Please wait while the formulary information is being retrieved.
Drug overview for PHENDIMETRAZINE TARTRATE (phendimetrazine tartrate):
Generic name: phendimetrazine tartrate (FEN-dye-meh-TRA-zeen)
Drug class: Amphetamines/Anorexiants/Stimulants
Therapeutic class: Weight Loss/Gain Agents
Phendimetrazine tartrate is an amphetamine congener that is used as an anorexigenic agent.
Phendimetrazine is used as an adjunct to caloric restriction in the short-term treatment (a few weeks) of exogenous obesity. The anorexigenic effect of sympathomimetic compounds used in the treatment of obesity is temporary, seldom lasting more than a few weeks and tolerance may occur. To help bring about and maintain loss of weight, the patient must be taught to curtail overeating and to consume a suitable diet. As with other anorexigenic agents, prolonged administration of phendimetrazine is not indicated.
Generic name: phendimetrazine tartrate (FEN-dye-meh-TRA-zeen)
Drug class: Amphetamines/Anorexiants/Stimulants
Therapeutic class: Weight Loss/Gain Agents
Phendimetrazine tartrate is an amphetamine congener that is used as an anorexigenic agent.
Phendimetrazine is used as an adjunct to caloric restriction in the short-term treatment (a few weeks) of exogenous obesity. The anorexigenic effect of sympathomimetic compounds used in the treatment of obesity is temporary, seldom lasting more than a few weeks and tolerance may occur. To help bring about and maintain loss of weight, the patient must be taught to curtail overeating and to consume a suitable diet. As with other anorexigenic agents, prolonged administration of phendimetrazine is not indicated.
DRUG IMAGES
PHENDIMETRAZINE 35 MG TABLET
The following indications for PHENDIMETRAZINE TARTRATE (phendimetrazine tartrate) have been approved by the FDA:
Indications:
Weight loss management for obese patient (body mass index 30 or greater)
Professional Synonyms:
None.
Indications:
Weight loss management for obese patient (body mass index 30 or greater)
Professional Synonyms:
None.
The following dosing information is available for PHENDIMETRAZINE TARTRATE (phendimetrazine tartrate):
The usual adult dosage of phendimetrazine tartrate is 35 mg 2 or 3 times daily, given one hour before meals. Dosage should be adjusted to individual response and tolerance and may range from 17.5 mg twice daily to a maximum of 70 mg 3 times daily. The usual adult dosage of the extended-release capsules is 105 mg once daily in the morning.
Phendimetrazine tartrate is administered orally.
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| PHENDIMETRAZINE 35 MG TABLET | Maintenance | Adults take 1 tablet (35 mg) by oral route 3 times per day 1 hour before meal(s) |
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| PHENDIMETRAZINE 35 MG TABLET | Maintenance | Adults take 1 tablet (35 mg) by oral route 3 times per day 1 hour before meal(s) |
The following drug interaction information is available for PHENDIMETRAZINE TARTRATE (phendimetrazine tartrate):
There are 1 contraindications.
These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.
| Drug Interaction | Drug Names |
|---|---|
| Sympathomimetics (Indirect & Mixed Acting)/MAOIs SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Catecholamine stores increased by MAOIs can be released by indirect acting sympathomimetics such as ephedrine and amphetamine. MAO inhibitors also interfere with gut and liver metabolism of direct acting sympathomimetics (e.g oral phenylephrine). CLINICAL EFFECTS: Concurrent use of MAOIs may result in potentiation of sympathomimetic effects, which may result in headaches, hypertensive crisis, toxic neurological effects, and malignant hyperpyrexia. Fatalities have occurred. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Concurrent use of monoamine oxidase inhibitors and sympathomimetics is contraindicated. The manufacturers of sympathomimetic agents recommend waiting 14 days after discontinuation of MAO inhibitors before initiating the sympathomimetic. DISCUSSION: Indirect acting sympathomimetic amines may cause abrupt elevation of blood pressure when administered to patients taking monoamine oxidase inhibitors, resulting in a potentially fatal hypertensive crisis. Mixed (direct and indirect) acting sympathomimetics have also been shown to interact with monoamine oxidase inhibitors depending on their degree of indirect action. The direct-acting sympathomimetics have not been reported to interact. Dopamine is metabolized by monoamine oxidase, and its pressor effect is enhanced by monoamine oxidase