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Benzphetamine

Benzphetamine is a sympathomimetic with pharmacological properties similar to amphetamines, primarily used as a short-term adjunct in the management of exogenous through suppression, in combination with a reduced-calorie and increased . Available as generic the salt in 25 mg and 50 mg oral tablets, it was approved by the U.S. in 1960 for patients aged 12 years and older with a of 30 kg/m² or greater who have not responded to appropriate non-drug interventions. As a Schedule III under the , benzphetamine carries a moderate potential for physical and , necessitating strict prescription controls. The mechanism of action involves binding to adrenergic receptors in the , particularly in the hypothalamic feeding center, which promotes the release of norepinephrine and to reduce hunger and increase metabolic rate. It is metabolized in the liver to active metabolites, including and , with a ranging from 16 to 31 hours and protein binding of 75-99%. Clinical studies indicate modest , typically a of a per week, with the greatest effects occurring in the initial treatment weeks, though may develop over time. Despite its efficacy in short-term use (generally a few weeks), benzphetamine is associated with significant risks, including cardiovascular effects such as palpitations, tachycardia, and elevated blood pressure, as well as central nervous system overstimulation manifesting as restlessness, insomnia, dizziness, and euphoria. Prolonged use beyond three months has been linked to serious adverse events like primary pulmonary hypertension (with a 23-fold increased risk) and valvular heart disease, prompting recommendations to discontinue therapy if weight loss is less than 4 pounds after four weeks. Contraindications include advanced arteriosclerosis, symptomatic cardiovascular disease, hyperthyroidism, glaucoma, and concurrent use with monoamine oxidase inhibitors, with precautions advised for patients with a history of drug abuse or psychiatric disorders.

Medical use

Indications

Benzphetamine is indicated for the short-term (a few weeks) management of exogenous obesity as an adjunct to caloric restriction as part of a weight reduction regimen that includes appropriate diet and exercise. It is specifically approved for use in patients aged 12 years and older with an initial body mass index (BMI) of ≥30 kg/m² who have not achieved adequate weight loss through non-pharmacologic measures alone, such as diet and physical activity. Patient selection emphasizes those for whom alternative weight management strategies have failed, and it is not intended for cosmetic weight reduction or long-term therapy, as tolerance to its appetite-suppressing effects typically develops over time, limiting sustained efficacy. In clinical trials, benzphetamine has demonstrated modest weight loss when combined with dietary restriction, with patients achieving an average additional reduction of approximately 2.5–3.3 kg compared to placebo over 12–17 weeks. However, weight loss plateaus after initial weeks, and most patients experience rebound weight gain to baseline levels upon discontinuation, underscoring the need for ongoing lifestyle interventions. Use is not recommended in children under 12 years due to lack of established and in pediatric populations.

Dosage and

Benzphetamine is available in oral tablet form in strengths of 25 mg and 50 mg. The recommended initial dose for adults is 25 to 50 mg administered once daily, preferably in the mid-morning or mid-afternoon, depending on the 's eating habits. Dosage should be individualized based on response and tolerance, with subsequent adjustments increasing the dose or frequency up to 25 to 50 mg one to three times daily, not exceeding a maximum of 150 mg per day. For elderly patients, dose selection should be cautious, typically starting at the lower end of the dosing range (25 mg once daily) due to the potential for decreased hepatic, renal, or cardiac function and concomitant disease or other drug therapy. In patients with renal impairment, no specific dosage adjustments are required, but caution is advised with close monitoring for adverse effects, as clearance may be altered. Doses should be titrated gradually based on efficacy and tolerability to minimize risks such as cardiovascular effects. Tablets should be swallowed whole with water and not crushed, chewed, or broken to ensure proper release and avoid potential overdose. Administration early in the day is preferred to reduce the risk of from its properties. Treatment should be discontinued if develops or if there is no satisfactory (at least 4 pounds) after 4 weeks of therapy at the maximum tolerated dose. During therapy, patients require regular monitoring, including and assessments at each visit, weight tracking to evaluate progress, and evaluation for signs of dependence or abuse every 2 to 4 weeks given its Schedule III status. Baseline cardiac evaluation is recommended, with ongoing checks for symptoms of or .

