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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes dizziness and tightness across the sternum after taking Phentermine?

Answered by
Dr. Shafi Ullah Khan

General & Family Physician

Practicing since :2012

Answered : 3614 Questions

Posted on Mon, 11 Aug 2014 in Medicines and Side Effects
Question: I was prescribed Phentermine 37.5mb pills two days ago from a weight loss clinic. I've been having dizzy spells even while sitting today and I'm concerned. I'm only on a half of a pill daily (for the first 4 days). I've also been having tightness across my sternum continuing to my collarbones. However, I've been told that I also have costochronditis from all of the physical activities in the Army. I've had a fair amount to eat today and about 64 fl oz of water, two cups of coffee and I also chew tobacco.

I am considering taking a 325mg Bayer Aspirin (NSAID) tablet to relieve some of the tightness and i'm not sure if it's a good idea or not.
Answered by Dr. Shafi Ullah Khan 2 hours later
Brief Answer:
lower the dose to 15.try mother nature

Detailed Answer:
Thank you for asking
What you are having are quite common adverse effects of Phentermine and I suggest you reduce the dose from 37.5 to 15 and aspirin you can take but won't help. Here are some other adverse effects this Phentermine is notorious for
Bad taste in mouth
Blurred vision
Changes in libido
Drug-induced GI disturbance
Dry mouth
Dysphoric mood
Hair loss
Heart valve disorder
Primary pulmonary hypertension
Psychotic disorder

Try some natural weight losing tricks and see if they are some tips for that.

Obesity is a very worrisome health crisis not only in states but all over the world. 36 % people are obese, and 50 % plus amongst rest are overweight.78 million adults who are more than age 20 (which include 37.5 million men and 40.6 million women) and 12.5 million children and adolescents age (5.5 million boys and 7 million girls) in the United States are obese with men and women 36 % prevalent( 36 among every 100) 17 % 17 among every 100 children and adolescents.

Lets talk what are the reasons a person get obese. Genetic , metabolic, activity levels, hormonal derangements, race type, sex common in males and in women pst menopausal, age related increment, ethnic and cultural issues, socioeconomic statuses ( previously used to be called the illness of rich people), Habits of eating, Cessation of smoking ( odd but a truth – no way a reason to continue smoking though), pregnancies in women, psychologic issues like bulimia etc, diabetes and gestational diabetes etc, lactation and breastfeeding etc, are some of the many reasons for the crime of obesity.

Amongst them all, inactivity and sedentary lifestyles are the most common troubles. less than half people amongst world meet the physical guidelines of active lifestyles, rest are sedentary as snails and lethal to themselves as a bomb. Even high school kids are inactive and every 7 out of 10 highschoolers are inactive and thus implants the ticking time bomb.

Now lets talk who is obese, who is morbidly obese and who is overweight and who is normal.

To know that calculate your BMI here

If you stand below 25 you are fine.

if between 25 and 29.9 then you are overweight

if above 30 and below 39.9 then obese

and if above 40 then morbid obesity is your category which you should not be proud of.

The more the BMI the more the odds for associated morbidities like coronary heart diseases, diabetic neuropathies, vasculopathies etc.

If you are above 40 the age odds increase by 20 years in men and 5 years in women.

Enough jibber jabber about the obesity. Now lets talk about the management and ways to combat it.

A good start is always a modification in diet and lifestyle. self monitoring of caloric intake, stimulus control, non food rewards, relapse prevention, seeking dietitian help etc.

Sign up to a weight loss program under an FDA approved clinician with realistic goals and expectations regarding weight loss.

I call them SMART: Specific, Measurable, Attainable, Realistic, and Timely.Before signing up to programs evaluation for psychiatric morbidities is a must do procedure to sort out depression, eating disorders, not complying will lead to drastic effects and changes in lifestyle and personality which one would regret for long time.

Now what should be the goal and target? it is usually recommended to lose weight at a pace of 1-2 pounds per week and faster than this can lead to issues inevitable. maximum of 10 % of the weight or more precise 30 pounds is to be reduced in one program on 12 weeks maximum followed by a break with try to maintain the loss for at least a year and then trying further.

