History of Phentermine
Phentermine is the most commonly prescribed prescription appetite
suppressant, accounting for 50% of the prescriptions. Part of this
reason is because it's significantly cheaper than the other major
FDA-approved diet drugs, Meridia and Xenical.
Phentermine first
received approval from the Food and Drug Administration (FDA) in
1959 as an appetite suppressant for the short-term treatment of
obesity.
Phentermine resin became available in the United States in 1959
and Phentermine Hydrochloride in the early 1970s.
In the US, Phentermine is currently sold under the brand names
Ionamin® (Medeva Pharmaceuticals) and Adipex-P® (Gate
Pharmaceuticals). It is also available as a generic medication,
known as 'phentermine'.
Previously, it was sold under the name Fastin® (formerly produced
by King Pharmaceuticals for SmithKline Beecham). In December 1998,
SK-Beecham withdrew Fastin from the market.
As Phentermine is an older drug, no new efficacy trials have been
conducted. The one notable exception, are several trials on the
combination of Phentermine and Fenfluramine in the early and mid
1990s.
FEN-PHEN (or Phen-Fen) and Dexfen-Phen - two passing trends
Fen-Phen refers to the combination, or cocktail, of Fenfluramine
or Pondimin (the "Fen") and Phentermine (the "Phen"). Fenfluramine
received FDA approval in 1973 for the short-term treatment of
obesity. Together, Phentermine and Fenfluramine produced a powerful
diet drug cocktail.
The FDA never approved the Fen-Phen combination, but once the
agency has approved a drug, doctors may prescribe it at will. Their
use, together, was considered "off-label".
In 1992, Dr. Michael Weintraub of the University of Rochester and
several colleagues published a study citing Fen-Phen as a more
effective method than dieting or exercise in reducing the weight of
the chronically obese. Even better - Fen-Phen, unlike an earlier
generation of speed-laden diet drugs, seemed to be without immediate
side effects
The Fen-Phen cocktail became an overnight sensation. 1996 saw 6.6
million prescriptions of Fen-Phen in the U.S.
Dexfen-Phen refers to the combination, or cocktail, of
Dexfenfluramine or Redux (the "Dexfen") and Phentermine (the
"Phen"). Dexfenfluramine received FDA approved in 1996 for use as an
appetite suppressant in the management of obesity.
Like Fen-Phen, Dexfen-Phen, too, became an overnight sensation.
Neither combination, however, was ever tested for safety ....
By the summer of 1997, the Mayo Clinic reported 24 cases of heart
valve disease. All 24 people had taken the Fen-Phen cocktail. The
cluster of unusual cases of heart valve disease in Fen-Phen users
suggested a co-relation between Fen-Phen use and heart valve
disease.
On July 8, 1997 the FDA issued a Public Health Advisory to report
the Mayo findings (which were later published in the August 28 issue
of the New England Journal of Medicine).
The FDA continued to received additional reports of heart
disease, including reports from patients who had taken only
Fenfluramine or Dexfenfluramine.
Further evaluations of patients taking Fenfluramine or
Dexfenfluramine, showed that approximately 30% had abnormal valve
findings. This figure is much higher than expected for abnormal test
results and suggest Fenfluramine and Dexfenfluramine as the likely
causes of Primary Pulmonary Hypertension (PPH) and valvular heart
disease.
The FDA responded promptly to the alarming findings, and in
September 1997, requested drug manufacturers to voluntarily withdraw
Fenfluramine and Dexfenfluramine. At the same time, the FDA
recommended that patients using either Fenfluramine or
Dexfenfluramine stop taking them. To view the FDA September 1997
statement regarding the withdrawals.
The FDA did not, however, request the withdrawal of the third
drug involved in the cocktails, Phentermine.