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Phentermine and Your Heart

Phentermine is the most commonly-prescribed weight loss pill in the United States ([trustedsource title=”Pub Med” content=”How physician obesity specialists use drugs to treat obesity (2009)” url=”https://www.ncbi.nlm.nih.gov/pubmed/19300434″]1[/trustedsource]). While most patients report only minor phentermine side effects, some people experience serious, potentially life-threatening reactions to the medication – including phentermine heart problems.

This article is intended for informational purposes only. We are not doctors and the information below does not in any way constitute or substitute a professional medical opinion. Always contact a licensed medical professional for medical advice.

Can Phentermine Cause Heart Problems?

Yes, phentermine can cause heart problems.

Two listed side effects of this medication are valvular heart disease and primary pulmonary hypertension: both critical cardiopulmonary problems.

Thankfully, these serious side effects are rare in patients taking phentermine alone. The medication more frequently causes other cardiovascular problems, such as increased (or irregular) heart rate or high blood pressure.

Recent evidence indicates that phentermine many also increase patients’ risk of coronary vasospasm.

For this reason, phentermine is only available under a doctor’s prescription & supervision and each patient must be evaluated individually before receiving a script for this medication.

Go to the hospital or contact your doctor immediately if you suspect any phentermine heart problems, or experience any of the systems listed at the end of this article.

Serious Phentermine Heart Problems

older woman clutching chest
Phentermine heart problems are a listed side effect of this medication

Valvular heart disease and primary pulmonary hypertension are two serious, heart-related side effects of phentermine. These complications were first identified in patients who took phentermine plus fenfluramine.

Fen-Phen (or Phen-Fen) was an off-label combination of these two medications that grew popular in the late 80s and early 90s and gained renown for its ability to help patients shed weight quickly and easily.

However, fenfluramine (and its more potent cousin: dexfenfluramine) was withdrawn from the market in 1997 after a prominent Mayo Clinic study linked use of Phen-Fen to an increased risk of pulmonary hypertension and heart valve disease ([trustedsource title=”The New England Journal of Medicine” content=”Valvular Heart Disease Associated with Fenfluramine–Phentermine (1997)” url=”https://www.nejm.org/doi/full/10.1056/NEJM199712113372414″]2[/trustedsource]).

While phentermine alone was never implicated in these reports, causative involvement cannot be ruled-out. As a result, these potentially-fatal conditions are still listed as side effects for any medication containing phentermine.

Phentermine Heart Valve Problems

The serendipitous discovery of a connection between Phen-Fen use and serious heart valve problems arose from informal communications between doctors at the Mayo Clinic and around the country in the mid-1990s.

The physicians noticed that 24 different female patients treated with Phen-Fen had developed leaky, misshapen and discolored valves after using the two weight loss medications for about one year. This was problematic because when a valve is leaky the heart has to work harder to pump the same amount of blood.

Depending on the degree of damage, leaky heart valves may be either repaired or replaced. In patients who required surgical intervention, surgeons noted heart valves had an atypical “glistening white appearance” ([trustedsource title=”The New England Journal of Medicine” content=”Valvular Heart Disease Associated with Fenfluramine–Phentermine (1997)” url=”https://www.nejm.org/doi/full/10.1056/NEJM199712113372414″]2[/trustedsource],[trustedsource title=”American Heart Association” content=”Problem: Heart Valve Regurgitation (2016)” url=”https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-heart-valve-regurgitation”]3[/trustedsource]).

Among the 113 Phen-Fen heart valve cases reported to the FDA in 1997, none of the affected patients took phentermine alone. This makes sense, given that the damage was eventually linked with activity of the 5-HT2b receptor on heart valves. Phentermine alone is not drawn to this receptor.

