Phen-Pro Method

This is the Phen-Pro method patented by Dr. Anchors.

The indication for the treatment is a body mass index BMI > 27 in a patient who has failed to reduce weight using voluntary diet & exercise alone. BMI is defined as the weight in kg/(height in m)*2.

Contraindications are mania, schizophrenia, anxiety, seizures, symptomatic enlarged prostate, severe hypertension , tachyarrhythmias, stage III or IV CHF or litigious nature of the patient. Preexisting heart valve disease is not a contraindication.

Phentermine co-treats attention deficit disorder, so Ritalin should be discontinued. Phentermine acts as a decongestant so patients need not take oral decongestants.

Qualified patients should be started on generic phentermine 15 mg po qAM between 8 and 10 AM with a little food and ONE of the following... Prozac 20 mg po qd, Zoloft 50 mg po qd, Celexa 20 mg po qd, Luvox 50 mg po qd, Effexor XR 75 mg po qd, generic trazadone 50 mg po QHS.

Important note. Doses of SSRI drugs much higher than the above doses cancel out the anorexic effect of phen (Padla, 1997).

After one week, the patient should increase the dose of phentermine to two 15 mg capsules taken together in the morning. Never start patients on 30 mg of phentermine!

No initial blood work or other studies is necessary, but if the patient fails to lose weight by the first follow-up visit in 4 weeks, TSH and cortisol should be checked. Expected weight loss is 2 lbs per week for the first 6 weeks, and 1-1.5 lb per week thereafter. Side-effects when they occur can usually be eliminated.

Some patients after being on phen-pro for several weeks or months report that their excess hunger returns. They still don't gain weight back, but they stop losing weight. If this occurs, the physician should inquire whether the hunger is occurring at a particular time of day.

If the hunger is occurring only at night, the patient should be encouraged to take phentermine later in the morning or even the early afternoon. Alternatively, the phentermine dose can be increased and/or split doses can be given. If the hunger is generally increased all day, then the patient should be given 5-HTP (5-hydroxytryptophan) 50 mg twice a day with a little food. 5-HTP is an over-the-counter medicine, but patients and physicians should obtain it from Pragmatic Research Many over-the-counter brands are impure. The Pragmatic Research brand is certified to be free of peak X. From 3 days to 2 weeks after ADDING 5-HTP to phen-pro, patients will feel their resurgent hunger go away again.

ALWAYS stress to the patient that ALL the physician can do is to make the patient less hungry. It is still up to the patient to EAT LESS FOOD. Nothing less will work. Nothing more is necessary.

When patients reach ideal body weight or get stuck after losing some weight, I recommend stopping phen-pro for a month to see if the patient can maintain their new low weight off the medicines.

Approximately one third of the patients can keep their weight low off the medicines. They do not need to continue taking medicine, but they should weigh themselves once or twice a month to be sure they are not regaining; they may need a "refresher course" of medicines in the future.

The remaining two thirds of patients, off the medicine, will see their weight start to go back up because their excessive hunger returns. They should be put back on phen-pro before they regain too much weight and they should be kept on phen-pro, indefinitely if necessary. It's no big deal. If they had high blood pressure, you would put the patients on life-long medicine. Ditto high cholesterol. Ditto gout. Ditto estrogen. No one should discriminate against weight loss medicines. No one should discriminate against obese people at all. Obesity is a medical disease like any other.

One little caveat. There is something called SSRI withdrawal syndrome, which occurs rarely when patients are discontinued from the shorter-acting SSRI drugs, such as Zoloft. I have seen this ONLY with Zoloft (and Paxil). The symptoms consist of nausea and flu-like feelings for several days. To avoid this possibility, patients being withdrawn from phen/Zoloft should have their Zoloft dose reduced to 25 mg for two weeks before going off Zoloft entirely. Gradual withdrawal from phentermine is NOT necessary unless the phentermine dose was pushed to 60 mg per day. In that case only, the phentermine should be decreased to 30 mg a day for two weeks before being finally discontinued.

The side-effects of phen-pro are less frequent and less serious than many medical therapies, certainly no worse than therapies for high blood pressure, etc. And the side-effects of phen-pro, if they do occur, tend to improve with time and patience. It's worth some sacrifice to cure obesity, a common, serious medical problem for which, at the moment, there is no other effective long-term treatment.

Note! Caffeine increases all the side-effects of phen-pro without making it work better. Patients should switch to decaffeinated coffee. The caffeine in soft drinks and tea is negligible. Only coffee matters.

COMMON SIDE-EFFECTS (LESS THAN 50% OF PATIENTS)

Dry mouth

The only solution is to drink more water. Phentermine reduces the production of spit, but so do Sudafed and other common decongestants. If drinking more water is not enough, patients can get Biotene mouth products over the counter or use Mouthcoat artificial saliva--these are rarely needed.

Trouble sleeping

Switch the SSRI to generic trazadone 50 mg at night.

LESS COMMON SIDE-EFFECTS (LESS THAN 10% OF PATIENTS)

Orgasmic delay

Switch SSRI to Luvox 50 mg or Effexor XR 75 mg.

Nervousness

Switch SSRI to Luvox 50 mg or add clonidine pill or patch .

Sweating

A common problem in overweight people generally. Obviously the patient can try to stay cool. If the excess sweating is in the feet or armpits, Drysol will handle the sweating well. If the sweating is more widespread, the patient can spray the sweating parts with Arrid Extradry.

Constipation

Switch SSRI to Zoloft 50 mg or add Senokot-S twice a day.

Rapid heartbeat

Start phentermine more gradually or temporarily add atenolol. Check for unrecognized hyperthyroidism or concomitant stimulant drugs.

Drowsiness

Switch SSRI to Effexor XR and consider undiagnosed ADD.