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The scenario where adding phentermine makes the strongest case is this: a patient on maximum tirzepatide dosing for at least 6 months, with a documented weight loss plateau lasting 8 or more weeks, who has optimized diet, exercise, sleep, and stress management, and whose provider has ruled out medical causes for the plateau (thyroid dysfunction, medication interactions, fluid retention)

Other designer drugs were prepared for the first time in clandestine laboratories

FDA approval in 2026 is considered unlikely (prediction markets put it at ~27%)

No mental math required

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