Phentermine: A prescription drug for weight loss

ARTICLE OVERVIEW

Phentermine is a prescription drug used to treat obesity. It is intended for short-term use along with a diet and exercise plan to help obese or overweight individuals who have other risk factors (such as high blood pressure or diabetes) lose weight.

Service-specific and duty-specific policies regarding the use of phentermine and other anti-obesity medications (AOMs) are currently under review since outdated policies conflict with newer guidance and have proven confusing for healthcare providers and Service Members. Some guidance is outlined below, but Service Members should keep in mind that policies regarding the use of these drugs continue to change.

Can military doctors prescribe phentermine and other prescription medications for weight loss?

TRICARE covers certain AOMs such as phentermine or benzphetamine, without the need for prior authorization (PA). However, other AOMs such as Wegovy®, Contrave®, or Mounjaro® require PA and/or a medical necessity form.
The use of AOMs during training, deployments, or operational platforms might not be authorized. However, these medications might be allowed on a case-by-case basis depending on service-specific policies and provider recommendations.

Service Members who are overweight with other risk factors or obese should work with their Department of Defense (DoD) medical officer to determine if an AOM is appropriate for their specific health situation and to discuss potential operational, training, and deployment impacts before starting these medications.

Can civilian doctors prescribe AOMs to Service Members?

Civilian doctors who evaluate and treat Service Members for obesity or being overweight may prescribe AOMs, but they should be familiar with the TRICARE coverage algorithm.

Service Members should use their installation’s Medical Treatment Facility (MTF) providers whenever possible. These providers will be more knowledgeable about service-specific policies regarding AOMs, as well as any local controls that might exist. In the long run, using MTF providers could help prevent problems with going against policy.

What are the side effects of taking phentermine?

Common adverse reactions of phentermine include:

Diarrhea
Insomnia
Dizziness
Headache
Dry mouth
Constipation
Heart palpitations
Increased blood pressure

What are some important warnings about phentermine use?

Risk of abuse and dependence. Phentermine is chemically similar to amphetamines, which are stimulant drugs known for being abused. Because of this, there's a risk that phentermine could also be misused, and this should be considered when deciding whether to use it for weight loss.
Precautions for specific populations. Phentermine might not be safe for children or adults over the age of 65, individuals with renal (kidney) impairment, and women who are pregnant or breast feeding.

Why is phentermine on the DoD Prohibited Dietary Supplement Ingredients List?

Phentermine is on the DoD Prohibited Dietary Supplement Ingredients List because it is listed as a Schedule IV substance on the Drug Enforcement Administration (DEA) Controlled Substances List. Per DoDI 6130.06, § 3.2(b)(2)(c), “Controlled substances regulated in Sections 802 and 812 of Title 21, United States Code…” are prohibited.

However, as mentioned above, Service Members may be permitted to use phentermine as a prescription drug as long as they are following current policies and using the drug under the care of their healthcare provider.

Phentermine and drug testing

Service Members should ensure all their medications are recorded in their military health record and work with their military Primary Care Provider to ensure their record is updated to reflect any missing prescription medications.
Because phentermine is similar to amphetamine, it might register on an initial urine screening test for amphetamines. If this happens, the specimen goes through another analysis for confirmation.
Phentermine will not cause a positive result on the confirmation drug test or be reported as positive through the military drug-testing program.

Bottom line

Phentermine is a prescription medication, not a dietary supplement. It should only be used under the supervision of a qualified healthcare provider familiar with your medical history.
Service Members should ensure all their medications are recorded in their military health record.
Service Members and providers should periodically check with their command medical officers regarding any updated guidance about the use of AOMs.