Terfamex can be referred to as a prescription drug chiefly containing phentermine hydrochloride as the chief ingredient in combination with topiramate (Qsymia) and as such its main characteristics and mechanism of action among others are solely based on the chef ingredient phentermine.

It is a stimulant that affects the central nervous system (brain and nerves), in such a way that surpresses the human’s appetite, increasing heart rate and blood pressure in the process. This controlled substance classified as a group IV drug is used together with diet and exercise to treat obesity especially in cases of diabetes and hypertension.

Classification of Terfamex

Terfamex can firstly be classified as a controlled substance, a Scheduled IV drugs and an anorectic drug. Controlled substances is generally a drug or chemical whose manufactured, possession or usage is regulated by the government which includes prescription medications designated by the law. A scheduled IV drug is a classification given to a drug substance or chemical that has a potential for abuse and low risk of dependence lower than schedule III drugs.

Although the actual potential appears to be low. An anorectic or anorexic drug is a drug which reduces appetite, resulting in lower food consumption, leading to weight loss and such drugs are termed anorexigenic, anorexiant or appetite suppressant.

Terfamex can further be classified as adrenergic agents which are drugs that act on the adrenergic receptors that affect the life cycle of adrenergic transmitters. They are also sympathomimetics which mimic the effects of stimulating postganglionic adrenergic sympathetic nerves. Central nervous system stimulants are loosley defined as a group of drugs thet tend to increase behavioural alertness, agitation or excitement without directly exciting the neurons.

Side effects of Terfamex

The more common side effects of the anorectic include; bad taste in the mouth, constipation, diarrhea, dry mouth, headache and vomiting but on severity of such common symptoms, a medical personnel should be approached. Furthermore, primary pulmonary hypertension (PPH) is a serious side effect of the drug which is clearly described as a type of high blood pressure that affects the arteries in your lungs and the right side of your heart.

The symptoms can include: shortness of breath, heart palpitation (fast, fluttering heartbeat), dizziness, cyanosis (bluish color to your lips and skin), tiredness, edema (swelling of your legs and ankles) and angina (chest pain). Valvular heart disease, is another side effect that possibly harms the heart valves so they can’t close properly and may leak.

The symptoms can include: fatigue and weakness, especially when you increase your activity level, shortness of breath during activity or when you lie down, edema (swelling of your legs and ankles), angina (chest pain), chest discomfort or tightness that often gets worse during exercise, lightheadedness or fainting, arrhythmia (irregular heartbeat), heart murmur, heart palpitations (fast, fluttering heartbeat), hypertension (high blood pressure), restlessness, tremors (uncontrollable rhythmic movement in one part of your body), insomnia (trouble sleeping) and erectile dysfunction in men (trouble getting or keeping an erection).

Interactions Terfamex

Terfamex capsule may interact with other medications, vitamins as well as herbs . An interaction is when a substance in a humans body alters the mechanism of action of the drug which could be harmful or prevent the drug from working well. On that note, proper consultation should be made with the medical personnel. Nevertheless, drugs hat can interact with terfamex include:

Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid, phenelzine, rasagiline, selegiline, and tranylcypromine. Terfamex shouldn’t be taken within 14 days of starting or stopping an MAOI. Taking these drugs together can cause a hypertensive crisis (a dangerous increase in blood pressure).

Other drugs for weight loss, such as amphetamine, benzphetamine, dextroamphetamine, diethylpropion, and phendimetrazine. Taking these drugs together may cause increased side effects. These include hypertensive crisis (a dangerous increase in blood pressure) or arrhythmia (a serious abnormal heart rhythm).

Serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, fluvoxamine, paroxetine, citalopram, escitalopram and nefazodone. Taking these drugs together can cause a hypertensive crisis (a dangerous increase in blood pressure).

Interactions Terfamex that causes more side effects

Not only do other substances or drugs interact with terfamex, they are also capable of causing more side effects. Such drugs or substances include:

Insulin and oral diabetes drugs, such as nateglinide, pioglitazone, repaglinide, rosiglitazone, metformin, glimepiride, glipizide, sitagliptin, saxagliptin, linagliptin, exenatide, and liraglutide. Taking these drugs together may cause a significant drop in your blood sugar levels. It may have to b e accompanied by lowering your dosage of your diabetes drugs while monitoring the blood sugar levels closely.


Such a schedule IV controlled substance comes with many warnings. Also, Terfamex is a category X pregnancy drug and Category X drugs should never be used during pregnancy.

