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Testosterone deficiency leads to endothelial dysfunction, and it may also be related to multiple mechanisms such as regulating endothelial progenitor cells (EPCs) and endothelium-derived vasoactive factors

In the same way, you want to avoid taking it if you need to be fully alert (like right before a road trip)

Overexpression of COX-2 is associated with tumour proliferation and invasion, inhibition of apoptosis, suppression of immune surveillance, and angiogenesis (Williams et al., 1999)

PMID: 205 LohrasbiPKarbalay-DoustSTabeiSMBAzarpiraNAlaeeSRafieeBet al

Other serious side effects of phentermine-topiramate include suicidal behavior and ideation and serious eye problems possibly leading to permanent vision loss (Vivus 2014)