Notably, 16% of the affected patients had taken fenfluramine or dexfenfluramine alone, without phentermine ([trustedsource title=”CDC” content=”Cardiac Valvulopathy Associated With Exposure to Fenfluramine or Dexfenfluramine: US Department of Health and Human Services Interim Public Health Recommendations, November 1997″ url=”https://www.cdc.gov/mmwr/preview/mmwrhtml/00049815.htm”]4[/trustedsource]). As a result, fenfluramine and dexfenfluramine were withdrawn from the market, but phentermine remained available for pharmaceutical weight loss.

Below is the official warning about phentermine and heart valve problems as written on the Adipex-P drug label ([trustedsource title=”FDA” content=” Adipex-P (phentermine hydrochloride) capsules label (2012)” url=”https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/085128s065lbl.pdf”]5[/trustedsource]):

“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.”

Phentermine and Pulmonary Hypertension

woman laying in hospital bed
Phentermine heart problems can be serious, or even fatal

Eight of the twenty-four women in the initial Mayo Clinic report also presented with primary pulmonary hypertension (PPH) after taking Phen-Fen ([trustedsource title=”The New England Journal of Medicine” content=”Valvular Heart Disease Associated with Fenfluramine–Phentermine (1997)” url=”https://www.nejm.org/doi/full/10.1056/NEJM199712113372414″]2[/trustedsource]).

PPH is a rare condition in which the small blood vessels in the lungs narrow and force blood pressure to increase precipitously in the pulmonary artery: the vessel that carries blood from the heart to the lungs. It can be fatal if left untreated ([trustedsource title=”Johns Hopkins Medicine” content=”Primary Pulmonary Hypertension (PPH)” url=”https://www.hopkinsmedicine.org/healthlibrary/conditions/respiratory_disorders/primary_pulmonary_hypertension_85,P01322″]6[/trustedsource]).

A 2010 article suggested a link between phentermine monotherapy and the development of pulmonary hypertension, but these findings are not universally accepted ([trustedsource title=”Yonsei University” content=”Pulmonary hypertension associated with use of phentermine (2010)” url=”https://yonsei.pure.elsevier.com/en/publications/pulmonary-hypertension-associated-with-use-of-phentermine”]7[/trustedsource],[trustedsource title=”Pub Med” content=”RE: Pulmonary hypertension associated with use of phentermine? (2011)” url=”https://www.ncbi.nlm.nih.gov/pubmed/21786457″]8[/trustedsource]).

Below is the warning about primary pulmonary hypertension, as printed on the same Adipex-P drug label ([trustedsource title=”FDA” content=” Adipex-P (phentermine hydrochloride) capsules label (2012)” url=”https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/085128s065lbl.pdf”]5[/trustedsource]):

“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.”

Phentermine and Coronary Vasospasm

Although not listed on the medication’s official label, a 2019 case report from the Mayo Clinic suggests a potential link between phentermine use and increased risk of coronary vasospasm, especially in patients with a history of nicotine use or arthrosclerosis ([trustedsource title=”Pub Med” content=”Phentermine and Coronary Vasospasm-Induced Myocardial Infarction (2019)” url=”https://www.ncbi.nlm.nih.gov/pubmed/31272579″]9[/trustedsource],[trustedsource title=”Pub Med” content=”Coronary Vasospasm Induced by Phentermine (2019)” url=”https://www.ncbi.nlm.nih.gov/pubmed/31272562″]10[/trustedsource]).

Coronary vasospasm is the sudden narrowing of the blood vessels in the heart. It causes extreme chest pain that can feel like a heart attack, and may lead to further complications if left untreated (including heart attack).

Vasospasm is already a documented as potential reaction to other legal and illegal stimulant drugs – including amphetamines, which are chemically-similar to phentermine ([trustedsource title=”Harvard Health Publishing” content=”Coronary artery vasospasm (2019)” url=”https://www.health.harvard.edu/newsletter_article/coronary-artery-vasospasm”]11[/trustedsource]). So, speak with your doctor about this possible risk before starting phentermine.