inhibitors. Since procarbazine, an antineoplastic agent, is a weak monoamine oxidase inhibitor, hypertensive reactions may result from its concurrent use with indirect and mixed acting sympathomimetics. Furazolidone, an antibacterial with monoamine oxidase inhibitor action, has also been shown to interact with indirect acting sympathomimetics. Linezolid is another antibacterial with monoamine oxidase inhibitor properties. Metaxalone is a weak inhibitor of MAO. Foods containing large amounts of tyramine have also been implicated in this interaction. Methylene blue, when administered intravenously, has been shown to reach sufficient concentrations to be a potent inhibitor of MAO-A. At recommended dosages, rasagiline, oral selegiline, and transdermal selegiline up to 6mg/day are selective for MAO-B; however, at higher dosages they have been shown to lose their selectivity. One or more of the drug pairs linked to this monograph have been included in a list of interactions that should be considered "high-priority" for inclusion and should not be inactivated in EHR systems. This DDI subset was vetted by an expert panel commissioned by the U.S. Office of the National Coordinator (ONC) for Health Information Technology. |
EMSAM, FURAZOLIDONE, MARPLAN, MATULANE, METAXALONE, METHYLENE BLUE, NARDIL, PARNATE, PHENELZINE SULFATE, PROCARBAZINE HCL, PROVAYBLUE, SELEGILINE HCL, TRANYLCYPROMINE SULFATE |
There are 7 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Select Indirect-Acting Sympathomimetics/Tricyclic Compounds SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Unknown. However, it is speculated that indirect-acting sympathomimetics would have decreased activity due to tricyclic blockage of their uptake into the adrenergic neuron. CLINICAL EFFECTS: Decreased effect of indirect acting sympathomimetics. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Use of tricyclic compounds and indirect-acting sympathomimetics should be approached with caution. Montior patients receiving concurrent therapy for decreased sympathomimetic efficacy. DISCUSSION: The pressor effects of the indirect-acting sympathomimetic amines (e.g., amphetamines, ephedrine, and methylphenidate) are antagonized by tricyclic antidepressants. |
AMITRIPTYLINE HCL, AMOXAPINE, ANAFRANIL, CHLORDIAZEPOXIDE-AMITRIPTYLINE, CLOMIPRAMINE HCL, DESIPRAMINE HCL, DOXEPIN HCL, IMIPRAMINE HCL, IMIPRAMINE PAMOATE, NORPRAMIN, NORTRIPTYLINE HCL, PAMELOR, PERPHENAZINE-AMITRIPTYLINE, PROTRIPTYLINE HCL, SILENOR, TRIMIPRAMINE MALEATE |
| Ergot Alkaloids/Sympathomimetics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of ergot alkaloids and sympathomimetics may result in additive or synergistic effect on peripheral blood vessels. CLINICAL EFFECTS: Concurrent use of ergot alkaloids and sympathomimetics may result in increased blood pressure due to peripheral vasoconstriction. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: When possible, avoid the concurrent use of ergot alkaloids and sympathomimetics. If concurrent use is warranted, monitor blood pressure and for signs of vasoconstriction. Decreasing the dose of one or both drugs may be necessary. DISCUSSION: There have been reports of severe vasoconstriction resulting in gangrene in patients receiving intravenous ergonovine with dopamine or norepinephrine. |
DIHYDROERGOTAMINE MESYLATE, ERGOLOID MESYLATES, ERGOMAR, ERGOTAMINE TARTRATE, ERGOTAMINE-CAFFEINE, METHYLERGONOVINE MALEATE, METHYSERGIDE MALEATE, MIGERGOT, MIGRANAL, TRUDHESA |
| Guanethidine/Sympathomimetics (Indirect Acting) SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Indirect-acting sympathomimetics may displace guanethidine from adrenergic neurons, thereby antagonizing the clinical effect. CLINICAL EFFECTS: Blood pressure may be increased. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: When possible, use an alternative antihypertensive agent or sympathomimetic. DISCUSSION: This interaction has been demonstrated with concomitant administration of anorexiant-type indirect-acting sympathomimetics and guanethidine. Increased blood pressure has been reported. |
GUANETHIDINE HEMISULFATE |