Adverse effects

Common side effects

Common side effects of benzphetamine, stemming from its stimulant properties, frequently include overstimulation, restlessness, , , , sweating, , dryness of the mouth, unpleasant taste, , , and other gastrointestinal disturbances. Additional commonly reported effects encompass , anxiety, , , nervousness, mood changes, and trouble sleeping. These adverse reactions typically manifest within the first week of treatment initiation and are generally mild and reversible. Many resolve spontaneously with continued use due to the development of tolerance or , or through dose reduction; however, some may persist if the dosage exceeds recommended levels, such as greater than 100 mg per day. Management of these effects focuses on supportive measures tailored to the symptom. For dry mouth, increasing fluid intake or using sugar-free lozenges can provide relief. may improve with adherence to sleep hygiene practices, such as avoiding late-day dosing and maintaining a consistent routine. Gastrointestinal issues like or can be addressed by incorporating and ensuring adequate hydration. Patients should report any persistent or bothersome side effects to their healthcare provider promptly, as adjustments may be necessary to continue effectively.

Serious adverse effects

Benzphetamine, like other agents, carries significant cardiovascular risks, particularly with prolonged use. It can cause , , and elevations in , which may exacerbate in susceptible individuals. More severe complications include primary , a rare but potentially fatal disorder associated with drugs; epidemiological studies indicate a 23-fold increased risk with use exceeding three months. has been reported with similar sympathomimetic agents, such as , though no cases have been specifically linked to benzphetamine monotherapy; the FDA recommends baseline cardiac evaluation to detect pre-existing valvular issues or before initiation. Isolated reports also describe and ischemic cardiac events, including potential , in patients with chronic use or predisposing factors. Psychiatric adverse effects are infrequent but can be profound, especially in overdose or extended . Rare instances of , including hallucinations and mania-like states, have occurred even at recommended doses, potentially resembling with chronic intoxication. Benzphetamine is a Schedule III controlled substance due to its potential for and , leading to severe social dysfunction; abrupt after high-dose use may precipitate extreme fatigue, mental depression, and changes in sleep patterns. Other serious reactions encompass in patients with cardiovascular risk factors and severe overdose manifestations. Overdose symptoms include restlessness, , , arrhythmias, fluctuating , hyperpyrexia, , seizures, and , with fatalities possible from acute . These events are rare, though the risk escalates in those with comorbidities or concurrent use.

Contraindications and precautions

Contraindications

Benzphetamine is contraindicated in patients with advanced , symptomatic , moderate to severe (systolic >140 mmHg or diastolic >90 mmHg), , , known hypersensitivity or idiosyncrasy to sympathomimetic amines, agitated states, or a history of drug abuse. It is also absolutely contraindicated during or within 14 days following the administration of monoamine oxidase inhibitors (MAOIs), due to the risk of . Additionally, benzphetamine should not be used concomitantly with other () . Use during is contraindicated due to risks of fetal harm, including teratogenicity and embryotoxicity observed in . Relative contraindications include mild , a history of , and Tourette's syndrome. Caution is advised in elderly patients owing to increased risks of falls and age-related declines in organ function that may heighten adverse effects. These contraindications stem from benzphetamine's sympathomimetic properties, which can exacerbate underlying conditions through elevated blood pressure, potential hypertensive crises, or cardiac events; in , the drug may increase via . Prior to initiating therapy, screening should include a baseline electrocardiogram (ECG) and ; treatment must not be started if any absolute is present.

Drug interactions

Benzphetamine, a sympathomimetic amine, exhibits significant drug interactions primarily due to its effects on monoamine neurotransmitters and cardiovascular parameters. Major interactions include those with monoamine oxidase inhibitors (MAOIs) such as , which can precipitate hypertensive crises through enhanced catecholamine release; concurrent use or administration within 14 days is contraindicated. Similarly, co-administration with serotonergic drugs like selective serotonin reuptake inhibitors (SSRIs) may potentiate the pharmacologic response to benzphetamine, increasing risks of jitteriness, nervousness, anxiety, restlessness, and . Sympathomimetics, including , amplify (CNS) stimulation, potentially leading to excessive sympathomimetic effects such as and . Moderate interactions involve antihypertensives like beta-blockers, where benzphetamine may counteract their hypotensive effects by stimulating norepinephrine release, necessitating and possible dose adjustments. Inhibitors of , such as clopidogrel—a minor metabolic pathway for benzphetamine—can prolong its by impeding N-demethylation, thereby increasing exposure and adverse effects. consumption exacerbates CNS depression and cardiovascular risks, including elevated and changes, advising caution or avoidance during . Minor interactions encompass urinary acidifying agents like ascorbic acid, which reduce benzphetamine absorption by promoting renal excretion, potentially diminishing efficacy. Comprehensive databases report 234 known drug interactions for benzphetamine, alongside 15 disease-related interactions and 3 involving or , underscoring the need for thorough prescriber review. Management strategies generally include avoidance of high-risk combinations, dose modifications for moderate interactions, and vigilant monitoring of when co-administered with stimulants or antihypertensives.

