What is the recommended strength of Lomaira (phentermine) for weight loss?

Recommended Strength of Lomaira (Phentermine) for Weight Loss

The recommended strength of Lomaira (phentermine) is 8 mg taken three times daily, while the standard phentermine formulation is typically dosed at 37.5 mg once daily or 15-30 mg daily for weight loss management. 1

Dosing Guidelines

• Lomaira-specific dosing: 8 mg three times daily (t.i.d.) 2
• Standard phentermine dosing:
  • 37.5 mg once daily (q.d.) 2
  • Or 15-30 mg daily, typically taken approximately 2 hours after breakfast 1

Patient Selection Criteria

Phentermine is indicated for patients with:

• BMI ≥30 kg/m² (without comorbidities)
• BMI ≥27 kg/m² with weight-related comorbidities (e.g., hypertension, diabetes, hyperlipidemia) 2, 3, 1

Administration Considerations

• Timing: Late evening administration should be avoided due to risk of insomnia 1
• Duration: Indicated only as a short-term adjunct (a few weeks) to diet and lifestyle modification 2, 1
• Renal impairment: Limit dosage to 15 mg daily for patients with severe renal impairment (eGFR 15-29 mL/min/1.73 m²) 1
• Food: Can be taken with or without food 1

Efficacy

• Average weight loss with phentermine: approximately 1.5 kg 2
• Percentage of patients achieving ≥5% loss of baseline weight: 37-46% 2

Safety Considerations and Monitoring

Contraindications

• History of cardiovascular disease (coronary artery disease, stroke, arrhythmias, heart failure, uncontrolled hypertension)
• During or within 14 days of MAO inhibitor use
• Hyperthyroidism
• Glaucoma
• Agitated states
• History of drug abuse
• Pregnancy or nursing
• Known hypersensitivity to sympathomimetic amines 1

Monitoring Requirements

• Blood pressure and heart rate should be monitored every 2 weeks during the first 12 weeks
• Efficacy and safety assessment at least monthly for the first 3 months 3

Common Adverse Effects

• Headache, elevated blood pressure, elevated heart rate
• Insomnia, dry mouth, constipation
• Anxiety, palpitations 2, 3, 1

Serious Adverse Effects

• Dyspnea, angina pectoris, syncope
• Severe hypertension 2

Important Clinical Considerations

• Phentermine is a Schedule IV controlled substance
• Not recommended for patients under 16 years of age 1
• Avoid coadministration with other weight loss medications 1
• May require adjustment of insulin or oral hypoglycemic medications in diabetic patients 3, 1
• Consider gradual tapering when discontinuing to minimize withdrawal effects 3

Limitations

• Limited long-term safety data
• Newer medications like GLP-1 receptor agonists (semaglutide, tirzepatide) may be preferred for long-term weight management due to greater efficacy and safety 3
• The American Diabetes Association recommends against long-term use due to limited safety data and potential cardiovascular risks 3