Terfamex Overdose

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How long did you take this medication to work?

What happens if I overdose Terfamex?

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include confusion; diarrhea; fainting; hallucinations; irregular heartbeat; mental or mood changes (eg, depression); nausea; overactive reflexes; rapid breathing; restlessness; seizures; severe dizziness or headache; stomach cramps; tiredness; tremor; vomiting.

Proper storage of Terfamex orally disintegrating tablets:

Store Terfamex orally disintegrating tablets at room temperature, between 68 and 77 degrees F (20 and 25 degrees C), in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Terfamex orally disintegrating tablets out of the reach of children and away from pets.

Overdose of Terfamex in details

infoWhen a dose is taken in higher dose than the recommended doses, it is called Overdose. Overdose always needs a clinical supervision. Any medicine or drug when consumed in Overdose produces untoward side effects on one or various organs in the body. A medicine is excreted in the kidney or metabolized in the liver most of the times. This process goes without any hurdles when taken in normal dose, but when taken in an overdose, the body is not able to metabolize it or send it out properly which causes the effects of anoverdose.
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Manifestations of acute overdosage with Terfamex include restlessness, tremor, hyperreflexia, rapid respiration, confusion, assaultiveness, hallucinations, panic states. Fatigue and depression usually follow the central stimulation. Cardiovascular effects include arrhythmias, hypertension or hypotension, and circulatory collapse. Gastrointestinal symptoms include nausea, vomiting, diarrhea, and abdominal cramps. Fatal poisoning usually terminates in convulsions and coma.

Management of acute Terfamex intoxication is largely symptomatic and includes lavage and sedation with a barbiturate. Experience with hemodialysis or peritoneal dialysis is inadequate to permit recommendations in this regard. Acidification of the urine increases Terfamex excretion.

Intravenous phentolamine (REGITINE) has been suggested for possible acute, severe hypertension, if this complicates Terfamex overdosage.

What should I avoid while taking Terfamex?

Drinking alcohol can increase certain side effects of Terfamex.

Terfamex may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Terfamex warnings

infoWarnings are a mix of Precautions. Contraindications and interactions and serious harmful effects associated with the medicine intake. A diabetic or Hypertensive patient need to be warned about few drug interactions. A known hypersensitivity patient needs to be careful about the reactions or anaphylactic shock. A pregnant woman or a breastfeeding woman should be warned of certain medications. A Hepatitis [liver disease] patient or a cardiac patient should avoid few drugs.
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Coadministration With Other Drug Products for Weight Loss

Terfamex® is indicated only as short-term (a few weeks) monotherapy for the management of exogenous obesity. The safety and efficacy of combination therapy with Terfamex® and any other drug products for weight loss including prescribed drugs, over-the-counter preparations, and herbal products, or serotonergic agents such as selective serotonin reuptake inhibitors (e.g., fluoxetine, sertraline, fluvoxamine, paroxetine), have not been established. Therefore, coadministration of Terfamex® and these drug products is not recommended.

Primary Pulmonary Hypertension

Primary Pulmonary Hypertension (PPH) – a rare, frequently fatal disease of the lungs – has been reported to occur in patients receiving a combination of Terfamex with fenfluramine or dexfenfluramine. The possibility of an association between PPH and the use of Terfamex® alone cannot be ruled out; there have been rare cases of PPH in patients who reportedly have taken Terfamex 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.

Valvular Heart Disease

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 Terfamex with fenfluramine or dexfenfluramine for weight loss. The possible role of Terfamex 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 Terfamex® alone cannot be ruled out; there have been rare cases of valvular heart disease in patients who reportedly have taken Terfamex alone.

Development of Tolerance, Discontinuation in Case of Tolerance

When tolerance to the anorectant effect develops, the recommended dose should not be exceeded in an attempt to increase the effect; rather, the drug should be discontinued.

Effect on the Ability to Engage in Potentially Hazardous Tasks

Terfamex® may impair the ability of the patient to engage in potentially hazardous activities such as operating machinery or driving a motor vehicle; the patient should therefore be cautioned accordingly.

Risk of Abuse and Dependence

Terfamex® is related chemically and pharmacologically to amphetamine (d- and dll-amphetamine) and other related stimulant drugs that have been extensively abused. The possibility of abuse of Terfamex® should be kept in mind when evaluating the desirability of including a drug as part of a weight reduction program. See Drug Abuse and Dependence (9) and Overdosage (10).

The least amount feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage.

Usage With Alcohol

Concomitant use of alcohol with Terfamex® may result in an adverse drug reaction.

Use in Patients With Hypertension

Use caution in prescribing Terfamex® for patients with even mild hypertension (risk of increase in blood pressure).

Use in Patients on Insulin or

Oral Hypoglycemic Medications for Diabetes Mellitus

A reduction in insulin or oral hypoglycemic medications in patients with diabetes mellitus may be required.

What should I discuss with my healthcare provider before taking Terfamex?

Do not use Terfamex if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, and tranylcypromine.

