Label: PHENTERMINE HYDROCHLORIDE tablet

  • Category: HUMAN PRESCRIPTION DRUG LABEL
  • DEA Schedule: CIV
  • Marketing Status: Abbreviated New Drug Application

Drug Label Information

Updated March 29, 2019

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  • HIGHLIGHTS OF PRESCRIBING INFORMATION
    These highlights do not include all the information needed to use Phentermine Hydrochloride Tablets USP safely and effectively. See full prescribing information for Phentermine Hydrochloride Tablets USP.

    PHENTERMINE Hydrochloride Tablets, USP CIV
    Initial U.S. Approval: 1959

    INDICATIONS AND USAGE


    Phentermine hydrochloride is a sympathomimetic amine anorectic indicated as a short-term adjunct (a few weeks) in a regimen of weight reduction based on exercise, behavioral modification and caloric restriction in the management of exogenous obesity for patients with an initial body mass index greater than or equal to 30 kg/m2, or greater than or equal to 27 kg/m2 in the presence of other risk factors (e.g., controlled hypertension, diabetes, hyperlipidemia). (1)

    The limited usefulness of agents of this class, including phentermine hydrochloride tablets USP, should be measured against possible risk factors inherent in their use. (1)

    DOSAGE AND ADMINISTRATION


    • Dosage should be individualized to obtain an adequate response with the lowest effective dose. (2.1)
    • Late evening administration should be avoided (risk of insomnia). (2.1)
    • Phentermine hydrochloride tablets can be taken with or without food (2.1)
    • Limit the dosage to 15 mg daily for patients with severe renal impairment (eGFR 15 to 29 mL/min/1.73 m2) (2.2)

    DOSAGE FORMS AND STRENGTHS

    • Tablets containing 37.5 mg phentermine hydrochloride USP (equivalent to 30 mg phentermine base). (3)

    CONTRAINDICATIONS

    • History of cardiovascular disease (e.g., coronary artery disease, stroke, arrhythmias, congestive heart failure, uncontrolled hypertension) (4)
    • During or within 14 days following the administration of monoamine oxidase inhibitors (4)
    • Hyperthyroidism (4)
    • Glaucoma (4)
    • Agitated states (4)
    • History of drug abuse (4)
    • Pregnancy (4, 8.1)
    • Nursing (4,8.3)
    • Known hypersensitivity, or idiosyncrasy to the sympathomimetic amines (4)

    WARNINGS AND PRECAUTIONS

    • Coadministration with other drugs for weight loss is not recommended (safety and efficacy of combination not established). (5.1)
    • Rare cases of primary pulmonary hypertension have been reported. Phentermine should be discontinued in case of new, unexplained symptoms of dyspnea, angina pectoris, syncope or lower extremity edema. (5.2)
    • Rare cases of serious regurgitant cardiac valvular disease have been reported. (5.3)
    • Tolerance to the anorectic effect usually develops within a few weeks. If this occurs, phentermine should be discontinued. The recommended dose should not be exceeded. (5.4)
    • Phentermine may impair the ability of the patient to engage in potentially hazardous activities such as operating machinery or driving a motor vehicle. (5.5)
    • Risk of abuse and dependence. The least amount feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage. (5.6)
    • Concomitant alcohol use may result in an adverse drug reaction. (5.7)
    • Use caution in patients with even mild hypertension (risk of increase in blood pressure). (5.8)
    • A reduction in dose of insulin or oral hypoglycemic medication may be required in some patients. (5.9)

    ADVERSE REACTIONS


    Adverse events have been reported in the cardiovascular, central nervous, gastrointestinal, allergic, and endocrine systems. (6)

    To report SUSPECTED ADVERSE REACTIONS, contact Aurobindo Pharma USA, Inc. at 1-866-850-2876 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch

    DRUG INTERACTIONS

    • Monoamine oxidase inhibitors: Risk of hypertensive crisis. (4, 7.1)
    • Alcohol: Consider potential interaction (7.2)
    • Insulin and oral hypoglycemics: Requirements may be altered. (7.3)
    • Adrenergic neuron blocking drugs: Hypotensive effect may be decreased by phentermine. (7.4)