| Selected Inhalation Anesthetic Agents/Sympathomimetics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: The exact mechanism is unknown. The anesthetics produce conduction changes that increase impulse re-entry into the myocardial tissue.(1) The anesthetics' ability to precipitate arrhythmias is enhanced by elevated arterial blood pressure, tachycardia, hypercapnia, and/or hypoxia, events that stimulate the release of endogenous catecholamines.(1) CLINICAL EFFECTS: Concurrent use of inhalation anesthetic agents and sympathomimetics may result in ventricular arrhythmias or sudden blood pressure and heart rate increase during surgery.(2) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Monitor blood pressure and avoid use of sympathomimetics in patients being treated with anesthetics on the day of surgery.(2) Intravenous use of epinephrine during surgery with halothane and related halogenated general anesthetics should be strongly discouraged. When intravenous epinephrine is necessary, nitrous oxide anesthesia supplemented with ether, muscle relaxants, or opioids should be used instead of halothane.(3,4) Epinephrine may safely be used subcutaneously with the following precautions: the patient is adequately ventilated to prevent hypoxia or respiratory acidosis; the total dose of epinephrine is limited to 100 mcg/10 minute period or 300 mcg/hour in adults, 3.5 mcg/Kg in infants, 2.5 mcg/Kg in children up to two years of age, and 1.45 mcg/Kg in children over two years of age; a minimum effective concentration of anesthetic is maintained; the drugs are not co-administered in patients with hypertension or other cardiovascular disorders; and the cardiac rhythm is continuously monitored during and after injection.(3-10) If arrhythmias occur after the administration of the epinephrine, the drugs of choice are lidocaine or propranolol, depending on the type of arrhythmia.(1) DISCUSSION: Administration of epinephrine during halothane anesthesia may may lead to serious ventricular arrhythmias.(3-6,11-18) This has occurred when epinephrine was administered intravenously,(6) when it was administered with lidocaine as a dental block,(11,14) or when it was administered supraperiosteally.(5) Norepinephrine has been shown to interact with halothane in a manner similar to epinephrine.(1) In two case reports, patients were given terbutaline (0.25 to 0.35 mg) for wheezing following induction of anesthesia with halothane. One patient's heart rate increased from 68 to 100 beats/minute, and the ECG showed premature ventricular contractions and bigeminy, while the other patient developed multiple unifocal premature ventricular contractions and bigeminy. The arrhythmias resolved in both patients following lidocaine administration.(19) Although not documented, isoproterenol causes effects on the heart similar to terbutaline(20) and would probably interact with halothane in a similar manner. Other inhalation anesthetics that increase the incidence of arrhythmias with epinephrine include chloroform,(20) methoxyflurane,(20) and enflurane.(12) A similar interaction may be expected between the other inhalation anesthetics and sympathomimetics. |
DESFLURANE, FORANE, ISOFLURANE, SEVOFLURANE, SUPRANE, TERRELL, ULTANE |
| Mixed;Indirect Sympathomimetics/Selected MAOIs SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Catecholamine stores increased by MAOIs can be released by indirect acting sympathomimetics such as ephedrine and amphetamine. MAO inhibitors also interfere with gut and liver metabolism of direct acting sympathomimetics (e.g oral phenylephrine). CLINICAL EFFECTS: Concurrent use of MAOIs may result in potentiation of sympathomimetic effects, which may result in headaches, hypertensive crisis, toxic neurological effects, and malignant hyperpyrexia. Fatalities have occurred with combinations of sympathomimetics and MAO-A inhibitors. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Concurrent use of MAO-A inhibitors and sympathomimetics is contraindicated. The manufacturers of sympathomimetic agents recommend waiting 14 days after discontinuation of MAO inhibitors before initiating the sympathomimetic. Patients receiving direct or indirect acting sympathomimetics should not receive linezolid unless they are monitored for potential increases in blood pressure. Initial dosages of dopamine and epinephrine should be reduced. At recommended dosages, oral selegiline and transdermal selegiline up to 6mg/day are selective for MAO-B; however, at higher dosages they have been shown to lose their selectivity. Patients receiving higher dosages of selegiline should be considered susceptive to this interaction. DISCUSSION: Indirect acting sympathomimetic amines may cause abrupt elevation of blood pressure when administered to patients taking monoamine oxidase inhibitors, resulting in a potentially fatal hypertensive crisis. Mixed (direct and indirect) acting sympathomimetics have also been shown to interact with monoamine oxidase inhibitors