Diethylpropion HCI

 Actions Stimulates satiety center in brain, causing appetite suppression.

 Indications Short-term (few weeks) adjunct to diet plan to reduce weight.

 Contraindications Advanced arteriosclerosis; symptomatic cardiovascular disease; moderate to severe hypertension; hyperthyroidism; hypersensitivity to sympathomimetic amines; glaucoma; agitated states; history of drug abuse; concurrent with or within 14 days of MAOI use; coadministration with other CNS stimulants.

 Route/Dosage

ADULTS: PO 25 mg tid, 1 hr before meals. Sustained-release tablets: 75 mg once daily, in mid-morning.

 Interactions

Guanethidine: May decrease hypotensive effect. MAOIs, furazolidone: Hypertensive crisis and intracranial hemorrhage may occur. Selective serotonin reuptake inhibitors: Sympathomimetic effects of diethylpropion may be increased; increased risk of “serotonin syndrome.” Tricyclic antidepressants: May decrease anorexiant effect.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Palpitations; tachycardia; arrhythmias; hypertension; hypotension. CNS: Overstimulation; dizziness; insomnia; euphoria; tremor; headache. DERMATOLOGIC: Excessive sweating; flushing. EENT: Mydriasis; blurred vision. GI: Dry mouth; unpleasant taste; nausea; diarrhea; constipation; stomach pain. GU: Dysuria; urinary frequency; impotence; menstrual disturbances. HEMATOLOGIC: Bone marrow depression; agranulocytosis; leukopenia. OTHER: Hair loss; myalgia; gynecomastia; allergic reactions (eg, urticaria; rash; erythema).

 Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Children: Not recommended in children < 16 yr. Cardiovascular effects: May cause or aggravate hypertension or arrhythmias. Convulsions: Diethylpropion may aggravate; dose titration or discontinuance may be necessary. Drug dependence: Related to amphetamine; has abuse potential. Tolerance: Tolerance may occur.

 Administration/Storage

• Give medication 1 hr before meals. Give sustained-release tablets once daily at mid-morning.
• Do not crush or open sustained-release tablets.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess physical and psychological status throughout therapy.
• Measure patient’s weight weekly.
• Notify health care provider and withhold medication if there is a BP increase of 20 mm Hg or if heart dysrhythmia or increase in heart rate develop.

 Patient/Family Education

• Explain potential for increased agitation, palpitations, and dizziness, and identify precaution to take when performing tasks that require physical coordination or mental concentration.
• Tell patient to record weight weekly.
• Explain that drug will make patient feel less hungry and thus make it easier to adhere to diet but that weight loss will occur only with calorie reduction and increased physical activity.
• Instruct patient on missed medication procedure: if < 2 hr, take medication; if > 2 hr, wait until next scheduled dose. Do not double up on medication.
• Advise patient to limit intake of coffee, tea, cocoa, chocolate, and caffeinated soft drinks.
• Identify techniques to prevent or treat dry mouth.