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Because of its vintage, phentermine's patent expired decades ago and since then it has been sold under dozens of generic trade names.
Release timing: does the pill or capsule dissolve as fast as a sugar cube in water and suddenly release its medication or is the drug slowly released like, say, pain in a sponge?
Bioavailability: How much of the total drug that is inside the pill or capsule actually gets inside the blood stream? Phentermine hydrochloride versus phentermine base: Phentermine can come as a salt (hydrochloride) or in its "pure" basic form.
The point is that over the years, there have been a lot of different doses, release-formulations and bioavailabilities of phentermine and that point to this whole discussion is that sometimes I'll see a patient to who I dispense phentermine who tells me that the medication "feels" noting like it "used to" when that patient was prescribed it, say, decades ago.
One of the biggest misconceptions about fen-phen is that the risk derived from the COMBINATION of the two drugs.

A serotonin agonist is a drug that directly binds to a protein molecule found on the surface of heart cells (and other cells) that are called "serotonin receptors". If you require further details regarding the transaction data, please contact the supplier directly.
Phentermine is the most widely prescribed weight loss drug in human history and is also one of the most commonly prescribed drugs period. And when I say (or write) that I mean that it REALLY works, that it is not merely effective but also efficacious and in case you aren't sure what the difference is between effectiveness and efficacy, I have provided a fairly long explanation for you. The goal of all drug manufacturers is to approach 100% bioavailability but for various practical reasons, that isn't always possible. Indeed, this WAS the concern initially, but since then (1997) it has become clear that the risk was ONLY related to the fenfluramine in fen-phen and was specifically NOT related to the phentermine. I want to be clear here that a serotonin agonist like fenfluramine is NOT the same thing as a selective serotonin reuptake inhibitor like Prozac, Zoloft, Paxil and other antidepressant medications. As I indicated above, phentermine has been on the market in the US for over fifty years and it has been used around the world by tens of millions of human beings.

The fenfluramine and phentermine dose combination used in the studies became known as "The Weintraub Protocol" and became a huge "hit" around the country. Anyway, it turns out that nearly all drugs that function as serotonin agonists cause cardiac fibrosis which, among other things, causes valve damage in the heart.
Although phentermine, like all medications, caries some risks, those risks are very well understood and generally easily avoided through intelligent screening and prescription. What nobody knew at the time was the fenfluramine was a dangerous drug that should never have been on the market. And then all of a sudden, in just a couple years, fenfluramine went from being a drug taken by maybe a few thousand patients in the US to one taken by thirty million people. As probably everyone now knows, by the summer of 1997, it was clear that people taking fen-phen were at significant risk for developing heart valve damage.

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