Dear Dolly,

Let's first talk about the medication you have been using. Your second spelling is correct: it is called Phentermine. Phentermine is an amphetamine-like (chemically and pharmacologically similar to amphetamine) substance that is the principal ingredient found in several obesity treatment products available only with a prescription, such as Ionamin and Fastin. Although not yet established, Phentermine supposedly facilitates weight loss by suppressing appetite, stimulating the central nervous system, and enhancing metabolism. It is most commonly used in conjunction with another medication called Fenfluramine hydrochloride, which is available as Pondimin. You may hear people refer to this regimen as Fen-phen [as of September 15, 1997, this drug combination is no longer available as fenfluramine and dexfenfluramine have been taken off the market by their manufacturers, at the request of the U.S. Food and Drug Administration (FDA), for possibly causing heart valve damage]. Fenfluramine acts on the central nervous system as well; it, however, is a depressant. The two drugs are usually prescribed as follows: Phentermine is taken once a day in the morning before breakfast, and Fenfluramine is taken three times a day, one before each meal.

Alice must stress that the Fen-phen regimen can only be prescribed by a physician and must be used under medical supervision. These are drugs that may cause multiple side effects (e.g., elevated blood pressure, increased heart rate, dry mouth, unpleasant taste, constipation, diarrhea, nervousness, restlessness, dizziness, insomnia, tremors, headaches, itchy skin, and changes in libido). Furthermore, people with certain medical conditions (such as pre-existing moderate to severe high blood pressure, arteriosclerosis, glaucoma, or symptomatic cardiovascular disease), people who abuse drugs, or people who are overweight (rather than obese — Body Mass Index, or BMI, which is a ratio of weight in kg over height in m², greater than 25.0) should not use these drugs.

Besides the possible adverse effects and contraindications for use, Phentermine is used to treat obesity only for a brief period of time. Tolerance to the weight loss effect of Phentermine usually develops within a few weeks. When this occurs, Phentermine should no longer be used because the intensification of problems from adverse reactions greatly outweigh the potential for easier weight management or increased weight loss with continued use of Phentermine at higher than recommended doses (greater than 30 mg a day for Phentermine resin and greater than 37.5 mg a day for Phentermine hydrochloride). As a result, Phentermine is taken only for a few weeks along with a healthy diet and regular physical activity, and possibly other drug therapy in the treatment of obesity of non-genetic origin.

Alice is concerned about your long-term Phentermine use and misuse. As with all prescribed medications, you should not use medication that has been prescribed for someone else (Alice also wonders with or without your relative's knowledge and/or permission?). Phentermine also must be taken under the supervision of a doctor. Furthermore, since Phentermine is prescribed as a short-term treatment for obesity only, taking it to control long-term bulimia bingeing behavior is not a good idea.

How much and how often have you been taking Phentermine during the past three months? Considering you have been taking Phentermine for three months now, tolerance to Phentermine is eventual — any benefits you feel you have gained thus far from its use are temporary. In addition, doses in excess of recommended dosages (previously mentioned) will do much more harm than good to your body — look at the long list of potential adverse reactions! So, although your bulimic "routine" begins again when you are not taking the medication, Alice urges you to reconsider taking Phentermine. One caveat of which you should be aware of is that sometimes when people abruptly stop taking Phentermine after using it for a while, they may experience mental depression and extreme fatigue. Because of your history of bulimia, these possible side effects following a sudden end in long-term Phentermine use worries Alice all the more. If you feel that Phentermine does help you control your bulimia, please go to a physician or other health care professional for more information on Phentermine and other treatment options so that he or she can monitor you and your health after you make a more informed decision.

You say that you have been bulimic for over fifteen years now and that nothing has helped you except for Phentermine. Have you talked to a mental health professional or physician about your bulimia? If so, great! For many people with bulimia, there are personal issues unrelated to eating that lead them to become anorexic or bulimic. It is often not until these issues are addressed that recovery is possible. Bulimia is also not without its side effects, such as dental and gastrointestinal problems, and electrolyte imbalance. Alice hopes you have or will see a doctor for a check-up to make sure that your long-term bulimia has not created some serious health problems.

To repeat, Alice is concerned. She hopes that you will get some help soon so that you will be able to start having a healthy relationship with food and with your inner self. If you are a Columbia student, please go to Health Services (John Jay 3), contact the Eating Disorders Team private voicemail line at x4-1177, or call x4-2468 to schedule an appointment with an eating disorders specialist at Counseling and Psychological Services (CPS). Since some people have found support groups to be very helpful, also take advantage of the workshops, groups, presentations, and other resources available to you at Columbia through Counseling and Psychological Services and Alice!, Columbia University's Health Education Program. If you are not affiliated with Columbia University, try the The National Eating Disorders Association eating disorders information and referrals line at 1.800.931.2237, the Anorexia Nervosa and Related Eating Disorders, Inc. (ANRED), and/or Overeaters Anonymous (OA) at 505.891.2664 for more information on eating disorders and support groups.

Alice