Clinical Pearl Wednesday #121

Cardiogram Heartbeat Heart  - HappyEnd / Pixabay

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.

2 Responses

  1. Justin,
    This is great information. I have been reluctant to start patients on phentermine. Coming from a short stint in primary care with a large corporation, we were highly micromanaged as to what was to be prescribed and what was frowned upon. I know typically this is a 12-ish week plan. Have you kept patients on this longer than that?

    I don’t want to be seen as a pill mill, but think I have a patient population that would benefit from the cost effectiveness of Phentermine. I also have patients that have had success with the medication in the past and would like to use it again. Some of these patients were on it for 6 months or more.

    Side note, there is a NP in my area that is giving written script to patients (processed by local pharmacy) and meeting them monthly in a parking lot and administering MICC IM. She is charging $80 a patient.

    1. Shannon,

      I typically have patients on it for 2-3 months and then take 2-3 month breaks. I don’t like patients on long-term stimulant therapy even though long term therapy has been shown to be safe and effective.

      If you don’t want to be a pill mill, then don’t be one… But don’t worry about this, it is just phentermine and no one really care. It isn’t opioids….

      Sounds like she is making a decent profit… Don’t know about the parking lot thing though lol…

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