    USE IN SPECIFIC POPULATIONS

    • Nursing mothers: Discontinue drug or nursing taking into consideration importance of drug to mother. (4, 8.3)
    • Pediatric use: Safety and effectiveness not established. (8.4)
    • Geriatric use: Due to substantial renal excretion, use with caution. (8.5)
    • Renal Impairment: Avoid use in patients with eGFR less than 15 mL/min/m2 or end-stage renal disease requiring dialysis). (8.6)

    See 17 for PATIENT COUNSELING INFORMATION.

    Revised: 3/2019

  • Table of Contents
  • 1 INDICATIONS & USAGE


    Phentermine hydrochloride tablets USP are indicated as a short-term (a few weeks) adjunct in a regimen of weight reduction based on exercise, behavioral modification and caloric restriction in the management of exogenous obesity for patients with an initial body mass index greater than or equal to 30 kg/m2, or greater than or equal to 27 kg/m2 in the presence of other risk factors (e.g., controlled hypertension, diabetes, hyperlipidemia).

    Below is a chart of body mass index (BMI) based on various heights and weights.

    BMI is calculated by taking the patient's weight, in kilograms (kg), divided by the patient's height, in meters (m), squared. Metric conversions are as follows: pounds ÷ 2.2 = kg; inches x 0.0254 = meters.


    BODY MASS INDEX (BMI), kg/m2
    Height (feet, inches)
    Weight
    (pounds)
    5'0"5'3"5'6"5'9"6'0"6'3"
    140
    27
    25
    23
    21
    19
    18
    150
    29
    27
    24
    22
    20
    19
    160
    31
    28
    26
    24
    22
    20
    170
    33
    30
    28
    25
    23
    21
    180
    35
    32
    29
    27
    25
    23
    190
    37
    34
    31
    28
    26
    24
    200
    39
    36
    32
    30
    27
    25
    210
    41
    37
    34
    31
    29
    26
    220
    43
    39
    36
    33
    30
    28
    230
    45
    41
    37
    34
    31
    29
    240
    47
    43
    39
    36
    33
    30
    250
    49
    44
    40
    37
    34
    31

    The limited usefulness of agents of this class, including phentermine, [see Clinical Pharmacology (12.1, 12.2)] should be measured against possible risk factors inherent in their use such as those described below.

  • 2 DOSAGE & ADMINISTRATION

    2.1 Exogenous Obesity


    Dosage should be individualized to obtain an adequate response with the lowest effective dose.
    The usual adult dose is one tablet as prescribed by the physician, administered in the morning, with or without food. Phentermine is not recommended for use in pediatric patients less than or equal to 16 years of age.

    Late evening medication should be avoided because of the possibility of resulting insomnia.

    With dry hands, gently remove the phentermine hydrochloride tablet from the bottle. Immediately place the phentermine hydrochloride tablet on top of the tongue where it will dissolve, then swallow with or without water.




    2.2 Dosage in Patients with Renal Impairment

    The recommended maximum dosage of phentermine hydrochloride tablet is 15 mg daily for patients with severe renal impairment (eGFR 15 to 29 mL/min/1.73m2). Avoid use of phentermine hydrochloride tablet in patients with eGFR less than 15 mL/min/1.73m2 or end-stage renal disease requiring dialysis [see Use in Specific Populations (8.6) and Clinical Pharmacology (12.3)]

  • 3 DOSAGE FORMS & STRENGTHS


    Phentermine hydrochloride tablets are white to off-white with blue specks, capsule shaped, uncoated tablets, debossed with “U40” on one side and break line on the other side, containing 37.5 mg phentermine hydrochloride USP (equivalent to 30 mg phentermine base).