Remember losing weight is easy. maintaining the loss is a challenge. and to do that one needs self monitoring of weight, low fat diet intake, daily exercise of at least 60 minutes with no breaks, minimum sedentary time in life like watching TV or bed ridden habits. Diet induced weight loss increases the hunger and appetite and creates a challenge for the patient and the perseverance and patience is tested otherwise rep lapse occurs and all effort goes in vane. And this applies to every age group but children more specific as their lifespan matters the most here.

Energy expenditures are obsolete these days as metabolism varies, usually 22 kilo calories are required for every kg to be maintained therefore  weight loss reduces the expenditure and dampen the pace of loss which most of the time disappoints the patient and then they commit the cheap publicity damaging stunts to be a super man in one day , time when they lose it.Also every decade / 10 years reduce the 100kcals consumption in a body so old people need more effort to lose the same weight as does the adult does , men lose more than women at the same effort.

What to eat, what not to eat how to eat how much to eat and when to eat are some very import an questions need to be answered.

Low fat diets like Ornish diets, Low carbohydrate diets like Atkin diets and Medievel diets like zone diets in which all three major nutrients of carbohydrates, fats and proteins are used in equal proportion , JOLSIN WHY WAIT diet for diabetic patients( 40-65 % carbohydrates, 20-30 % fats and less than 35 % fats) are some of the diets clinicians recommend for obesity.

these are balanced. low calories and reduced-portion sized diets recommended by dieticians

portion control can be attained by getting involved in  weight loss programs like  Jenny XXXXXXX Nutrisystem or by the use of products such as meal-replacement shakes, bars, prepackaged meals, and frozen entrees (eg, Slim-Fast, Glucerna, Lean Cuisine, Healthy Choice, Smart Ones). These have adequate and enough amounts of the major diet components based on the food pyramid from the US Department of Agriculture and recommended daily allowances (RDAs). These sources also have adequate micro components of nutrition and trace elements like vitamins and minerals etc.

Alcohol, sodas, most fruit juices, and highly concentrated sweets are generally calorie dense and nutrient deficient (so-called empty calories). therefore, these are generally prohibited and to be avoided or reduced to a minimum levels of possible.

If you keep the calories intake in the range of 500-1000 kcal/ day ro 800-1800 kcal/day , you will start losing weight at a pace of 1-2 pounds ( 0.4-0.5 kg) every week. ideal loss in 10 – 20 pounds for 200 pounds person over 3- 6 months.

if you try more faster than this you will develop complications like Vitamin deficiency, starvation ketosis, electrolyte derangements and gall bladder stones etc are some amongst them. keep preteens in range of .8 to 1.5 per kg do not exceed 100 gm. carbohydrates maximum 50 gram per day, water drinking of more than 1000 ml or minimum of 6 glasses,

it is said that drinking cold water 10ml per kg ( e.g. 700 ml / 3 glasses for 70 kg man) before every meal accelerates thew weight loss and makes it easy. so make a habit of drinking water before meal.

Last but not the least way is exercise. Intensive exercise programs work like charm but cardiac and respiratory profiles need to be evaluated first before prescribing them. Aerobic isotonic exercises are the best amongst all. Ideal is 30 – 60 minutes a day 5 – 7 imps a week. Anaerobic isometric exercises, resistant training can be used as side technique but with a lot of monitoring.

Modify behaviour before its to late, never sleep for more than 7 to 8 hours..sleeping less than 6 and more than 9 hours are both lethal and a great addition to obesity. so balance of sleep is advised and any extreme would exaggerate the obesity issue.

Now the list of medications prescribed in obesity but to be used only after consulting a physicians and let them choose what is best.

  Lorcaserin Belviq

 Phentermine/topiramate (Qsymia)

Phentermine (Adipex-p, Ionamin, Suprenza) 

Diethylpropion (Tenuate, Tenuate Dospan)

Phendimetrazine (Bontril,Bontril PDM, Adphen, Aplhazine,Phenazine )

Benzphetamines (Didrex)

Orlistat (Xenical, Alli)

There are many products like above mentioned available over the counter with out prescription like ephedrine, caffeine, benzocaine, chromium, psyllium, chitosan, and herbal preparations. Herbal ingredients frequently include ma huang (Ephedra sinica), St. John’s wort (Hypericum perforatum), guarana (Paulinia cupana), kola nut (Cola nitida, Cola acuminata, and Garcinia cola), hydroxycitric acid (Garcinia cambogia) etc.

Bariatric Surgeries are new development and advised to BMIs above 40 or people in old age where exercise is not an option for weight loss.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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