Pharm

Orlistat

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Orlistat, Xenical

  • See Also
  1. Medications Associated with Weight Gain
  2. Lorcaserin (Belviq)
  3. Phentermine (Ionamin, Fastin)
  4. Phentermine and Topiramate (Qsymia, Qnexa)
  5. Obesity
  6. Obesity in Children
  7. Obesity Evaluation
  8. Obesity Measurement (or Obesity Screening)
  9. Obesity Risk (or Obesity Comorbid Conditions)
  10. Obesity Management
  11. Obesity Medication
  12. Dietary Supplements in Obesity
  13. Exercise in Obesity
  14. Obesity Resources
  1. Body Mass Index over 30 kg/m2
  2. Body Mass Index over 27 kg/m2 with comorbidity
    1. Diabetes Mellitus
    2. Hypertension
    3. Dyslipidemia
  • Mechanism
  1. Pentanoic acid ester binds gastric, pancreatic Lipase
  2. Lipase Inhibitor (Blocks Fat absorption)
    1. Decreased Triglyceride absorption
    2. Decreased Cholesterol absorption
  • Pharmacokinetics
  1. Minimal systemic absorption
  • Efficacy
  1. Weight loss is greater with 120 mg (7.5 lb or 3.4 kg) than with 60 mg (5.5 lb or 2.5 kg)
  2. Combined results of two large Placebo controlled trials
    1. Year one
      1. Orlistat: 9-10 kg loss (10% of baseline weight)
      2. Placebo: 6 kg (6% of baseline weight)
    2. Year two
      1. Orlistat: 1.5-3 kg regained weight
      2. Placebo: 4-6 kg regained weight
  3. References
    1. Sjostrom (1998) Lancet 352:167 [PubMed]
    2. Davidson (1999) JAMA 281:235 [PubMed]
  • Adverse effects
  1. Gastrointestinal side effects (40%)
    1. Flatus with discharge
    2. Oily stool with spotting
    3. Fecal urgency
    4. Fecal Incontinence
    5. Abdominal Pain
  2. Fat soluble Carotenoid (fruit, vegetable) malabsorption
  3. Fat soluble Vitamin malabsorption (daily MVI recommended in package insert)
    1. Vitamin A
    2. Vitamin D
    3. Vitamin E
    4. Vitamin K
  • Drug Interactions
  1. Does not interfere with absorption of other medications
    1. Coumadin
    2. Oral Contraceptives
    3. Antihypertensives
  • Dosing
  1. Take three times daily with each meal containing fat
  2. Prescription dose: 120 mg orally three times daily
  3. OTC dose: 60 mg orally three time daily
  • Precautions
  1. Avoid fat-soluble Vitamins within 2 hours of Orlistat
  2. Maintain Dietary Fat intake <30% of calories
  • References
  1. (1999) Med Lett Drugs Ther 41(1055):55-6 [PubMed]
  2. Erlandson (2016) Am Fam Physician 94(5): 361-8 [PubMed]