  • 4 CONTRAINDICATIONS

    • History of cardiovascular disease (e.g., coronary artery disease, stroke, arrhythmias, congestive heart failure, uncontrolled hypertension)
    • During or within 14 days following the administration of monoamine oxidase inhibitors
    • Hyperthyroidism
    • Glaucoma
    • Agitated states
    • History of drug abuse
    • Pregnancy [see Use in Specific Populations (8.1)]
    • Nursing [see Use in Specific Populations (8.3)]
    • Known hypersensitivity, or idiosyncrasy to the sympathomimetic amines
  • 5 WARNINGS AND PRECAUTIONS

    5.1 Coadministration with Other Drug Products for Weight Loss


    Phentermine hydrochloride tablets are indicated only as short-term (a few weeks) monotherapy for the management of exogenous obesity. The safety and efficacy of combination therapy with phentermine and any other drug products for weight loss including prescribed drugs, over-the-counter preparations, and herbal products, or serotonergic agents such as selective serotonin reuptake inhibitors (e.g., fluoxetine, sertraline, fluvoxamine, paroxetine), have not been established. Therefore, coadministration of phentermine and these drug products is not recommended.

    5.2 Primary Pulmonary Hypertension


    Primary Pulmonary Hypertension (PPH) - a rare, frequently fatal disease of the lungs - has been reported to occur in patients receiving a combination of phentermine with fenfluramine or dexfenfluramine. The possibility of an association between PPH and the use of phentermine alone cannot be ruled out; there have been rare cases of PPH in patients who reportedly have taken phentermine alone. The initial symptom of PPH is usually dyspnea. Other initial symptoms may include angina pectoris, syncope or lower extremity edema. Patients should be advised to report immediately any deterioration in exercise tolerance. Treatment should be discontinued in patients who develop new, unexplained symptoms of dyspnea, angina pectoris, syncope or lower extremity edema, and patients should be evaluated for the possible presence of pulmonary hypertension.

    5.3 Valvular Heart Disease


    Serious regurgitant cardiac valvular disease, primarily affecting the mitral, aortic and/or tricuspid valves, has been reported in otherwise healthy persons who had taken a combination of phentermine with fenfluramine or dexfenfluramine for weight loss. The possible role of phentermine in the etiology of these valvulopathies has not been established and their course in individuals after the drugs are stopped is not known. The possibility of an association between valvular heart disease and the use of phentermine alone cannot be ruled out; there have been rare cases of valvular heart disease in patients who reportedly have taken phentermine alone.

    5.4 Development of Tolerance, Discontinuation in Case of Tolerance


    When tolerance to the anorectant effect develops, the recommended dose should not be exceeded in an attempt to increase the effect; rather, the drug should be discontinued.

    5.5 Effect on the Ability to Engage in Potentially Hazardous Tasks


    Phentermine may impair the ability of the patient to engage in potentially hazardous activities such as operating machinery or driving a motor vehicle; the patient should therefore be cautioned accordingly.

    5.6 Risk of Abuse and Dependence


    Phentermine is related chemically and pharmacologically to amphetamine (d- and d/l-amphetamine) and other related stimulant drugs that have been extensively abused. The possibility of abuse of phentermine should be kept in mind when evaluating the desirability of including a drug as part of a weight reduction program. See Drug Abuse and Dependence (9)and Overdosage (10) .

    The least amount feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage.

    5.7 Usage with Alcohol


    Concomitant use of alcohol with phentermine may result in an adverse drug reaction.

    5.8 Use in Patients with Hypertension


    Use caution in prescribing phentermine for patients with even mild hypertension (risk of increase in blood pressure).

    5.9 Use in Patients on Insulin or Oral Hypoglycemic Medications for Diabetes Mellitus


    A reduction in insulin or oral hypoglycemic medications in patients with diabetes mellitus may be required.

  • 6 ADVERSE REACTIONS


    The following adverse reactions are described, or described in greater detail, in other sections:
    -   Primary pulmonary hypertension [see Warnings and Precautions (5.2)]
    -   Valvular heart disease [see Warnings and Precautions (5.3)]
    -   Effect on the ability to engage in potentially hazardous tasks [see Warnings and Precautions (5.5)]
    -   Withdrawal effects following prolonged high dosage administration [see Drug Abuse and Dependence (9.3)]

    The following adverse reactions to phentermine have been identified:

    Cardiovascular


    Primary pulmonary hypertension and/or regurgitant cardiac valvular disease, palpitation, tachycardia, elevation of blood pressure, ischemic events.