depending on their degree of indirect action. The direct-acting sympathomimetics have not been reported to interact. Dopamine is metabolized by monoamine oxidase, and its pressor effect is enhanced by monoamine oxidase inhibitors. Furazolidone, an antibacterial with monoamine oxidase inhibitor action, has also been shown to interact with indirect acting sympathomimetics. Foods containing large amounts of tyramine have also been implicated in this interaction. A significant pressor response was observed in normal subjects receiving linezolid and tyramine doses of more than 100 mg. Administration of linezolid (600 mg BID for 3 days) with pseudoephedrine (60 mg q 4 hours for 2 doses) increased blood pressure by 32 mmHg. Administration of linezolid (600 mg BID for 3 days) with phenylpropanolamine (25 mg q 4 hours for 2 doses) increased blood pressure by 38 mmHg. One or more of the drug pairs linked to this monograph have been included in a list of interactions that should be considered "high-priority" for inclusion and should not be inactivated in EHR systems. This DDI subset was vetted by an expert panel commissioned by the U.S. Office of the National Coordinator (ONC) for Health Information Technology. |
EMSAM, LINEZOLID, LINEZOLID-0.9% NACL, LINEZOLID-D5W, SELEGILINE HCL, XADAGO, ZELAPAR, ZYVOX |
| Iobenguane I 123/Agents that Affect Catecholamines SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Many compounds that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells.(1) CLINICAL EFFECTS: Compounds that reduce catecholamine uptake or that deplete catecholamine stores may interfere with imaging completed with iobenguane.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Discuss the use of agents that affect catecholamines. Discontinue drugs that reduce catecholamine uptake or deplete catecholamine stores prior to imaging with iobenguane. Before imaging with iobenguane, discontinue agents that affect catecholamines for at least 5 biological half-lives, as clinically tolerated.(1) DISCUSSION: Many agents may reduce catecholamine uptake or deplete catecholamine stores.(1) Examples include: - CNS stimulants or amphetamines (e.g. cocaine, methylphenidate, dextroamphetamine) - norepinephrine and dopamine reuptake inhibitors (e.g. phentermine) - norepinephrine and serotonin reuptake inhibitors (e.g. tramadol) - monoamine oxidase inhibitors (e.g. phenelzine, linezolid) - central monoamine depleting drugs (e.g. reserpine) - non-select beta adrenergic blocking drugs (e.g. labetalol) - alpha agonists or alpha/beta agonists (e.g. pseudoephedrine, phenylephrine, ephedrine, phenylpropanolamine, naphazoline) - tricyclic antidepressants or norepinephrine reuptake inhibitors (e.g. amitriptyline, bupropion, duloxetine, mirtazapine, venlafaxine) - botanicals that may inhibit reuptake of norepinephrine, serotonin or dopamine (e.g. ephedra, ma huang, St. John's Wort, yohimbine) |
ADREVIEW |
| Mixed;Indirect Sympathomimetics/Rasagiline SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Catecholamine stores increased by MAOIs can be released by indirect acting sympathomimetics such as ephedrine and amphetamine. MAO inhibitors also interfere with gut and liver metabolism of direct acting sympathomimetics (e.g oral phenylephrine). CLINICAL EFFECTS: Concurrent use of MAOIs may result in potentiation of sympathomimetic effects, which may result in headaches, hypertensive crisis, toxic neurological effects, and malignant hyperpyrexia. Hypertensive crisis has been reported in patients taking recommended doses of rasagiline with sympathomimetic agents. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: At recommended dosages, rasagiline is selective for MAO-B; however, at higher dosages it has been shown to lose its selectivity. Patients receiving higher dosages of rasagiline should be considered susceptive to this interaction. Concurrent use should be approached with caution. DISCUSSION: Indirect acting sympathomimetic amines may cause abrupt elevation of blood pressure when administered to patients taking monoamine oxidase inhibitors, resulting in a potentially fatal hypertensive crisis. Mixed (direct and indirect) acting sympathomimetics have also been shown to interact with monoamine oxidase inhibitors depending on their degree of indirect action. The direct-acting sympathomimetics have not been reported to interact. Dopamine is metabolized by monoamine oxidase, and its pressor effect is enhanced by monoamine oxidase inhibitors. |
AZILECT, RASAGILINE MESYLATE |
There are 0 moderate interactions.
