Orlistat

Brand names of orlistat

  • Xenical

Orlistat is a drug that prevents digestion and absorption of fat from food and so promotes weight loss. An enzyme produced by the pancreas and called lipase breaks up food in the intestines for absorption by the body. The work that lipase does gets blocked when orlistat is given and so break up and absorption of fat is reduced by 25% of a meal and is not absorbed in the intestines. Fat that remains unabsorbed by the body passes out in the stool. Orlistat is a prescription drug approved by the FDA in 1999 whereas Alli a dose that is less potent than orlistat is sold over the counter and has been approved by the FDA in 2007 as a non-prescription drug.

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Orlistat belongs to the group of drugs known as lipase inhibitors. Orlistat is prescribed for overweight individuals who could also be suffering at the same time from high blood pressure, high cholesterol, heart disease or diabetes. It is also given to patients to continue to maintain the weight they may have lost so they do not regain weight. Alli as well as orlistat works best with an individualized exercise program along with a low fat low calorie diet to help people to lose weight.

Things you need to tell your physician before taking orlistat

Before you start on orlistat let your doctor know of your allergy to orlistat or any other medication if it should be so.

You should be alert to the fact that cyclosporine suppresses the immune system and should not be taken at the same time as orlistat. Neoral or Sandimmune (cyclosporine) should be taken 2 hours before or 2 hours after orlistat.

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Communicate particularly to the doctor if you are taking any anticoagulants for thinning the blood, such as warfarin (Coumadin), medications for controlling blood pressure and diabetes or if you are on insulin, also mention any thyroid medication or any other weight loss medication. Besides these mention also if you are taking non-prescription medicines and vitamins, nutritional supplements or any herbal substances besides the prescription drugs.

If the doctor knows before hand about any organ transplant you could have had or if you suffer from a condition known as cholestasis when the bile is blocked from flowing out of the liver or if you have problems absorbing food like a malabsorption syndrome then in all three instances the doctor would not prescribe orlistat to you.

Tell your doctor if you have ever suffered from eating disorders like anorexia, bulimia or nervosa or from diabetes, kidney stones, pancreatitis that is inflammation in the pancreas or gall bladder or thyroid disease.

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If you are pregnant or plan on getting pregnant or are breast feeding tell the doctor as he will then probably advise you not to take orlistat.

Usage

Orlistat is prescribed to those patients who have a BMI (Body Mass Index) of 30 or more and to those who have a BMI of 27 if they also suffer from diseases like diabetes, high blood cholesterol or high blood pressure. To achieve weight loss or weight maintenance then orlistat is used in conjunction with recommended physical exercise and a diet which has reduced calories. The diet as well as the exercise plan has to be approved by the doctor who could also recommend certain lifestyle changes and behaviour patterns in order to help the patient lose significant weight. Orlistat prevents weight gain and this helps to reduce obesity related health risks like heart disease, diabetes, high blood pressure, some forms of cancer, breathing problems and therefore a longer and better quality of life could accrue.

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Any food that contains fats is broken up in the intestines so it can be absorbed by the body and undigested fat passes out in the bowel movement. Orlistat works to block the break up of fat so more passes out of the body. However one draw back is that orlistat does not block calorie absorption from sugar or from non fat foods and that is why restriction in total intake of calories is required.

How to use orlistat

Closely follow the instructions given in the patient information booklet provided by the pharmacist before you begin taking orlistat and read the instructions with each refill. Address any questions to your pharmacist or doctor. Take the medicine orally with any liquid during each fat containing main meal or in one hour after a meal that will come to three times a day or follow the doctor's directions.

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In case you miss a meal miss the medication too and also if you have a diet that has no fat in it so that unpleasant side effects can be avoided. No more than 30% of the calories must come from fat in your meal and fat, protein and calorie intake should be spread out evenly in the three meals.

It is recommended that along with orlistat the patients must take a multivitamin supplement such as vitamins A, D, E, K as there could be interference with the absorption of these nutrients. The multivitamin should be taken either two hours before orlistat is taken or two hours after. In order that cyclosporine is fully absorbed by the bloodstream it also needs to be taken two hours prior to orlistat or two hours after and for levothyroxine the gap between the two medications should be at least 4 hours. Weight loss will be evident within two weeks after you first start orlistat and in case the weight remains static or you become worse contact the doctor.

How orlistat works

Lipases are intestinal enzymes that are required to digest fats from the diet. Orlistat impedes the work of lipases and so prevents the breakdown of some of the ingested fat. As the fat cannot be absorbed it is passed out of the body in feces. Fat absorption is reduced by 30% with a full dose of orlistat.

Side effects

Common
  • gas with discharge
  • oily stool
  • increased defecation
  • oily spotting
  • fecal urgency
  • anal leakage
  • fecal incontinence
Less common
  • abdominal pain or discomfort

Possible interactions

A variety of herbal products that promise weight loss are easily available. Some of these herbal medicines like ma huang (ephedra) are considered to be of potential danger. An herbal product in combination with orlistat is not recommended but consult your doctor if you wish to consider any herbal weight loss remedy. You could also ask your doctor about taking supplementary nutrients and vitamins (A, D, E, and K) as well as beta carotene.
Food should be taken according to the doctor's recommended portions and avoid food that tend to cause flatulence (gas formation) or have caused this problem earlier.

Discontinuation

Once orlistat is stopped fully then any medication whose dosage was altered when taken with orlistat should appropriately be changed again, according to the patient's need, especially medication like warfarin which is potentially toxic.

Storage instructions

Orlistat is best stored away from light and moisture and at room temperature of 77°F or 25°C. The medication should not be kept in the bathroom but it should be kept out of reach of children and pets. On expiry, the medicine should not be flushed down or poured into the drain, unless specified by the pharmacist or local waste disposal unit, who will guide you to its safe removal when consulted.

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