Go to the hospital right away if you feel pain in your chest, left arm, jaw or back, or have any other heart attack-like symptoms, while taking phentermine.

Other Effects of Phentermine on the Heart

Serious phentermine heart problems are always possible, and very serious, but not as common other phentermine effects on the heart such as: racing pulse, increased blood pressure and irregular heartbeat.

In fact, almost 1 in 4 phentermine users reported some type of heart or blood pressure problem while taking this medication ([trustedsource title=”Unpublished raw data” content=”User Report of Common Phentermine Side Effects (2019)” url=””]12[/trustedsource]).

doctor taking a patient's pulse
A doctor will monitor your heart rate and rhythm during treatment with phentermine

Phentermine and Heart Rate

Increased blood pressure and tachycardia (fast heart rate) are listed side effects of phentermine ([trustedsource title=”FDA” content=” Adipex-P (phentermine hydrochloride) capsules label (2012)” url=”https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/085128s065lbl.pdf”]5[/trustedsource]).

A normal heart rate is 60-100 beats per minute, while optimal is blood pressure is around 120/80 mm Hg for the average adult ([trustedsource title=”Cleveland Clinic Heart & Vascular Team” content=”True or False? 6 Common Beliefs About Blood Pressure, Heart Rate (2018)” url=”https://health.clevelandclinic.org/6-myths-blood-pressure-heart-rate/”]13[/trustedsource]).

However, stimulant medications like phentermine can raise heart rate and blood pressure well above normal ranges. The pills’ effect on the heart are part of the reason that phentermine is not suitable for patients with cardiovascular disease or uncontrolled high blood pressure.

Interestingly, some recent research indicates that phentermine does not significantly increase heart rate or blood pressure when taken as prescribed ([trustedsource title=”Pub Med” content=”Blood pressure and heart rate effects, weight loss and maintenance during long-term phentermine pharmacotherapy for obesity (2011)” url=”https://www.ncbi.nlm.nih.gov/pubmed/21527891″]14[/trustedsource]).

Therefore, it is critical that the prescribing physician monitor heart rate and blood pressure throughout treatment. For some patients, it may also be beneficial to monitor heart rate and blood pressure at home between appointments.

Seek immediate medical attention if you show any signs of abnormally high heart rate or blood pressure while taking phentermine.

Phentermine and Heart Palpitations

Heart palpitations are another potential side effect of phentermine weight loss pills ([trustedsource title=”FDA” content=” Adipex-P (phentermine hydrochloride) capsules label (2012)” url=”https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/085128s065lbl.pdf”]5[/trustedsource]). A heart palpitation is when it feels like your heart is pounding, fluttering or skipping a beat.

Phentermine heart palpitations occur because, as a stimulant, this drug makes your heart more sensitive to electrical signals and may cause it to beat slightly outside of its normal rhythm. However, these palpitations may also indicate a more serious problem and can prove dangerous if not corrected ([trustedsource title=”Livestrong” content=”Heart Problems Caused by Phentermine” url=”https://www.livestrong.com/article/164815-heart-problems-caused-by-phentermine/”]15[/trustedsource]).

Call your doctor or seek medical attention right away if you feel like your heart is pounding, fluttering or beating irregularly while taking this medication.

Signs of Phentermine Heart Problems

Call your doctor or go to the hospital IMMEDIATELY if you suspect a phentermine heart problem or notice any of the following symptoms ([trustedsource title=”WebMD” content=”Phentermine Oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing (2019)” url=”https://www.webmd.com/drugs/2/drug-4151/phentermine-oral/details”]16[/trustedsource],[trustedsource title=”American College of Cardiology” content=”Phentermine (2011)” url=”https://www.cardiosmart.org/Healthwise/d008/06/d00806″]17[/trustedsource]):

  • Shortness of breath, even with only mild exertion
  • Chest pain
  • Lightheadedness or faintness
  • Swelling in your legs, ankles or feet (edema)
  • Pounding or irregular heartbeat, or fluttering in your chest
  • Slurred speech or weakness on one side of your body
  • Unusual thoughts or behavior, such as confusion, irritability, rage or hallucinations
  • Extreme happiness or sadness
  • Symptoms of dangerously high blood pressure, such as: severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats or seizures.

