Considering putting a patient on phentermine for weight loss? Are you considering doing an ECG? Well, it might not be necessary for every patient…
I prescribe phentermine often in my men’s health practice because it works. Semaglutide is great, but it is expensive. Good old fashion phentermine is cheap, and effective. But it does come with some side effects, and the biggest ones are increased blood pressure and elevated heart rate.
An ECG is not necessary to do on every single patient you put on phentermine. It is usually only necessary if they have cardiac risk factors (hypertension, diabetes, history of cardiovascular disease, etc.). Otherwise, if the patient is relatively healthy outside of their elevated weight and they have a blood pressure <150/90 and a resting HR <80, then I do not do an ECG. It provides no value outside of incidental findings in most patients. If they have an elevated resting HR, then it would be wise to do one just to cover your bases.
If you have a patient in their 30s who needs to lose 40lbs, has no significant medical history, and has vital signs within range, then consider skipping the ECG. It adds onto the cost of practice and rarely ever results in any substantial findings outside of incidental findings. Instead, just have the patient return in 3-4 days for vital sign rechecks and then every 2 weeks after that.
As usual, use your best clinical judgement.