pulmonary hypertension.

Long term use- the safety and efficacy of dexfenfluramine use for > 1 year have not been determined

. Glucoma- use with caution in patients with glaucoma

Elderly- as with CNS -active medications, excercise caution intreating elderly patients with dexfenfluramine

Pregnancy- there are no adequate and well controlled studies in pregnant women and its use is not recommended in these patients.

Lactation- do not administer to a nursing woman

Children- safety and efficacy in children have not been established.

Indication

Exogenous Obesity

Approved by FDA on April 29,1996.

Dosage-

The usual dose is 15mg twice daily with meals. Doses greater than 30mg/day are not recomended. Overdosage- Symptoms Agitation, drowsiness, mydriasis, sweating, shivering, nausea, and vomiting.

Treatment

1. Institute general supportive measures for oral overdose.

2. Measures that have been used include aspiration of gastric contents, gastric lavage with acivated charcoal, osmotic diuresis, forced acid diuresis and careful monitoroing of CNS respiratory depression.

3. The effectiveness of dialysis is unknown.

4. Follow patients closely until there is no further evidence of drug related CNS effects.

5. No specific therapy for dexfenfluramine overdose is known.

Missed dose- 

1. If you miss a dose of this medicine, take it as soon as possible.

2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing schedule.

3. Do not double doses.

Anorexiants include- Phenetermine Hcl, Benzphentamine Hcl, phenetrazine Hcl, Phendimetrazine tartarate, Diethylpropion Hcl, Mazindol, Fenfluramine, Sibutramine Refer - Dexfenfluramine HCl

1. May cause insomnia, avoid taking medication late in the day.

2. Weight reduction requires strict adherance to dietary restriction.

3. Do not take more frequently than prescribed.

4. Notify physician if palpitations, nervousness or dizziness occurs.

5. Medication may cause dry mouth and constipation, notify physician if these become pronounced

6. May produce dizziness or blurred vision; observe caution while driving or performing tasks requiring alertness.

7. Allergies- Tell your doctor if you have ever had any unusual or allergic reaction to ampheatamine. dextroamphetamine, ephedrine, epinephrine, isoproterenol, metaproternol, methamphetamine, norepinephrine, [henylephrine, phenypropylamine, psudoephedrine, terbutaline, or appetite suppressants Also tell your doctor if you are allergic to other substances such as foods, preservatives or dyes

8. Pregnancy- Benzhetamine- must not udsed during pregnancy Diethylpropion- has not been reported to cause birth defects or other problems in human and animal studies Mazindol- animal studies have shown that mazindol increases the chance of death in the newborn when given in large doses Phendimetrazine and phentermine- these medicines have been shown to cause birth defects or other problems in humans.

9. Breast feeding- diethylpropoion and benzephetamine pass into breast milk . Problems in nursing babies not reported.

10. Children- appetite suppressants should not be used by children upto 12 years of age.

11. Elderly- not studioed in older people. No specified information in the elderly is available,

12. Other medicines- Tell your doctor if you are taking any of the following- Amantadine or Ampetamine or Caffeine or Chlophediol or Cocaine or Medicines for asthma, or other breathing problems Medicines for cold ,sinus problems, or hay fever or other allergies

13.. Other medical problems- Tell your doctor if you have any of the folowing medical problems- Alcohol abuse or Drug abuse dependence - dependence on drug appetite suppressants may develop. Diabetes mellitus- amount of insulin or oral antidiabetes medicine that you may need to take may change

Epilepsy- diethylproipin may increase the risk of seizures Glaucoma or Heart or blood vessel disease or Mental illness or Overactive thyroid- appetite suppressants may make the condition worse Kidney disease- higher blood levels of mazindol may occur

Pharmacology:

Dexfenfuramine is an anti-obesity drug. The action in treating obesity is primarily via decreased calorie intake associated with increased serotinin levels in brain synapes.

Pharmacokinetics:

Dexfenfluramine is completely absorbed after oral dosage with a systemic bioavailability of 68% because of first pass metabolism by the liver.

Not significant.

Pregnancy:

There are no adequate and well controlled studies in pregnant women. Its use is not recommended. Lactation: Do not admi ster dexfenfluramine to nursing woman

Children:

Safety and efficacy in children not established.