Terfamex is an amphetamine that stimulates neurons to release or maintain high levels of a particular group of neurotransmitters known as catecholamines; these include dopamine and norepinephrine. High levels of these catecholamines tend to suppress hunger signals and appetite. The drug seems to inhibit reuptake of noradrenaline, dopamine, and seratonin through inhibition or reversal of the reuptake transporters. It may also inhibit MAO enzymes leaving more neurotransmitter available at the synapse. Terfamex (through catecholamine elevation) may also indirectly affect leptin levels in the brain. It is theorized that Terfamex can raise levels of leptin which signal satiety. It is also theorized that increased levels of the catecholamines are partially responsible for halting another chemical messenger known as neuropeptide Y. This peptide initiates eating, decreases energy expenditure, and increases fat storage.
Take Terfamex only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. If you take too much of Terfamex, it may become habit-forming (causing mental or physical dependence).
Terfamex is available in four forms: capsules, disintegrating tablets, extended-release capsules, and tablets. Carefully follow the dosing instructions for the form you are using.
Swallow the extended-release capsule whole. Do not crush, break, or chew it.
Take the disintegrating tablet with or without food. Make sure your hands are dry before touching the tablet. Place the tablet on the top of your tongue right after removing it from the bottle. It should melt quickly. After the tablet has melted, swallow or take a sip of water.
Carefully follow your doctor's instructions for a reduced-calorie diet plan and regular exercise. Talk with your doctor before starting an exercise program.
To avoid trouble with sleeping, take the last dose of the day about 4 to 6 hours before bedtime, unless your doctor tells you otherwise.
The dose of Terfamex will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of Terfamex. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
If you miss a dose of Terfamex, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.
Some brands of Terfamex should be taken on an empty stomach before breakfast or within 2 hours after breakfast.
Terfamex disintegrating tablets can be taken with or without food.
Using dry hands, remove the Terfamex tablet from the medicine bottle and place the tablet in your mouth. It will begin to dissolve right away. Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.
To prevent sleep problems, take this medication early in the day, no later than 6:00pm.
Talk with your doctor if you have increased hunger or if you otherwise think the medication is not working properly. Taking more of this medication will not make it more effective and can cause serious, life-threatening side effects.
Terfamex should be taken only for a short time, such as a few weeks.
Do not stop taking Terfamex suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using Terfamex.
Store at room temperature away from moisture and heat.
Keep track of the amount of medicine used from each new bottle. Terfamex is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.
Terfamex is a sympathomimetic amine with pharmacologic activity similar to the prototype drugs of this class used in obesity, amphetamine (d- and dll-amphetamine). Drugs of this class used in obesity are commonly known as “anorectics” or “anorexigenics.” It has not been established that the primary action of such drugs in treating obesity is one of appetite suppression since other central nervous system actions, or metabolic effects, may also be involved.
Typical actions of amphetamines include central nervous system stimulation and elevation of blood pressure. Tachyphylaxis and tolerance have been demonstrated with all drugs of this class in which these phenomena have been looked for.
In terms of rate and extent of exposure, Terfamex orally disintegrating tablets are equivalent to Terfamex capsules and tablets administered under fasting conditions.
Following the administration of the oral disintegrating tablet (ODT), Terfamex reaches peak concentrations (Cmax) after 3.0 to 4.4 hours. Swallowing the ODT after disintegration with or without water did not affect the extent (AUC) of Terfamex exposure.
Administration of the ODT after a high fat/high calorie breakfast decreased the Cmax of Terfamex by approximately 5% and the AUC by approximately 12%. Despite the decrease in Cmax and AUC, Terfamex ODT can be administered with or without food.
Swallowing the ODT without prior disintegration decreased the Cmax of Terfamex by approximately 7% and the AUC by approximately 8% compared to swallowing the ODT after disintegration.
In a single-dose study comparing the exposures after oral administration of a combination capsule of 15 mg Terfamex and 92 mg topiramate to the exposures after oral administration of a 15 mg Terfamex capsule or a 92 mg topiramate capsule, there is no significant topiramate exposure change in the presence of Terfamex. However in the presence of topiramate, Terfamex Cmax and AUC increase 13% and 42%, respectively.
Terfamex was not studied in patients with renal impairment. The literature reported cumulative urinary excretion of Terfamex under uncontrolled urinary pH conditions is 62%-85%. Exposure increases can be expected in patients with renal impairment. Use caution when administering Terfamex to patients with renal impairment.
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Information checked by Dr. Sachin Kumar, MD Pharmacology