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 Subject : Phentermine.. 02/20/2023 09:17:12 PM 
Zef Arroyo DO
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How long are you recommending stopping Phentermine prior to surgery? Have seen 4-7 days. However plastic surgeon worried about weaning Phentermine vs abrupt stoppage. Not a lot of literature about Phentermine withdrawal.

Thanks all for your insight.
 Subject : Re:Phentermine.. 02/20/2023 09:44:16 PM 
Dr. Yvonne Wagner M.D.
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I have always insisted on stopping it for 4-7 days due to the well-described risk of tachyarrythmias. For elective procedures it would be hard to defend going ahead if there was a problem of that kind.
 Subject : Re:Phentermine.. 02/20/2023 10:06:54 PM 
Leopoldo Rodriguez, MD, MBA, FAAAP, FASA, SAMBA-F
Posts: 53
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Sympathomimetic anorexiants should be stopped at least 5 days. but preferably 7 days.
Stephens LC, Katz SG. Phentermine and anaesthesia. Anaesth Intensive Care. Aug 2005;33(4):525-527.

In regards to withdrawal, it is extremely unlikely, "Phentermine abuse or psychological dependence (addiction) does not occur in patients treated with phentermine for obesity. Phentermine treatment does not induce phentermine drug craving, a hallmark sign of addiction. Amphetamine-like withdrawal does not occur upon abrupt treatment cessation even at doses much higher than commonly recommended and after treatment durations of up to 21 years."

"Abrupt cessation of long-term phentermine therapy does not induce amphetamine-like withdrawal. Long-term phentermine therapy does not induce phentermine cravings. Symptoms observed after abrupt phentermine cessation represent loss of therapeutic effect and are not withdrawal."
 Subject : Re:Phentermine.. 02/20/2023 11:19:15 PM 
Dr. Jean Sprengel M.D.
Posts: 12
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My understanding is that it takes 2 weeks for norepinephrine to get back up to 50% of normal levels after stopping phentermine. So that seems like a reasonable amount of time. However, does that suppose a starting level of zero? Not likely. So it’s a guessing game at best without good research. I just ask a lot of questions about how long they’ve been on it and how long off, then do my best. The only patients I have had BP trouble with have been those who didn’t stop and didn’t admit to taking it pre-op. They only confessed post-operatively after a roller coaster ride of an anesthetic.
 
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