Orlistat Brand Name– alli | Xenical
What is Orlistat
Orlistat is a gastrointestinal lipase inhibitor. It is used by prescription (Xenical) as an adjunct to lifestyle modifications for weight loss and chronic weight management in adults and pediatric patients 12 years and older.
A low-dose non-prescription product (Alli) is available for overweight adults.
Orlistat can produce a mean weight loss of approximately 4% and can reduce the risk for weight regain in chronic use.
Modification of some cardiovascular risk factors in obese patients after 1 year of treatment have been noted.
Unlike other weight loss medications, orlistat works non-systemically, blocking the absorption of dietary fat.
The non-systemic action of orlistat can be beneficial in obese patients with conditions such as cardiovascular disease, renal disease, or substance abuse; however, treatment is associated with significant gastrointestinal side effects (loose/oily stools, flatulence, fecal urgency) that can affect treatment adherence, limiting the utility of the drug for chronic weight management.
Because orlistat reduces the absorption of fat-soluble vitamins, a daily multivitamin containing fat-soluble vitamins (i.e., vitamins A,D,E,K) is recommended during therapy.
According to the American Association of Clinical Endocrinologists and American College of Endocrinology (AACE/ACE) Obesity Clinical Practice Guidelines, weight loss medications should be offered as chronic treatment along with lifestyle modifications to patients with obesity when the potential benefits outweigh the risks.
Short-term pharmacotherapy has not been shown to produce longer-term health benefits and cannot be generally recommended.
A generalized heirarchy for medication preferences that would be applicable to all obese patients cannot currently be scientifically justified. Individualized weight loss pharmacotherapy is recommended, based upon factors such as the specific characteristics of each weight loss medication, the presence of weight-related complications, and the medical history of the patient.
In pediatric patients, orlistat remains the only FDA-approved medication for weight loss; pharmacotherapy is usually reserved for pediatric patients with a BMI at the 95th percentile or more.
Pharmacotherapy for overweight children (BMI 85th to 94th percentile) should be reserved for those with significant, severe comorbidities who have not responded to lifestyle modification.
Orlistat was initially approved by the FDA in 1999 as a prescription product; the reduced-dose non-prescription status was attained in 2007.
Indications
- obesity
- weight management
For the treatment of obesity and for chronic weight management as an adjunct to a reduced-calorie diet and lifestyle modification
Side Effects
- abdominal pain
- anaphylactoid reactions
- angioedema
- anxiety
- back pain
- bronchospasm
- bullous rash
- cholelithiasis
- depression
- diarrhea
- dizziness
- edema
- elevated hepatic enzymes
- fatigue
- fecal incontinence
- fecal urgency
- flatulence
- headache
- hepatic failure
- hepatic necrosis
- hepatitis
- hypoglycemia
- hypothyroidism
- hypovitaminosis
- increased defecation
- infection
- maculopapular rash
- menstrual irregularity
- musculoskeletal pain
- myalgia
- nausea
- pancreatitis
- pruritus
- purpura
- rash
- seizures
- steatorrhea
- urticaria
- vaginitis
- vasculitis
- vitamin D deficiency
- vomiting
Monitoring Parameters
- growth rate
- weight
Contraindications
- anorexia nervosa
- anticoagulant therapy
- bariatric surgery
- breast-feeding
- bulimia nervosa
- children
- cholelithiasis
- cholestasis
- diabetes mellitus
- gallbladder disease
- geriatric
- heart failure
- hepatic disease
- hepatitis
- hepatotoxicity
- human immunodeficiency virus (HIV) infection
- hypothyroidism
- infants
- malabsorption syndrome
- malnutrition
- nephrolithiasis
- organ transplant
- pancreatitis
- pregnancy
- renal disease
- renal failure
- renal impairment
- schizophrenia
- seizure disorder
Interactions
- Abacavir
- Abacavir; Dolutegravir; Lamivudine
- Abacavir; Lamivudine, 3TC
- Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
- Acitretin
- Albiglutide
- Alogliptin
- Alogliptin; Metformin
- Alogliptin; Pioglitazone
- Alpha-glucosidase Inhibitors
- Amiodarone
- Amprenavir
- Apixaban
- Aspirin, ASA; Pravastatin
- Atazanavir
- Atazanavir; Cobicistat
- Bexarotene
- Bictegravir; Emtricitabine; Tenofovir Alafenamide
- Canagliflozin
- Canagliflozin; Metformin
- Cranberry, Vaccinium macrocarpon Ait.
- Cyclosporine
- Dabigatran
- Dalteparin
- Dapagliflozin
- Dapagliflozin; Metformin
- Dapagliflozin; Saxagliptin
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Delavirdine
- Didanosine, ddI
- Dipeptidyl Peptidase-4 Inhibitors
- Dolutegravir; Lamivudine
- Doravirine; Lamivudine; Tenofovir disoproxil fumarate
- Dulaglutide
- Edoxaban
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Empagliflozin
- Empagliflozin; Linagliptin
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Emtricitabine
- Emtricitabine; Rilpivirine; Tenofovir alafenamide
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Emtricitabine; Tenofovir alafenamide
- Emtricitabine; Tenofovir disoproxil fumarate
- Enoxaparin
- Entecavir
- Ertugliflozin
- Ertugliflozin; Metformin
- Ertugliflozin; Sitagliptin
- Etravirine
- Exenatide
- Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
- Fondaparinux
- Fosamprenavir
- Glimepiride; Pioglitazone
- Glimepiride; Rosiglitazone
- Glipizide; Metformin
- Glyburide; Metformin
- Heparin
- Incretin Mimetics
- Indinavir
- Insulin Degludec; Liraglutide
- Insulin Glargine; Lixisenatide
- Insulins
- Isotretinoin
- Lamivudine, 3TC
- Lamivudine, 3TC; Zidovudine, ZDV
- Lamivudine; Tenofovir Disoproxil Fumarate
- Levothyroxine
- Levothyroxine; Liothyronine (Porcine)
- Levothyroxine; Liothyronine (Synthetic)
- Linagliptin
- Linagliptin; Metformin
- Liothyronine
- Liraglutide
- Lixisenatide
- Lopinavir; Ritonavir
- Lorcaserin
- Meglitinides
- Metformin
- Metformin; Pioglitazone
- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Nelfinavir
- Nevirapine
- Non-nucleoside reverse transcriptase inhibitors
- Nucleoside reverse transcriptase inhibitors
- Ombitasvir; Paritaprevir; Ritonavir
- Phentermine
- Phentermine; Topiramate
- Phytonadione, Vitamin K1
- Pioglitazone
- Pramlintide
- Pravastatin
- Propafenone
- Protease inhibitors
- Ritonavir
- Rivaroxaban
- Rosiglitazone
- Saquinavir
- Saxagliptin
- Semaglutide
- SGLT2 Inhibitors
- Simvastatin; Sitagliptin
- Sitagliptin
- Stavudine, d4T
- Sulfonylureas
- Telbivudine
- Tenofovir Alafenamide
- Tenofovir Alafenamide
- Tenofovir, PMPA
- Thiazolidinediones
- Thyroid hormones
- Tinzaparin
- Tipranavir
- Tretinoin, ATRA
- Triheptanoin
- Vitamin A
- Vitamin D
- Vitamin D analogs
- Vitamin E
- Vitamin E
- Warfarin
- Zalcitabine, ddC
- Zidovudine, ZDV
