Bays Harold Edward, Lazarus Ethan, Primack Craig, Fitch Angela
Diplomate of American Board of Obesity Medicine, Louisville Metabolic and Atherosclerosis Research Center, University of Louisville Medical School, 3288 Illinois Avenue, Louisville, KY, 40213, USA.
Diplomate American Board of Obesity Medicine, Obesity Medicine Association Delegate to the American Medical Association, Clinical Nutrition Center, Greenwood Village, Colorado, USA.
Obes Pillars. 2022 Jun 28;3:100024. doi: 10.1016/j.obpill.2022.100024. eCollection 2022 Sep.
Phentermine is a sympathomimetic amine, approved for "short-term"treatment of patients with obesity. Among phentermine contraindications include use in patients with cardiovascular disease or patients with uncontrolled hypertension.
This roundtable discussion includes perspectives from 3 obesity specialists with experience in the clinical use of phentermine. The questions asked of the panelists were derived from publications regarding phentermine safety and efficacy.
While the panelists generally agreed upon core principles of phentermine use, each obesity specialist had their own priorities and style regarding the administration of phentermine. Among the variances in perceptions (based upon their individual "real world" clinical experiences) included the degree of efficacy and degree of clinical benefit of phentermine, degree of concern regarding phentermine use in patients with cardiovascular disease risk factors, the advisability of a screening electrocardiogram, and the role of telehealth in prescribing phentermine and monitoring for the efficacy and safety of phentermine.
Providing universal guidance regarding phentermine treatment for obesity is challenging because of the lack of long-term, prospective, randomized, placebo-controlled, health outcomes data. Such data is unlikely forthcoming any time soon. Also challenging are the substantial variances in governmental restrictions on phentermine use. Therefore, clinicians are left to rely on the best available evidence, their individual practical clinical experience, as well as the collective clinical experiences of others - as reflected by this roundtable.
苯丁胺是一种拟交感神经胺，被批准用于肥胖患者的“短期”治疗。苯丁胺的禁忌证包括心血管疾病患者或未控制的高血压患者。
本次圆桌讨论纳入了3位有苯丁胺临床使用经验的肥胖症专家的观点。向小组成员提出的问题源自有关苯丁胺安全性和有效性的出版物。
虽然小组成员普遍认同苯丁胺使用的核心原则，但每位肥胖症专家在苯丁胺给药方面都有自己的优先事项和风格。在认知差异方面（基于他们各自的“现实世界”临床经验），包括苯丁胺的疗效程度和临床获益程度、对有心血管疾病风险因素的患者使用苯丁胺的关注程度、筛查心电图的可取性，以及远程医疗在苯丁胺处方和监测其疗效及安全性方面的作用。
由于缺乏长期、前瞻性、随机、安慰剂对照的健康结局数据，为肥胖症的苯丁胺治疗提供通用指南具有挑战性。此类数据近期不太可能出现。苯丁胺使用的政府限制存在很大差异也具有挑战性。因此，临床医生只能依靠现有最佳证据、他们个人的实际临床经验，以及其他人的集体临床经验——正如本次圆桌会议所反映的那样。