Pharmacology

Pharmacodynamics

Benzphetamine is an indirect-acting sympathomimetic with pharmacological activity similar to amphetamines, primarily exerting its effects through stimulation. It promotes the release of catecholamines, particularly norepinephrine from presynaptic neurons, and to a lesser extent , in the lateral hypothalamic feeding center, thereby suppressing by enhancing signals. This release occurs via reversal of the synaptic vesicular amine transporter (VMAT2), which facilitates the efflux of amines from storage vesicles into the and subsequently into the synaptic cleft. Additionally, benzphetamine inhibits the sodium-dependent (DAT), further elevating extracellular levels in the . The drug also acts as an at alpha-1A and alpha-2A adrenergic receptors, contributing to its sympathomimetic effects, including mild central stimulation and modest elevations in . Unlike serotonergic agents such as , benzphetamine does not significantly promote serotonin release, focusing its activity on noradrenergic and . This distinction limits its impact on -mediated side effects while targeting catecholamine-dependent appetite regulation. As a , benzphetamine undergoes hepatic to active metabolites, including and , which contribute substantially to its overall pharmacological profile and duration of action. Tolerance and develop rapidly with repeated use, typically within weeks, limiting long-term efficacy; this is attributed to downregulation of adrenergic receptors and adaptations in monoamine systems, though the exact mechanisms remain incompletely elucidated. In preclinical studies using models, benzphetamine reduces food intake through central catecholamine modulation, with effects potentiated by interactions such as co-administration, though specific quantitative reductions vary by dose and model. Benzphetamine does not significantly alter or nitrogen excretion, emphasizing its primary role in suppression over direct thermogenic mechanisms.

Pharmacokinetics

Benzphetamine is rapidly absorbed from the following , with peak plasma concentrations typically occurring within 1 to 3 hours post-dose. The drug exhibits high , allowing for effective systemic exposure. Pharmacokinetic data in humans are not available, with much information derived from animal studies or related compounds. Once absorbed, benzphetamine is widely distributed throughout the body, with a averaging 5 L/kg. It is highly lipid-soluble and readily crosses the blood-brain barrier, facilitating its effects. Plasma protein binding ranges from 75% to 99%. Benzphetamine undergoes extensive hepatic primarily via cytochrome P450 2B6, yielding active metabolites including d-methamphetamine and d-amphetamine. These metabolites undergo further demethylation and hydroxylation to form compounds such as p-hydroxyamphetamine. Elimination of benzphetamine occurs mainly through renal of metabolites, with only 5% to 30% of the parent excreted unchanged in the over 24 hours; this fraction is highly dependent on urinary , increasing under acidic conditions. The elimination of the parent compound is approximately 4 to 5 hours, while the active metabolites and have half-lives of approximately 10 hours and 12 hours, respectively (pH-dependent).

Chemistry

Chemical structure and properties

Benzphetamine, chemically known as (2S)-N-benzyl-N-methyl-1-phenylpropan-2-amine, is a synthetic derivative of featuring N-methyl and N-benzyl substitutions on the amino group. Its molecular formula is C₁₇H₂₁N, with a of 239.36 g/. The possesses a chiral center at the C2 position adjacent to the nitrogen atom, and the biologically active form is the dextro (S)-. It is typically administered as the salt to enhance and . The hydrochloride salt of benzphetamine appears as a white crystalline powder. It has a melting point of 129–130 °C. The compound is readily soluble in water and 95% , with the base form also soluble in organic solvents such as , , acetone, , and . Its calculated octanol-water partition coefficient () is 4.1, reflecting moderate that facilitates penetration into the . For stability, benzphetamine is stored in tight containers at controlled (15–30 °C) to maintain integrity.

