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  • Phentermine-Effexor: Is it effective? An interview with Dr. Paul Rivas


    Posted by .(JavaScript must be enabled to view this email address)
    Saturday, January 08, 2005 5:15 am Email this article
    Paul Rivas, M.D. is an internist in the Baltimore area who is using the combination of phentermine and Effexor (venlafaxine) with good success. Larry Hobbs interviewed Dr. Rivas by phone.

    Hobbs: How many patients have you treated with Phen-Effexor?

    Rivas: About 500.

    Hobbs: What dose do you use?

    Rivas: A 37.5 mg caplet of phentermine given either once in the morning, or split between morning and afternoon. This combined with 37.5 mg of the extended-release Effexor—Effexor-XR. It can be taken either in the morning, or at night if a patient says that it makes them sleepy. Because it’s extended-release the timing of the Effexor doesn’t seem to matter that much.

    Hobbs: Do you prefer the extend-release?

    Rivas: Yes. The extended-release doesn’t cause the nausea like I saw with the immediate-release.

    Hobbs: How much weight loss have you seen?

    Rivas: Up to 75 or 80 pounds in some patients. In about a third of patients it works just great. Universally those patients say “It was like turning off a switch.” For the other two-thirds, it’s not as dramatic. They lose 20 or 25 pounds on average, but it’s still a struggle. The medicines help, but they don’t completely eliminate cravings.

    Hobbs: Do you think craving control is important?

    Rivas: Yes?very important. I think the major reason that most of my patients are overweight is because of sweet cravings, compulsive eating and appetite. Most of them have at least one, and some have all three. I believe that if you control these three things, patients will lose weight without any major changes in the rest of their diet.

    Hobbs: Is Effexor a serotonin reuptake inhibitor?

    Rivas: Actually it blocks both serotonin and noradrenaline reuptake, however it’s 5 times more potent at blocking serotonin reuptake.

    Hobbs: What other combinations have you tried?

    Rivas: Phen-Prozac, Phen-Zoloft, Phen-Serzone, Phen-Phendimetrazine and Phen-Wellbutrin.

    Hobbs: How does Phen-Effexor compare to Phen-Prozac or Phen-Zoloft?

    Rivas: I think they are equally effective, but I prefer the Effexor because it doesn’t cause sexual dysfunction, particularly delayed orgasm, that some patients complain about with Prozac. Secondly, patients don’t have a bias against Effexor like some do against Prozac.

    Hobbs: What did you find with Phen-Serzone?

    Rivas: The biggest problem was sleepiness. Patients complained of feeling tired and not being able to wake up. I couldn’t get around this. Even increasing the dose of phentermine didn’t seem to help.

    Hobbs: How effective was Phen-Phendimetrazine?

    Rivas: Ok, but not great. It’s somewhat better than phentermine alone, but not as effective as Phen-Effexor. But I found I could get the same effect by doubling the dose of phentermine, so I’ve stopped using phendimetrazine.

    Hobbs: How about Phen-Wellbutrin?

    Rivas: I’ve had very good success with it. I know that other physicians say that it doesn’t work, but it works for me. The only problem is that patients build up a tolerance after about two months. At that time I’ll switch them to something else and then switch back later.

    Hobbs: What patients do best with Phen-Wellbutrin?

    Rivas: Patients who haven’t responded to one of the serotonin reuptake inhibitors like Effexor or Prozac often do well with Phen-Wellbutrin. I’ve used it with about 50 patients.

    Hobbs: How much Wellbutrin do you use?

    Rivas: 150 mg of the sustained-release Wellbutrin-SR once or twice a day. But I make sure doses are spaced at least eight hours apart because there is a small increased risk of seizure that you need to be cautious about.

    Hobbs: What are the side effects with Phen-Effexor?

    Rivas: It increases migraines in patients who are prone to that. Other than that it’s just nuisance side effects like dry mouth, sleepiness or insomnia, but the last two can be controlled by changing the timing of the dose.

    Hobbs: What is your experience with Phentermine alone?

    Rivas: Phentermine is an excellent appetite suppressant, but it doesn’t control sweet cravings and compulsive eating which fenfluramine did. But I’ve found that adding the Effexor helps to take care of the sweet cravings and compulsive eating.

    Paul Rivas, M.D. can be reached at:

    Rivas Medical Weight Loss Program
    1205 York Rd
    Lutherville, MD 21093
    (410) 583-5677 phone
    (410) 583-5680 fax

     

    Articles on the same subject can be found here:


    COMMENTS

    On Mar 11, 2008 at 1:35 am joanna king wrote:

    . . . . .

    could you please tell me if there is a doctor in seattle wa. that will prescribe this medication?
    thanks
    Joanna

    On Mar 11, 2008 at 7:42 am Larry Hobbs wrote:

    . . . . .

    Two weight loss doctors in Seattle are listed on the American Society of Bariatric Physicians' website.

    I would call and to see what medicines they use.