    Central Nervous System


    Overstimulation, restlessness, dizziness, insomnia, euphoria, dysphoria, tremor, headache, psychosis.

    Gastrointestinal


    Dryness of the mouth, unpleasant taste, diarrhea, constipation, other gastrointestinal disturbances.

    Allergic


    Urticaria.

    Endocrine


    Impotence, changes in libido.

  • 7 DRUG INTERACTIONS

    7.1 Monoamine Oxidase Inhibitors


    Use of phentermine is contraindicated during or within 14 days following the administration of monoamine oxidase inhibitors because of the risk of hypertensive crisis.

    7.2 Alcohol


    Concomitant use of alcohol with phentermine may result in an adverse drug reaction.

    7.3 Insulin and Oral Hypoglycemic Medications


    Requirements may be altered [see Warnings and Precautions (5.9)].

    7.4 Adrenergic Neuron Blocking Drugs


    Phentermine may decrease the hypotensive effect of adrenergic neuron blocking drugs.

  • 8 USE IN SPECIFIC POPULATIONS

    8.1 Pregnancy


    Pregnancy Category X

    Phentermine is contraindicated during pregnancy because weight loss offers no potential benefit to a pregnant woman and may result in fetal harm. A minimum weight gain, and no weight loss, is currently recommended for all pregnant women, including those who are already overweight or obese, due to obligatory weight gain that occurs in maternal tissues during pregnancy. Phentermine has pharmacologic activity similar to amphetamine (d- and d/l-amphetamine) [see Clinical Pharmacology (12.1)]. Animal reproduction studies have not been conducted with phentermine. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus.

    8.3 Nursing Mothers


    It is not known if phentermine is excreted in human milk; however, other amphetamines are present in human milk. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

    8.4 Pediatric Use


    Safety and effectiveness in pediatric patients have not been established. Because pediatric obesity is a chronic condition requiring long-term treatment, the use of this product, approved for short-term therapy, is not recommended.

    8.5 Geriatric Use


    In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

    This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.

    8.6 Renal Impairment


    Based on the reported excretion of phentermine in urine, exposure increases can be expected in patients with renal impairment. [seeClinical Pharmacology (12.3)].


    Use caution when administering Phentermine to patients with renal impairment. In patients with severe renal impairment (eGFR 15 to 29 mL/min/1.73m2), limit the dosage of Phentermine to 15 mg daily [see Dosage and Administration (2.2)]. Phentermine has not been studied in patients with eGFR less than 15 mL/min/1.73m2, including end-stage renal disease requiring dialysis; avoid use in these populations.

  • 9 DRUG ABUSE AND DEPENDENCE

    9.1 Controlled Substance


    Phentermine is a Schedule IV controlled substance.

    9.2 Abuse


    Phentermine is related chemically and pharmacologically to the amphetamines. Amphetamines and other stimulant drugs have been extensively abused and the possibility of abuse of phentermine should be kept in mind when evaluating the desirability of including a drug as part of a weight reduction program.

    9.3 Dependence


    Abuse of amphetamines and related drugs may be associated with intense psychological dependence and severe social dysfunction. There are reports of patients who have increased the dosage of these drugs to many times than recommended. Abrupt cessation following prolonged high dosage administration results in extreme fatigue and mental depression; changes are also noted on the sleep EEG. Manifestations of chronic intoxication with anorectic drugs include severe dermatoses, marked insomnia, irritability, hyperactivity and personality changes. A severe manifestation of chronic intoxication is psychosis, often clinically indistinguishable from schizophrenia.

  • 10 OVERDOSAGE


    The least amount feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage.

    10.1 Acute Overdosage


    Manifestations of acute overdosage include restlessness, tremor, hyperreflexia, rapid respiration, confusion, assaultiveness, hallucinations, and panic states. Fatigue and depression usually follow the central stimulation. Cardiovascular effects include tachycardia, arrhythmia, hypertension or hypotension, and circulatory collapse. Gastrointestinal symptoms include nausea, vomiting, diarrhea and abdominal cramps. Overdosage of pharmacologically similar compounds has resulted in fatal poisoning usually terminates in convulsions and coma.