You should not take Terfamex if you are allergic to Terfamex, or if you have:

  • a history of heart disease (coronary artery disease, heart rhythm problems, congestive heart failure, stroke);

  • a history of pulmonary hypertension;

  • severe or uncontrolled high blood pressure;

  • overactive thyroid;

  • glaucoma;

  • if you are pregnant or breast-feeding;

  • if you are in an agitated state;

  • if you have a history of drug or alcohol abuse; or

  • if you are allergic to other diet pills, amphetamines, stimulants, or cold medications.

Taking Terfamex together with other diet medications such as fenfluramine (Phen-Fen) or dexfenfluramine (Redux) can cause a rare fatal lung disorder called pulmonary hypertension. Do not take Terfamex with any other diet medications without your doctor's advice.

To make sure you Terfamex is safe for you, tell your doctor if you have:

  • high blood pressure;

  • diabetes;

  • kidney disease;

  • a thyroid disorder; or

  • if you are allergic to aspirin or to yellow food dye (FD & C Yellow No. 5, or tartrazine).

Terfamex may be habit forming. Never share Terfamex with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

FDA pregnancy category X. Weight loss during pregnancy can harm an unborn baby, even if you are overweight. Do not use Terfamex if you are pregnant.

Terfamex can pass into breast milk and may harm a nursing baby. You should not breast-feed while taking Terfamex.

Do not give this medication to a child younger than 16 years old.

Terfamex precautions

infoCertain people who are very sick or very old or who are sensitive show an exacerbation of side effect of the drug which can turn dangerous at times. So, it is very important to remember the precautions while taking the medicine. Pregnancy and Breastfeeding are also special categories wherein extra care or precaution is needed when taking a drug. Few patients may have a hypersensitivity reaction to few medications, and that can be life-threatening rarely. Penicillin hypersensitivity is one example. Diarrhea, rashes are few other symptoms which need a watch. A patient with other co-existing diseases like liver disease, heart disease, kidney disease should take special precautions.
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Coadministration With Other Drug Products for Weight Loss

Terfamex® is indicated only as short-term (a few weeks) monotherapy for the management of exogenous obesity. The safety and efficacy of combination therapy with Terfamex® and any other drug products for weight loss including prescribed drugs, over-the-counter preparations, and herbal products, or serotonergic agents such as selective serotonin reuptake inhibitors (e.g., fluoxetine, sertraline, fluvoxamine, paroxetine), have not been established. Therefore, coadministration of Terfamex® and these drug products is not recommended.

Primary Pulmonary Hypertension

Primary Pulmonary Hypertension (PPH) – a rare, frequently fatal disease of the lungs – has been reported to occur in patients receiving a combination of Terfamex with fenfluramine or dexfenfluramine. The possibility of an association between PPH and the use of Terfamex® alone cannot be ruled out; there have been rare cases of PPH in patients who reportedly have taken Terfamex 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.

Valvular Heart Disease

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 Terfamex with fenfluramine or dexfenfluramine for weight loss. The possible role of Terfamex 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 Terfamex® alone cannot be ruled out; there have been rare cases of valvular heart disease in patients who reportedly have taken Terfamex alone.

Development of Tolerance, Discontinuation in Case of Tolerance

When tolerance to the anorectant effect develops, the recommended dose should not be exceeded in an attempt to increase the effect; rather, the drug should be discontinued.

Effect on the Ability to Engage in Potentially Hazardous Tasks

Terfamex® may impair the ability of the patient to engage in potentially hazardous activities such as operating machinery or driving a motor vehicle; the patient should therefore be cautioned accordingly.

Risk of Abuse and Dependence

Terfamex® is related chemically and pharmacologically to amphetamine (d- and dll-amphetamine) and other related stimulant drugs that have been extensively abused. The possibility of abuse of Terfamex® should be kept in mind when evaluating the desirability of including a drug as part of a weight reduction program. See Drug Abuse and Dependence (9) and Overdosage (10).

The least amount feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage.

Usage With Alcohol

Concomitant use of alcohol with Terfamex® may result in an adverse drug reaction.

Use in Patients With Hypertension

Use caution in prescribing Terfamex® for patients with even mild hypertension (risk of increase in blood pressure).

Use in Patients on Insulin or

Oral Hypoglycemic Medications for Diabetes Mellitus

A reduction in insulin or oral hypoglycemic medications in patients with diabetes mellitus may be required.

What happens if I miss a dose of Terfamex?

infoWhen you miss a dose, you should take it as soon as you remember, but you should take care that it should be well spaced from the next dose. You should not take an extra dose at the time of the second dose as it will become a double dose. The double dose can give unwanted side effects, so be careful. In chronic conditions or when you have a serious health issue, if you miss a dose, you should inform your health care provider and ask his suggestion.

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.



References

  1. DrugBank. "phentermine". http://www.drugbank.ca/drugs/DB00191 (accessed September 17, 2018).
  2. MeSH. "Central Nervous System Stimulants". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).

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Information checked by Dr. Sachin Kumar, MD Pharmacology

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