From the FDA Drug Label
Renal Impairment: Avoid use in patients with eGFR less than 15 mL/min/m 2 or end-stage renal disease requiring dialysis. ( 8.6)
The patient has CKD5, which implies end-stage renal disease.
- Phentermine is not recommended for patients with end-stage renal disease requiring dialysis 1.
- The FDA label advises to avoid use in such patients.
- Therefore, phentermine is not appropriate for a patient with CKD5 and no DM.
From the Research
For patients with stage 5 chronic kidney disease (CKD5) without diabetes mellitus, orlistat is the safest weight loss medication option due to its minimal systemic absorption and local action in the gut. The standard dose of orlistat is 120mg three times daily with meals containing fat, and side effects include oily spotting, flatulence, and fecal urgency 2. Phentermine may be considered with extreme caution at reduced doses (15-30mg daily) and only with close nephrology monitoring, as it's primarily excreted by the kidneys 2. Most newer weight loss medications like GLP-1 agonists (semaglutide, liraglutide) should be avoided in CKD5 due to limited safety data and potential kidney effects, even though they're often used in diabetic patients 2. Bupropion-naltrexone and phentermine-topiramate combinations are contraindicated in severe kidney disease 2. Non-pharmacological approaches should be emphasized, including dietary modifications supervised by a renal dietitian, appropriate physical activity, and behavioral therapy 3, 4. Any medication initiation should involve collaborative decision-making with the patient's nephrologist due to the complex nature of medication clearance in end-stage kidney disease 5. Key considerations for weight loss in CKD5 patients without diabetes include:
- Avoiding medications with potential kidney effects
- Emphasizing non-pharmacological approaches
- Collaborative decision-making with the patient's nephrologist
- Close monitoring of kidney function and medication clearance.