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  • Phen-Prozac: More effective than Fen-Phen?

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    Saturday, November 15, 2003 8:25 pm Email this article
    The author of a study on the combination of Phentermine and Prozac discusses his findings.

    The combination of phentermine and Prozac may be as effective as Fen-Phen like Michael Anchors, M.D. suggests, or may be even more effective. This according to preliminary results from a retrospective study performed by Dennis Padla, M.D. and J. Spoke, P.A. of St. Joseph, Mich.

    These results were presented in Cancun, Mexico in November at a conference held by the North American Association for the Study of Obesity. Larry Hobbs talked to Dr. Padla by phone.

    Hobbs: What was the most effective dose of phentermine and Prozac?

    Padla: 30 mg of phentermine combined with 20 mg of Prozac was most effective. The average weight loss after six months was 44 lbs. Patients taking Phen-Prozac using a higher dose of Prozac, that is 40 mg, lost considerably less weight??Ωonly 15 lbs. Those taking the lower dose of Prozac (20 mg) lost more weight every month, at least through the six months that we have analyzed. Patients taking 20 mg of Prozac but a lower dose of phentermine, 15 mg, also lost less weight??Ωonly 9 lbs.

    Hobbs: How does this compare to those who had taken Fen-Phen or those who had taken Prozac alone?

    Padla: Our Fen-Phen patients, who had taken 15 mg of phentermine and 30 mg of fenfluramine, on average lost 20 lbs. Patients taking 40 mg of Prozac alone on average lost 8 lbs.

    Hobbs: Have you tried Phen-Prozac using only 10 mg of Prozac like Dr. Anchors suggests?

    Padla: Not many. I like the 20 mg of Prozac because many patients have an underlying depression and 20 mg is the lowest dose usually considered effective for that. The only time I??Ωll lower it from 20 mg to 10 mg is if a patient complains of side effects. But I haven??Ωt seen any patients lose more weight with 10 mg. In other words, I don??Ωt think 10 mg works any better than 20 mg.

    Hobbs: Do you have any data on patients taking Fen-Phen that took 30 mg of phentermine?

    Padla: Some patients took 30 mg of phentermine and 30 mg of fenfluramine, but there weren??Ωt enough of them to include in the analysis.

    Hobbs: What time of day do you have patients take the medicine?

    Padla: Both medicines are usually taken first thing in the morning.

    Hobbs: What are the side effects of Phen-Prozac and how common are they?

    Padla: Roughly 10 percent of patients stopped Phen-Prozac because of side effects including decreased sex drive, inability to achieve orgasm, insomnia, and daytime sleepiness. Other side effects include rash, hair getting thin, headaches, tremor, increased sweating, an increase in panic attacks, drowsiness and sluggishness. But side effects with Phen-Prozac are no more common than with Prozac alone. And most patients taking Phen-Prozac said that they felt much better.

    Hobbs: Why do you think a lower dose of Prozac works better than a higher dose?

    Padla: I don??Ωt know for sure, but it might be that the higher dose increases fatigue causing people to be less active. The higher dose might also increase appetite in some patients.

    Hobbs: Do you use phentermine resin (Ionamin??Ω) or phentermine Hcl (Fastin??Ω or Adipex??Ω)?

    Padla: I use both about equally. I generally start with phentermine resin, or Ionamin??Ω, but sometimes switch to a generic phentermine Hcl because it is cheaper. Occasionally, however, a patient will say that the generic phentermine Hcl does not work as well or it doesn??Ωt work at all. I??Ωve heard other people say the same thing, that some brands of generic are not effective.

    Hobbs: Is there concern for heart valve damage with Phen-Prozac?

    Padla: Not that we have seen so far. We have seen no unusual echocardiograms in the few patients that have been tested. One of the lectures in Cancun also stated that they had not seen any reportable problems in 20 patients that they had tested. We had only 1 patient complain of shortness of breath and 1 other report chest pain. We are currently embarking on a study with Eli Lilly to check more patients to see if there are any valve abnormalities.


    ??Ω Padla D, Spoke J. Weight loss comparison between a fluoxetine/phentermine regimen and select common regimens: A retrospective study. Obesity Research, 1997 Nov, 5(Suppl 1):abstract P117. Correspondence: Dennis Padla M.D., Center for Psychiatry and Weight Management, 820 Lester Ave, St. Joseph, MI 49085, (616) 983-3885, (616) 983-5763 fax.

    ??Ω Also see ORU, Aug 97, p 57??ΩThe interview with Michael Anchors, MD, author of Safer Than Phen-Fen; ORU, Aug 97, p 63??ΩEditorial on Phen-Prozac; ORU, Sept 97, p 65??ΩDr. Anchors responds to Phen-Prozac editorial.

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