These symptoms can indicate a serious phentermine side effect. Seek professional medical attention immediately if you notice these or any other unusual reactions while taking phentermine.

Back to All Phentermine Side Effects

References
  1. Hendricks, E. J., Rothman, R. B., & Greenway, F. L. (2009). How Physician Obesity Specialists Use Drugs to Treat Obesity. Obesity, 17(9), 1730-1735. doi:10.1038/oby.2009.69
  2. Connolly, H. M., Crary, J. L., McGoon, M. D., Hensrud, D. D., Edwards, B. S., Edwards, W. D., & Schraff, H. V. (1997). Valvular Heart Disease Associated with Fenfluramine–Phentermine. New England Journal of Medicine, 337(24), 1772-1776. doi:10.1056/nejm199712113372414
  3. American Heart Association. (2016, May 31). Problem: Heart Valve Regurgitation.
  4. Centers for Disease Control and Prevention. (1997). Cardiac Valvulopathy Associated With Exposure to Fenfluramine or Dexfenfluramine: US Department of Health and Human Services Interim Public Health Recommendations, November 1997. JAMA: The Journal of the American Medical Association, 278(21), 1729. doi:10.1001/jama.1997.03550210025016
  5. U.S. Food and Drug Administration. (2012). Adipex-P (phentermine hydrochloride) capsules label [Brochure].
  6. Johns Hopkins Medicine. (n.d.). Primary Pulmonary Hypertension (PPH).
  7. Bang, W., Kim, J., Choo, S., Jang, J., Oh, C., Joung, B., & Chang, H. (2010). Pulmonary Hypertension Associated with Use of Phentermine. Yonsei Medical Journal, 51(6), 971-973. doi:10.3349/ymj.2010.51.6.971
  8. Hendricks, E. J., & Rothman, R. B. (2011). RE: Pulmonary Hypertension Associated with Use of Phentermine? Yonsei Medical Journal, 52(5), 869. doi:10.3349/ymj.2011.52.5.869
  9. Prasad, M., Sabbagh, A.E., Rihal, C., & Lerman, A. (2019). Phentermine and Coronary Vasospasm-Induced Myocardial Infarction. Mayo Clinic Proceedings, 94(7), 1374-1377. doi:10.1016/j.mayocp.2018.08.029
  10. Franke, K. B., & Psaltis, P. J. (2019). Coronary Vasospasm Induced by Phentermine. Mayo Clinic Proceedings,94(7), 1138-1140. doi:10.1016/j.mayocp.2019.05.021
  11. Harvard Health Publishing. (2010, June). Coronary Artery Vasospasm.
  12. Members of “Losing Weight with Phentermine” Support Group on Facebook & Phentermine.com Forum. (2019, March 13). [User Report of Common Phentermine Side Effects]. Unpublished raw data.
  13. Hendricks, E. J., Greenway, F. L., Westman, E. C., & Gupta, A. K. (2011). Blood Pressure and Heart Rate Effects, Weight Loss and Maintenance During Long-Term Phentermine Pharmacotherapy for Obesity. Obesity, 19(12), 2351-2360. doi:10.1038/oby.2011.94
  14. Cleveland Clinic Heart & Vascular Team. (2018, December 13). True or False? 6 Common Beliefs About Blood Pressure, Heart Rate.
  15. Nevins, P. (n.d.). Heart Problems Caused by Phentermine.
  16. WebMD. (2019). Phentermine Oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing.
  17. CardioSmart: American College of Cardiology. (2011, November 21). Phentermine.
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