What are the uses for orlistat?
- Orlistat is combined with a reduced-calorie
diet to promote
weight loss. - Orlistat also may be used to prevent
weight gain after weight has
been lost. - Candidates for treatment with orlistat are patients who are
obese
with a
body mass index (a measure of
obesity) of more than 30 kg/m2. - Candidates
also include patients with a body mass index of between 27 and 30 kg/m2 if other
risk factors for
arteriosclerosis are present such as
high blood pressure,
diabetes, and
elevated blood
cholesterol or
triglycerides. - Based on several
scientific studies, the average
weight loss that is achieved when orlistat is
taken as recommended for six months to one year is 12.4 to 13.4 pounds.
What brand names are available for orlistat?
Xenical, alli
Is orlistat available as a generic drug?
No
Do I need a prescription for orlistat?
Orlistat yes, Alli no
What are the side effects of orlistat?
The most common side effects of orlistat are:
- oily spotting on underwear,
- flatulence,
- urgent bowel movements,
- fatty or oily stools,
- increased number of bowel movements,
- abdominal pain or discomfort, and
- inability to control stool (incontinence).
From 1 in 250 and 1 in 70 patients experienced
one or more of these symptoms in the first year. Generally, the side effects
occurred within three months of starting therapy. In about 50% of patients, the
side effects resolved within one to four weeks, but the effects in some patients
lasted six months or longer. To reduce the occurrence of these side effects,
meals should contain no more than 30% fat because it is the unabsorbed fat that
causes most of the symptoms. alli causes fewer side effects because it contains
half the dose of prescription-strength orlistat. Patients receiving orlistat
with a history of oxalate kidney stones may develop increased levels of oxalate
in their urine, which may increase the risk of kidney stones.
Liver failure has been reported in patients treated with orlistat. Orlistat should be discontinued if symptoms of liver failure (loss of appetite, anorexia, itching, jaundice, dark urine,
light colored stools, or right upper abdominal pain) occur while taking orlistat.
Other serious side effects of orlistat include:
- Serious allergic reactions
- Angioedema
- Deficiency in fat-soluble vitamins
What is the dosage for orlistat?
- The recommended prescription dose for Xenical is one capsule (120 mg)
three times daily. - The recommended dose for alli is 60 mg three times daily.
- Orlistat should be taken one hour after or during a meal containing about 15 mg
of fat. Meals without fat do not require orlistat. - No additional benefit has
been shown when orlistat was taken in doses greater than 120 mg. - Patients should
eat a nutritionally balanced, reduced calorie
diet that contains approximately
30% of calories from fat. - alli includes an individually tailored online weight
loss support program.
Some dietary vitamins bind to fat (vitamins A, D, E and beta- carotene). When
orlistat is taken, these vitamins are not absorbed and are eliminated in the
stool in increased amounts along with the fat. Therefore, patients taking
orlistat should take a multivitamin containing these “fat-soluble” vitamins to
ensure that adequate amounts of the vitamins are available for absorption. To
ensure that the vitamins in the multivitamins are not bound to fat like the
vitamins in the diet, the multivitamin should be taken at least two hours before
or several hours after the orlistat.
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Which drugs or supplements interact with orlistat?
- The blood thinning effect of
warfarin (Coumadin,
Jantoven) depends
on the amount of
vitamin K in the body, and vitamin K is one of the vitamins
that binds to fat. Patients receiving warfarin who begin orlistat should have
their blood clotting monitored closely because the orlistat may cause levels of
vitamin K to decline. This will increase the effects of warfarin and lead to
abnormal bleeding from the warfarin. There is no evidence that a deficiency of
vitamin K occurs in patients who are taking orlistat. - Orlistat may reduce the absorption and blood levels of
cyclosporine
(Sandimmune) when both
drugs are administered together. Therefore, cyclosporine
should be administered two hours before or after orlistat, and more frequent
monitoring of cyclosporine levels may be needed. -
Hypothyroidism has been reported when orlistat and
levothyroxine (Synthroid,
Levoxyl,
Levothroid,
Unithroid) were
combined. Patients treated with both orlistat and levothyroxine should be
monitored for changes in
thyroid function. The orlistat and levothyroxine
should be taken at least four hours apart.
Is orlistat safe to take if I’m pregnant or breastfeeding?
- Safe use of orlistat during
pregnancy has not been established.
Therefore, orlistat is not recommended during pregnancy. - It is not known if orlistat is secreted in
breast milk.
Therefore, it probably should not be taken by
nursing mothers.
What else should I know about orlistat?
What preparations of orlistat are available?
Capsules: 60 mg (alli), 120 mg
(Xenical)
How should I keep orlistat stored?
Capsules should be stored at room temperature, 15 C – 30 C (59 F – 86 F)