    Management of acute phentermine hydrochloride intoxication is largely symptomatic and includes lavage and sedation with a barbiturate. Experience with hemodialysis or peritoneal dialysis is inadequate to permit recommendations in this regard. Acidification of the urine increases phentermine excretion. Intravenous phentolamine (Regitine®, CIBA) has been suggested on pharmacologic grounds for possible acute, severe hypertension, if this complicates overdosage. 

    10.2 Chronic Intoxication


    Manifestations of chronic intoxication with anorectic drugs include severe dermatoses, marked insomnia, irritability, hyperactivity and personality changes. The most severe manifestation of chronic intoxications is psychosis, often clinically indistinguishable from schizophrenia. See Drug Abuse and Dependence (9.3).

  • 11 DESCRIPTION


    Phentermine hydrochloride USP is a sympathomimetic amine anorectic. Its chemical name is a,a-dimethylphenethylamine hydrochloride. The structural formula is as follows: 


    phenterminestr


    Phentermine hydrochloride USP is a white, odorless, hygroscopic, crystalline powder which is soluble in water and lower alcohols, slightly soluble in chloroform and insoluble in ether.

    Phentermine hydrochloride tablets USP are available as an oral tablet containing 37.5 mg of phentermine hydrochloride USP (equivalent to 30 mg of phentermine base). Each phentermine hydrochloride tablet USP also contains the inactive ingredients microcrystalline cellulose, pregelatinized starch, anhydrous lactose, crospovidone, colloidal silicon dioxide, magnesium stearate, sucrose, corn starch and FD&C Blue #1.

  • 12 CLINICAL PHARMACOLOGY

    12.1 Mechanism of Action


    Phentermine is a sympathomimetic amine with pharmacologic activity similar to the prototype drugs of this class used in obesity, amphetamine (d- and d/l-amphetamine). Drugs of this class used in obesity are commonly known as "anorectics" or "anorexigenics." It has not been established that the primary action of such drugs in treating obesity is one of appetite suppression since other central nervous system actions, or metabolic effects, may also be involved.

    12.2 Pharmacodynamics


    Typical actions of amphetamines include central nervous system stimulation and elevation of blood pressure. Tachyphylaxis and tolerance have been demonstrated with all drugs of this class in which these phenomena have been looked for.

    12.3 Pharmacokinetics


    Following the administration of phentermine, phentermine reaches peak concentrations (Cmax) after 3 to 4.4 hours.

    Drug Interactions

     


    In a single-dose study comparing the exposures after oral administration of a combination capsule of 15 mg phentermine and 92 mg topiramate to the exposures after oral administration of a 15 mg phentermine capsule or a 92 mg topiramate capsule, there is no significant topiramate exposure change in the presence of phentermine. However in the presence of topiramate, phentermine Cmax and AUC increase 13% and 42%, respectively.

    Specific Populations

    Renal Impairment
    Cumulative urinary excretion of phentermine under uncontrolled urinary pH conditions was 62% to 85%. 





    Systemic exposure of phentermine may increase up to 91%, 45%, and 22% in patients with severe, moderate, and mild renal impairment, respectively [seeDosage and Administration (2.2)and Use in Specific Populations (8.6)].




  • 13 NONCLINICAL TOXICOLOGY

    13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility


    Studies have not been performed with phentermine to determine the potential for carcinogenesis, mutagenesis or impairment of fertility.

  • 14 CLINICAL STUDIES


    In relatively short-term clinical trials, adult obese subjects instructed in dietary management and treated with “anorectic” drugs lost more weight on the average than those treated with placebo and diet.

