Pediatric Healthy Lifestyles & Nutrition Toolkit | Page 48

Obesity Pharmacotherapy c.

Follow-up i. See patient monthly x 3 initially ii. Review BP, HR, cardiac exam, height, side effects, pregnancy risk at each visit iii. Check electrolytes at 3-6 months to monitor bicarbonate and regularly thereafter( serum CO2 >
17 is acceptable). iv. If patient is tolerating phentermine / topiramate ER 7.5mg / 46mg and desired weight loss not achieved, increase to 11.25mg / 69mg x 14 days, then 15mg / 92mg v. Dosage should be individualized to obtain desired response with the lowest effective dose. The minimum desired response is BMI stabilization in patients whose BMI had been trending upward before starting phentermine / topiramate ER vi. May experience irregular bleeding or spotting if also on OCPs due to interference with metabolism, do not discontinue OCPs. vii. If long-term therapy, also monitor bone density. viii. If BMI is not stabilized or does not decrease by ≥5 % in 3 months, consider:
1. Increasing dose ix. Adding a second medication such as a GLP1RA x. If patient has side effects, such as high blood pressure or neurological symptoms, consider decreasing dose d. Discontinue: i. If BMI continues to increase at full dose after 3-4 months, taper down prior to discontinuation
8.
Lisdexamfetamine( Vyvanse
)
a.
Patient Selection:
i.
FDA approval
1.
Youth ≥6 years old for attention deficit hyperactivity disorder( ADHD)
2.
Adults ≥18 years old for binge eating disorder( BED)
3.
Other Considerations
a.
Consider for patients:
i.
With ADHD
ii.
Impulsivity or impulsive eating
iii. Binge eating behaviors
ii.
CONTRAINDICATIONS
1.
Use of MAO inhibitors within 14 days
2.
Taking phentermine
iii. USE CAUTION
1.
High blood pressure
2.
History of congenital heart disease or pacemaker
b.
To Start Lisdexamfetamine:
i.
Dosage forms:
ii.
Capsules: 10,20,30,40,50,60, 70 mg, capsules can be opened and sprinkled on to food
iii. Chewable tablets: 10,20,30,40,50,60 mg. Check BP and HR, CV exam, height, pregnancy test
iv. Review side effects with patient and family: Anxiety, loss of appetite, nausea, diarrhea, trouble
sleeping, dizziness, upper stomach pain, dry mouth, vomiting, irritability, growth suppression
v.
Start lisdexamfetamine 20-30 mg QAM; if patient does not have diagnosis of ADHD, consider
using diagnostic code of“ impulsive”
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