1. (a)

   1. (1) An established APRN–patient relationship shall exist.

   2. (2) The patient shall:

      1. (A) Be age eighteen (18) or older; or
      2. (B) Have written consent from a parent or guardian.

   3. (3) The medication shall only be an adjunct to a comprehensive weight loss program focused on:

      1. (A) Appropriate nutrition education;
      2. (B) A change in lifestyle;
      3. (C) Counseling; and
      4. (D) An individualized exercise program.
   4. (4) The APRN shall determine whether or not the patient has made a substantial good faith effort to lose weight through diet and alteration of lifestyle prior to beginning drug therapy.

2. (b)

   1. (1) The treating APRN shall:

      1. (A) Take a complete history of the patient, including a detailed family history and dietary history; and
      2. (B) Perform a complete physical examination.

   2. (2) The physical examination shall include a minimum of:

      1. (A) Checking the blood pressure and pulse;
      2. (B) Examining the heart and lungs;
      3. (C) Recording height and weight; and
      4. (D) Administering any other appropriate diagnostic tests to evaluate for a metabolic disorder.

   3. (3) The history and examination shall be sufficient to determine if the patient has previously been drug dependent, to determine:

      1. (A) If there is a metabolic cause of the obesity that would make anorexiant drugs inappropriate; and
      2. (B) If there are other contraindications to use of anorexiant drugs exists.

3. (c)

   1. (1) The APRN shall discuss with the patient:

      1. (A) Different approaches to the treatment of obesity; and
      2. (B) The risks and benefits associated with each approach.
   2. (2) Risks shall include potential side effects, such as cardiovascular and pulmonary complications, as well as the potential for lack of success with weight loss.
   3. (3) The APRN shall be aware of potential drug interactions between anorexiants and other centrally acting drugs.

   4. (4) The treating APRN shall:

      1. (A) Prescribe a diet for weight loss and appropriate counseling regarding lifestyle change; and
      2. (B) Record these changes on the patient’s medical record.
   5. (5) Consideration on the use of anorexiant medications shall take into account the degree of overweight and associated medical conditions.
   6. (6) The body mass index (BMI) shall be used as a guide to determine the degree of overweight status.
   7. (7) In general, anorexiant medications shall only be used if the BMI is more than twenty-seven (27).

   8. (8)

      1. (A) In the case of associated obesity-related medical conditions, anorexiant medications may be considered with a BMI above twenty-five (25).
      2. (B) Obesity-related medical conditions include, but are not limited to:

4. (i) Diabetes;

   1. (ii) Hypertension;

      1. (iii) Dyslipidemia;

         1. (iv) Cardiovascular disease;
         2. (v) Sleep apnea;
         3. (vi) Psychological conditions;
         4. (vii) Disc disease; and
         5. (viii) Severe arthritis of the lower extremities.
         6. (d) The treating APRN shall prescribe a daily dosage that does not exceed the dosage recommended in the manufacturer’s prescribing information for the drug prescribed.

5. (e)

   1. (1) The APRN shall not prescribe more than a thirty-day supply for a patient at each visit, and regular follow-up visits shall not exceed thirty (30) days.
   2. (2) The patient shall be weighed at each visit prior to the prescribing of an additional supply of the drug.

6. (f)

   1. (1) At the time of each return patient visit, the treating APRN shall monitor progress of the patient.
   2. (2) The patient’s weight, blood pressure, pulse, heart, and lungs shall be assessed.
   3. (3) In addition to any side effects of the medications, the APRN shall perform appropriate exams and tests to monitor the safety of any weight loss.

   4. (4) This may include:

      1. (A) A detailed dietary questionnaire;
      2. (B) Serum electrolytes;
      3. (C) Blood glucose; and
      4. (D) Other tests deemed appropriate.
   5. (5) The APRN shall discontinue the anorexiant medications when the patient reaches weight loss goals.

   6. (6) These goals may be defined as:

      1. (A) A body weight that is no longer considered “obese” (e.g., BMI of less than or equal to twenty-seven (27)); or
      2. (B) An improvement in medical conditions (e.g., normalization of blood glucose).
   7. (7) After the goal is reached, the APRN may continue to prescribe anorexiant drugs for up to an additional sixty (60) days.

7. (g)

   1. (1) Except as otherwise provided by this part, Schedule III and/or Schedule IV anorexiant drugs are only recommended for short-term use (e.g., ninety (90) days).
   2. (2) In addition, anorexiant drugs shall not be prescribed to a patient with a BMI of less than twenty-seven (27), unless prescribing for obesity-related conditions with a BMI of above twenty-five (25).

   3. (3) The treating APRN may extend therapy beyond ninety (90) days under the following conditions:

      1. (A) When the anorexiant drugs are indicated for treatment of diseases other than obesity; and
      2. (B) When, in the APRN’s professional judgment, the treating APRN is assessing and recording significant progress or benefit from the drugs and no adverse effects occur that are related to the treatment.

Codification Notes: “APRN” means advanced practice registered nurse.