    ----

    Craig Keebler MD
    Seattle, WA
    (206) 215-2908 phone

    -----

    Vernon Neppe MD, PhD
    Seattle, WA
    (206) 527-6289 phone

    ------

    The list os weight loss doctors in Washington is posted here:

    http://asbp.org/physicians/index.php?state=WA

    On Apr 26, 2008 at 6:07 am karen wrote:

    . . . . .

    can you tell me if there is a similar doctor in or near Hagerstown maryland
    thank you

    On Apr 26, 2008 at 7:37 am Larry Hobbs wrote:

    . . . . .

    Karen,

    It looks like he is about 50 miles away, but this is the doctor.

    Dr. Anchors is the one who discovered Phen-Pro, as he calls it, combining phentermine with serotonin reuptake inhibitors.

    Michael Anchors, MD, PhD
    16220 Frederick Rd Ste 210
    Gaithersburg, MD 20877
    (301) 990-6061 phone
    .(JavaScript must be enabled to view this email address)
    http://www.phenpro.com/

    On Oct 04, 2008 at 6:08 pm KJ wrote:

    . . . . .

    Can you tell me if any doctors in Memphis, Tn prescribe this combination?

    On Oct 04, 2008 at 8:08 pm Larry Hobbs wrote:

    . . . . .

    KJ,

    I don't know.

    I would suggest you check the website for the American Bariatric Society (ASBP) and call physicians in your area.

    Here is the link to their website:

    http://asbp.org/

    ---

    Click on "Locate a Physician" which will take you here:

    http://asbp.org/locate_physician.php

    ---

    Then click on your state.

    For Tennessee, it will take you here:

    http://asbp.org/physicians/index.php?state=TN

    ---

    Other combinations are also as effective.

    If it were me, I would first just try phentermine and see how well it works alone.

    Then, if necessary, I would add 100 mg of 5-HTP, a supplement which is converted into serotonin.

    L-Tryptophan converts into 5-HTP which then gets converted into sertonin.

    100 mg is the dose that the majority of doctors who use it give to their patients.

    Some doctors say it does not matter when the 5-HTP is taken, however, it makes the most sense to me to take the phentermine in the morning sometime, and the 5-HTP at maybe 5 or 6 PM to reduce night time eating.

    I am not a big fan of Effexor or other drugs that inhibit noradrenaline reuptake as part of their mechanism of action.

    My guess is that they cause the adrenals to atrophy / shrink and cause problems in the long run.

    I am not a fan of other SSRI's either, which includes Effexor as well as Prozac, Zoloft, etc, and believe that taking L-tryptophan or 5-HTP is much healthier and safer than taking an SSRI.

    On Oct 04, 2008 at 9:50 pm KJ wrote:

    . . . . .

    Thank you for the info, I will look into 5-HTP. I have used phentermine off and on; first being exposed to it during the phen-fen craze. I lost 15lbs in 3 weeks. I have not however, had any success with phentermine alone, it doesn't appear to affect my appetite and/or cravings at all. I have also noticed that I am an emotional eater and phentermine does not help with this either.

    On Oct 04, 2008 at 9:58 pm Larry Hobbs wrote:

    . . . . .

    KJ,

    You can also ask Michael Anchors, MD, PhD questions on the Discussion Forums on his website.

    http://www.phenpro.com/

    He invented Phen-Pro, combining phentermine with SSRI's.

    He also uses phentermine plus 5-HTP.

    -----

    You might also be interested in reading about phentermine combined with Zonegran.

    Dr. Jay Piatek has used more of this than anyone I know.

    Dr. Piatek says Zonegran is the new and improved Topamax, although some other doctors have told me they get better results with Topamax.

    He starts with a small dose of Zonegran and increases it very slowly to minimize side effects.

    Here is how Jay Piatek, MD uses it:

    http://fatnews.com/index.php/weblog/comments/896/

    -----

    Other articles about Zonegran are posted here:

    http://fatnews.com/index.php/weblog/C73/

    On Nov 25, 2008 at 5:27 pm KJ wrote:

    . . . . .

    I haven't seen much on the internet related to phentermine and tofranil. Is this a likly combo?

    On Jul 02, 2010 at 10:00 am Mary Carlsson wrote:

    . . . . .

    How well does Pristiq work with Phentermine?

    On Jul 02, 2010 at 10:57 am Larry Hobbs wrote:

    . . . . .

    Mary,

    I would ask Michael Anchors, MD, PhD in his Discussion Forum on PhenPro.com.

    He has lots of experience with using phentermine with SSRI's and drugs like Pristiq.

    He can tell you if it works or not, or what he prefers instead.

    Here is the link to his website:

    http://www.phenpro.com/

    On Feb 28, 2011 at 10:41 am Edy wrote:

    . . . . .

    I am about to start taking Phentermine with Effexor XR 150. I have read online where these drugs MAY interact..considered a Major Interaction on drugs dot com...yet it seems you have had success with your patients. Would you consider these does of these 2 medications safe to take together? Thank you!

    On Feb 28, 2011 at 10:57 am Larry Hobbs wrote:

    . . . . .

    Edy,

    I would suggest that you ask Michael Anchors, MD PhD in his Discussion Forum on PhenPro.com.

    http://www.phenpro.com

    The Discussion Forum link is on the left.

    He has used SSRI's with phentermine with thousands of patients over the past 14+ years.

    He is the best one to give you advice on this.

    Please feel free to share your comments about this article.


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