Synthesis

Benzphetamine was first synthesized through N-alkylation of d-desoxyephedrine (also known as dextromethamphetamine ) with . The process, patented by The Company in 1957, involves liberating the of d-desoxyephedrine by treatment with , followed by reaction with in the presence of anhydrous at 120°C for 2 hours. The mixture is then extracted with , the solvent distilled, and the residue fractionally distilled under reduced pressure (127°C at 0.2 mmHg) to isolate the . The is formed by dissolving the base in and adding ethanolic , yielding white crystals with a of 129–130°C. This method preserves the (S)-configuration at the chiral center, as the starting material is the enantiopure (S)-. A scalable for benzphetamine hydrochloride, developed by and published in , improves upon the original by conducting the N- in an aqueous medium to enhance safety and efficiency under (GMP) conditions. hydrochloride is reacted with (1.1 equivalents) in at 75±2°C, using (3.0 equivalents) as a mild to facilitate the reaction over several hours. The reaction mixture is cooled, extracted with to isolate the , which is concentrated under , and then converted to the hydrochloride by with 10% HCl in at 10–15°C. The is crystallized directly from the mixture without additional purification steps, resulting in >99% purity by HPLC and effective control of impurities such as unreacted . This is optimized for large-scale production and avoids organic solvents during the alkylation step to minimize environmental impact. Enantioselective routes to (S)-benzphetamine have been explored to bypass reliance on controlled precursors like . One such method, reported in , employs electrophilic azidation of chiral enolates derived from an achiral equivalent, followed by reduction of the to the primary , N-benzylation with , and N-methylation via with and . Key conditions include lithium hexamethyldisilazide for enolate formation at -78°C and diphenyl phosphoryl as the azidating agent, achieving >99% enantiomeric excess for the (S)-. The overall yield for the sequence exceeds 40% over five steps, with final purification of the via HPLC or recrystallization to >98% purity. This approach maintains stereochemical integrity without and supports scalable synthesis for pharmaceutical applications. Benzphetamine hydrochloride for commercial use, such as in the brand Didrex, has been manufactured by (a of Inc.) at facilities compliant with GMP standards. Recent patents, including a 2010 application for high-purity crystalline forms (US 2010/0113831 A1), emphasize crystallization techniques from or isopropanol to further reduce impurities and improve , enabling yields of 70–80% in the final formation while meeting regulatory requirements for agents.

History

Development

Benzphetamine was developed in the early 1950s by chemists Richard V. Heinzelman and Brooke D. Aspergren at the Upjohn Company in , as part of an extensive search for analogs intended to serve as safer anorectics. The compound, chemically known as N-benzyl-N,α-dimethylphenethylamine, emerged from efforts to modify the structure to preserve appetite-suppressing effects while minimizing risks associated with traditional amphetamines, such as high abuse liability and excessive stimulation. This work was prompted by growing public health concerns over in the post-World War II era, when dietary habits and sedentary lifestyles contributed to rising prevalence, and amphetamines were widely prescribed for short-term despite their addictive potential. Pharmaceutical researchers, including those at , aimed to engineer derivatives that could support caloric restriction regimens without the pronounced euphoric or hyperstimulant side effects that limited broader clinical adoption of parent compounds like . Preclinical evaluations in animal models confirmed benzphetamine's anorexigenic activity, revealing it to be roughly one-third as potent as d-amphetamine in suppressing food intake over chronic dosing periods but approximately one-eighth as stimulating on motor activity in mice, suggesting a reduced propensity for central excitation. These findings established an initial characterization of the drug's profile, highlighting its potential as a balanced sympathomimetic for treatment. The core synthesis and pharmacological groundwork were documented in US Patent 2,789,138, filed on June 2, 1952, and granted on April 16, 1957, to the Upjohn Company; the patent outlined preparation via alkylation of d-desoxyephedrine with benzyl chloride and included early assessments of the compound's activity.