    The magnitude of increased weight loss of drug-treated patients over placebo-treated patients is only a fraction of a pound a week. The rate of weight loss is greatest in the first weeks of therapy for both drug and placebo subjects and tends to decrease in succeeding weeks. The possible origins of the increased weight loss due to the various drug effects are not established. The amount of weight loss associated with the use of an “anorectic” drug varies from trial to trial, and the increased weight loss appears to be related in part to variables other than the drugs prescribed, such as the physician-investigator, the population treated and the diet prescribed. Studies do not permit conclusions as to the relative importance of the drug and non-drug factors on weight loss.

    The natural history of obesity is measured over several years, whereas the studies cited are restricted to a few weeks’ duration; thus, the total impact of drug-induced weight loss over that of diet alone must be considered clinically limited.

  • 16 HOW SUPPLIED/STORAGE AND HANDLING

    Product: 50090-4216

    NDC: 50090-4216-0 30 TABLET in a BOTTLE

  • 17 PATIENT COUNSELING INFORMATION


    Patients must be informed that phentermine hydrochloride is a short-term (a few weeks) adjunct in a regimen of weight reduction based on exercise, behavioral modification and caloric restriction in the management of exogenous obesity, and that coadministration of phentermine with other drugs for weight loss is not recommended [seeIndications and Usage (1) and Warnings and Precautions (5)].

    Patients must be instructed on how much phentermine to take, and when and how to take it [see Dosage and Administration (2)].

    Advise pregnant women and nursing mothers not to use phentermine [see Use in Specific Populations (8.1, 8.3)].

    Patients must be informed about the risks of use of phentermine (including the risks discussed in Warnings and Precautions), about the symptoms of potential adverse reactions and when to contact a physician and/or take other action. The risks include, but are not limited to:

    See also, for example, Adverse Reactions (6)and Use in Specific Populations (8).


    The patients must also be informed about


    Tell patients to keep phentermine in a safe place to prevent theft, accidental overdose, misuse or abuse. Selling or giving away phentermine may harm others and is against the law.

    Manufactured by:
    Aurolife Pharma LLC
    Dayton, NJ 08810

    Manufactured for:
    Aurobindo Pharma USA, Inc.
    Dayton, NJ 08810

    Revised: 03/2017

  • Phentermine Hydrochloride

    Label Image
  • INGREDIENTS AND APPEARANCE
    PHENTERMINE HYDROCHLORIDE 
    phentermine hydrochloride tablet
    Product Information
    Product TypeHUMAN PRESCRIPTION DRUGItem Code (Source)NDC:50090-4216(NDC:13107-061)
    Route of AdministrationORALDEA ScheduleCIV    
    Active Ingredient/Active Moiety
    Ingredient NameBasis of StrengthStrength
    PHENTERMINE HYDROCHLORIDE (UNII: 0K2I505OTV) (PHENTERMINE - UNII:C045TQL4WP) PHENTERMINE HYDROCHLORIDE37.5 mg
    Inactive Ingredients
    Ingredient NameStrength
    ANHYDROUS LACTOSE (UNII: 3SY5LH9PMK)  
    SILICON DIOXIDE (UNII: ETJ7Z6XBU4)  
    STARCH, CORN (UNII: O8232NY3SJ)  
    CROSPOVIDONE (15 MPA.S AT 5%) (UNII: 68401960MK)  
    FD&C BLUE NO. 1 (UNII: H3R47K3TBD)  
    MAGNESIUM STEARATE (UNII: 70097M6I30)  
    MICROCRYSTALLINE CELLULOSE (UNII: OP1R32D61U)  
    SUCROSE (UNII: C151H8M554)  
    Product Characteristics
    ColorWHITE (Off-white with blue specks) Score2 pieces
    ShapeCAPSULESize10mm
    FlavorImprint Code U40
    Contains    
    Packaging
    #Item CodePackage DescriptionMarketing Start DateMarketing End Date
    1NDC:50090-4216-030 in 1 BOTTLE; Type 0: Not a Combination Product03/25/2019
    Marketing Information
    Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
    ANDAANDA20306808/06/2014
    Labeler - A-S Medication Solutions (830016429)
    Establishment
    NameAddressID/FEIBusiness Operations
    A-S Medication Solutions830016429RELABEL(50090-4216) , REPACK(50090-4216)