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Reliable online pharmacy phentermine is not as effective an oral medication for narcolepsy, a disease that is characterized by excessive daytime sleepiness.1,2,2,7 Although phentermine has been studied in a number of clinical trials, it has not received general commercial approval in this indication and the risk of adverse events is higher than for oral preparations of the same drug.6,8 This study aimed, through a pooled analysis of data from 4 randomized controlled trials, to evaluate whether phentermine and an oral methylphenidate were similarly effective in treating narcolepsy. We hypothesized that the combination of two treatments would provide a superior outcome and were also interested in comparing the adverse event profiles between 1:1 combination and a 2:1 of methylphenidate phentermine. Methods Study Design A total of 4 randomized, double-blinded, placebo-controlled trials, 2 with 5- to 7-year follow-up, included approximately 2500 patients with narcolepsy recruited in 6 countries (Australia, Canada, China, Egypt, Nigeria, and South Africa). The trials were conducted in United States and Kingdom 2004 2004, respectively.9–12,13,14 The 6 studies were well designed with 2 primary comparisons involving the administration of phentermine (50 mg/day) combined with methylphenidate to patients who were not treated with either drug alone. We analyzed the data in patients who underwent ≥1 treatment, as there was considerable attrition over time. Searches for published systematic reviews, case series, and unpublished data were conducted in order to identify relevant studies. In addition, we identified relevant reports relating to the design of trials and data regarding the patients at baseline and during the first 3 months. We performed the data extraction, primary analyses, and discussion of the results in collaboration with relevant investigators (Table 1). We also carried out a sensitivity analysis of the data in order to assess the effect of missing data. All analyses were carried out with the use of IBM SPSS software. Results Fourteen comparisons between phentermine and methylphenidate were found, only a few not significantly better for any treatment group relative to the 2:1 combination. In 7 comparisons, phentermine What is the penalty for drug trafficking in canada was superior to methylphenidate and in 3 comparisons it was comparable with the 2:1 combination (P <.05) (Table 1 and Figure 1). Sensitivity Analysis In the analyses of data for patients who underwent single or double (compared with 3:4 combination) phentermine and methylphenidate treatments, there were significant differences (P≤.01, compared with placebo) on measures of alertness and daytime sleepiness. The results Phentermine 37.5mg 30 pills US$ 170.00 US$ 5.67 of this analysis have been included as a sensitivity analysis in addition to all comparisons (eg, using get prescription online phentermine 37.5 combination of 2:1 and 2:3 phentermine or combined with oral methylphenidate) in the published article (Cunningham et al).19 Safety Studies There were no serious adverse events during the study (1 case of sleepwalking, 1 nausea and vomiting, 2 cases of diarrhea, both asymptomatic), and there were no discontinuations because of adverse events. There were 4 patients who experienced sleep-related serious or life-threatening adverse events (hypothermia hypotension in 2 instances, and pneumonia, both asymptomatic) to which it was impossible provide a sufficient explanation. One of these patients had a history of excessive consumption alcohol; this history could not be excluded when the clinical details (eg, dose, timing, and the reason for ingestion) were examined to exclude the possible effect of other factors. Also it could be reasonably argued that online pharmacy that sells phentermine this individual could be regarded as at higher risk, based on the history and other characteristics of the patient. No patient reported an increased or decreased appetite energy during the study. Clinical Trials Review The main strengths and weaknesses of the studies presented in this review are summarized Table 2. It was evident that some studies had smaller sample sizes than those of some other studies. In cases differences were noted between the individual studies and pooled data. The data presented in Table 2 phentermine 37.5 order online and Figure 1 are generally consistent, in that 1:1 (methylphenidate:phentermine) compared with 2:1 (methylphenidate:phentermine and phentermine) provided a superior outcome. Sensitivity Tests The analyses of data for patients who were not included in any of the trials should be interpreted with caution. A sensitivity analysis using subset of patients from one study (which was reported for the comparison between methylphenidate and phentermine) provided additional evidence that the dose-response pattern (ie, 1∶2∶1∶2; methylphenidate:phentermine) was consistent and that.
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