Regulatory approval

Benzphetamine hydrochloride, marketed under the brand name Didrex, received original approval from the U.S. Food and Drug Administration (FDA) on October 26, 1960, through New Drug Application (NDA) 12-427 held by Pharmacia & Upjohn Company. The approval was for 25 mg and 50 mg tablets indicated as a short-term adjunct in the management of exogenous obesity, for patients with an initial body mass index (BMI) ≥ 30 kg/m² who have not responded to appropriate weight-reducing regimens (diet and/or exercise) alone, as an adjunct to caloric restriction. In 1973, as part of the FDA's Drug Efficacy Study Implementation () program, the agency reviewed and confirmed the effectiveness of benzphetamine hydrochloride 25 mg tablets for the labeled indication, solidifying its regulatory standing post the 1962 Kefauver-Harris Amendments. Under the of 1970, benzphetamine was classified as a Schedule III effective May 1, 1973, reflecting its moderate potential for abuse relative to Schedule II substances but higher than Schedule IV. The prescribing information includes warnings regarding the risk of primary and , drawing from associations observed with appetite suppressants like and in the 1990s; however, no such cases have been reported with benzphetamine monotherapy. Baseline cardiac evaluation, including in patients with heart murmurs, is recommended prior to initiation, with discontinuation advised if new cardiac symptoms arise. Internationally, benzphetamine has seen limited adoption due to concerns over abuse potential and cardiovascular risks. In the , it is listed in Schedule IV of the 1971 and considered an obsolete pharmaceutical product in several member states. As of 2025, it remains available with restricted short-term prescribing but faces ongoing scrutiny amid evolving options.

Society and culture

Brand names

Benzphetamine was formerly marketed under the brand name Didrex in the United States, developed and originally distributed by (now part of ), and available in tablet formulations of 25 mg and 50 mg. The Didrex brand has since been discontinued, with the drug now available only in generic form. Other brand names in the US include Regimex and Recede, though Regimex has been discontinued. Internationally, benzphetamine has limited availability and is typically sold under its generic name, benzphetamine hydrochloride, or the International Nonproprietary Name (INN) benzfetaminum in select regions, with no major trade name variations reported outside . Generic versions of benzphetamine became available following the expiration of patents on the original Didrex formulation in the , allowing multiple manufacturers to produce it as benzphetamine hydrochloride tablets. As of 2025, generic producers include Avet Lifesciences, , Pharma LLC, Impax Laboratories, and KVK-Tech Inc. In the United States, benzphetamine is classified as a Schedule III controlled substance under the administered by the (DEA), a designation effective since June 15, 1973. This schedule reflects its moderate potential for physical and , lower than that of Schedule I and II substances but higher than Schedule IV and V, attributable in part to its hepatic metabolism into active metabolites including and . As a Schedule III drug, benzphetamine requires a prescription from a licensed healthcare provider and cannot be refilled without authorization; federal regulations allow up to five refills within six months, but clinical practice for appetite suppressants like benzphetamine typically mandates periodic re-evaluation to assess ongoing need and safety. It is not available over-the-counter anywhere in the world. Benzphetamine's abuse is regulated through state-based Monitoring Programs (PDMPs), which track dispensing of Schedule III-V controlled substances to detect patterns of misuse or diversion. It holds the distinction of being one of the few analogs classified as Schedule III, unlike most structurally related compounds placed in Schedule II due to higher abuse liability. Misuse or unauthorized distribution under the carries penalties including fines up to $250,000 and imprisonment ranging from up to one year for simple possession (first offense) to up to five years for trafficking. Internationally, benzphetamine is listed in Schedule IV of the 1971 [Convention on Psychotropic Substances](/page/Convention_on_Psychotropic Substances), subjecting it to controls on manufacture, trade, and distribution while permitting medical and scientific use under strict oversight. In , it is controlled as a Schedule I substance under the , prohibiting possession, trafficking, or production except for authorized medical purposes. The classifies it as a Class C under the , with penalties for unauthorized possession up to 2 years imprisonment and/or unlimited fines, and up to 14 years for supply or possession with intent to supply. In , it falls under Schedule 4 (prescription-only medicines) of the Poisons Standard, requiring authorization for import, supply, and possession. It is prohibited in under stimulant laws and similarly banned for non-medical use in as part of broader restrictions. As of 2025, prescribing of benzphetamine remains restricted following the expiration of broad flexibilities under the Ryan Haight Online Pharmacy Consumer Protection Act; while a temporary extension allows it until December 31, 2025, providers must conduct an in-person evaluation for new patients or meet specific exceptions to avoid violations.

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