Allergy and Alcohol interaction

Terfamex can cause a severe allergic reaction with symptomps such as trouble breathing and
swelling of throat and tongue respectively. The use of drinks that contain alcohol can increase your risk of side effects from phentermine. These side effects can include dizziness, feeling nervous and excitable, headache, hard stools or diarrhea, dry mouth, and not being able to sleep. They can also include decreased interest in sex or change in ability to have sex. People with certain health conditions such as :

(1) Individuals with history of primary pulmonary hypertension (PPH) shouldn’t take phentermine. Terfamex may make your PPH worse.

(2) People with heart disease: Cases including stroke, arrhythmia (irregular heartbeat), heart failure, coronary
artery disease, valve disease, and uncontrolled high blood pressure should not be combined with terfamex which may cause a serious increase in your blood pressure. Hyperthyroidis: In cases of hyperthyroidism (an overactive thyroid). Terfamex may increase one’s thyroid activity, thereby raising the thyroid levels beyond the expected and recommended level.

(3) Individuals with glaucoma problem: This drug has been known to increas eye pressure even more. This may cause
permanent damage to one’s vision.

Mechanism of action

Phentermine containing terfamex is an indirect-acting sympathomimetic agent that acts by releasing noradrenaline from the presynaptic vesicles in the lateral hypothalamus.

This ncrease in noradrenaline concentration in the synaptic cleft results in the stimulation of beta2- adrenergic receptors. Phentermine which is the chief constituent is classified as an indirect sympathomimetic due to the increase in the level of norepinephrine, dopamine and its indirect effect towards serotonin.

Some reports have indicated that this controlled substance inhibits the neuropeptide which is a principal signaling pathway for the induction of hunger. This combined effect produces a continuous flight-or-fight response in the body which reduces the hunger signal as this state is on the immediate need for energy.

Lastly, some reports have indicated that phentermine is a weak inhibitor of monoamine oxidase but this mechanism does not tend to produce a clinically significant response. The main mechanism of action is the genration of appetite suppression with effective report due to the increase in resting energy expenditure.

Anorectics can be divided on the basis of their mechansim of action into those like amphetamine and phenylethylamines which depress food intake by interacting with brain catecholamines among others.

Absorption It shows a dose-dependent pharmacokinetic profile. After oral administration of a dose of 15 mg, the maximal concentration was achieved after 6 hours and its bioavailability was not
affected by the consumption of high-fat meals (Garvey, 2013).

The reported plasma concentration at steady-state is of around 200 ng/ml as observed in clinical trials Volume of distribution. The reported volume of distribution for phentermine is reported to be of 5L/kg.

Protein binding

The protein binding of phentermine the main constituent is determined to be of 17.5%. Phentermine undergoes minimal p-hydroxylation, N-oxidation and N-hydroxylation followed by conjugation. The total proportion of the drug that goes under metabolism only represents about 6% of the administered dose where about 5% is represented by the N-oxidized and N-Hydroxylated metabolites.


The reported LD 50 after oral administration of phentermine in rats is reported to be of 151 mg/kg.

Reports of acute overdose include restlessness, tremors, hyperreflexia, rapid respiration, confusion, assaultiveness, hallucinations and panic state followed by fatigue, and depression.

In the cardiovascular system, there are reports of tachycardia, arrhythmia, hypertension, hypertension, circulatory collapse. In the gastrointestinal tract, there are symptoms of nausea, vomiting, diarrhea and abdominal cramps.

The management of acute overdosage includes symptomatic treatment as well as lavage and sedation with barbiturates. On the other hand, chronic overdosage is marked by dermatoses, insomnia, irritability, hyperactivity and personality changes.

In severe cases, it can derive into a schizophrenia-like psychosis. Studies regarding the carcinogenic potential have not been performed On the case of mutagenic assays, phentermine was shown to not be mutagenic nor clastogenic.

Phentermine Hydrochloride

Phentermine better known as phenyl-tertiary-butylamine, is marketed under many brand names and formulations worldwide, including Acxion, Adipex, Adipex-P, Duromine, Elvenir, Fastin, Ionamin, Lomaira (phentermine hydrochloride), Panbesy,Qsymia (phentermine and topiramate), Razin, Redusa, Sentis, Suprenza, and Terfamex. It is a medication used together with diet and exercise to treat obesity.

It has live metabolism with a half life of 25 hours(pH dependent) and excreted mainly through the urine. In such anorectic drug which imposes anorexia on the consumer, side effects such as fast heart beat, high blood pressure, insomnia and restlessness are common. Chemically,
phentermine is a substituted amphetamine.

Phentermine is used for a short period of time to promote weight loss, if exercise and calorie reduction are not sufficient, and in addition to exercise and calorie reduction. Phentermine is approved for up to 12 weeks of use and most weight loss occurs in the first weeks. However, significant loss continues through the sixth month and has been shown to continue at a slower rate through the ninth month.

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