The following contraindication information is available for PHENDIMETRAZINE TARTRATE (phendimetrazine tartrate):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 11 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Cardiac arrhythmia |
| Cerebrovascular accident |
| Chronic heart failure |
| Coronary artery disease |
| Drug abuse |
| Glaucoma |
| Hyperthyroidism |
| Lactation |
| Pregnancy |
| Pulmonary hypertension |
| Severe uncontrolled hypertension |
There are 2 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Hypertension |
| Valvular heart disease |
There are 1 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Diabetes mellitus |
The following adverse reaction information is available for PHENDIMETRAZINE TARTRATE (phendimetrazine tartrate):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 9 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Hypertension |
Allergic dermatitis Cardiac arrhythmia Urticaria |
| Rare/Very Rare |
|---|
|
Cardiomyopathy Drug-induced psychosis Myocardial ischemia Pulmonary hypertension Valvular heart disease |
There are 25 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Dysgeusia Insomnia Nervousness Xerostomia |
Acute abdominal pain Agitation Blurred vision Constipation Diarrhea Dizziness Dysuria Euphoria Flushing Headache disorder Libido changes Palpitations Skin rash Tachycardia Tremor |
| Rare/Very Rare |
|---|
|
Depression Dysphoric mood Erectile dysfunction Hyperhidrosis Increased urinary frequency Nausea |
The following precautions are available for PHENDIMETRAZINE TARTRATE (phendimetrazine tartrate):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
Safe use of phendimetrazine during pregnancy has not been established. During pregnancy it is questionable whether potential benefits from anorexigenic agents outweigh potential risks and this condition should probably be considered a contraindication to their use, especially during the first trimester. Phendimetrazine should not be used in women who may become pregnant unless, in the opinion of the physician, the potential benefits outweigh the possible risks.
Safe use of phendimetrazine during lactation has not been established.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for PHENDIMETRAZINE TARTRATE (phendimetrazine tartrate):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for PHENDIMETRAZINE TARTRATE (phendimetrazine tartrate)'s list of indications:
| Weight loss management for obese patient (bmi >= 30) | |
| E66 | Overweight and obesity |
| E66.0 | Obesity due to excess calories |
| E66.01 | Morbid (severe) obesity due to excess calories |
| E66.09 | Other obesity due to excess calories |
| E66.1 | Drug-induced obesity |
| E66.2 | Morbid (severe) obesity with alveolar hypoventilation |
| E66.8 | Other obesity |
| E66.81 | Obesity class |
| E66.811 | Obesity, class 1 |
| E66.812 | Obesity, class 2 |
| E66.813 | Obesity, class 3 |
| E66.89 | Other obesity not elsewhere classified |
| E66.9 | Obesity, unspecified |
| Z68.3 | Body mass index [BMi] 30-39, adult |
| Z68.30 | Body mass index [BMi] 30.0-30.9, adult |
| Z68.31 | Body mass index [BMi] 31.0-31.9, adult |
| Z68.32 | Body mass index [BMi] 32.0-32.9, adult |
| Z68.33 | Body mass index [BMi] 33.0-33.9, adult |
| Z68.34 | Body mass index [BMi] 34.0-34.9, adult |
| Z68.35 | Body mass index [BMi] 35.0-35.9, adult |
| Z68.36 | Body mass index [BMi] 36.0-36.9, adult |
| Z68.37 | Body mass index [BMi] 37.0-37.9, adult |
| Z68.38 | Body mass index [BMi] 38.0-38.9, adult |
| Z68.39 | Body mass index [BMi] 39.0-39.9, adult |
| Z68.4 | Body mass index [BMi] 40 or greater, adult |
| Z68.41 | Body mass index [BMi] 40.0-44.9, adult |
| Z68.42 | Body mass index [BMi] 45.0-49.9, adult |
| Z68.43 | Body mass index [BMi] 50.0-59.9, adult |
| Z68.44 | Body mass index [BMi] 60.0-69.9, adult |
| Z68.45 | Body mass index [BMi] 70 or greater, adult |
| Z68.55 | Body mass index [BMi] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age |
| Z68.56 | Body mass index [BMi] pediatric, greater than or equal to 140% of the 95th percentile for age |
Formulary Reference Tool