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Orlistat
Aka: Orlistat, Xenical
Indication for Obesity Management Body Mass Index over 30 kg/m2Body Mass Index over 27 kg/m2 with comorbidityDiabetes Mellitus Hypertension Dyslipidemia
MechanismPentanoic acid ester binds gastric, pancreatic Lipase Lipase Inhibitor (Blocks Fat absorption)Decreased Triglyceride absorption Decreased Cholesterol absorption
PharmacokineticsMinimal systemic absorption
EfficacyCombined results of two large Placebo controlled trialsYear oneOrlistat: 9-10 kg loss (10% of baseline weight) Placebo : 6 kg (6% of baseline weight) Year twoOrlistat: 1.5-3 kg regained weight Placebo : 4-6 kg regained weight ReferencesSjostrom (1998) Lancet 352:167 Davidson (1999) JAMA 281:235
Adverse effectsGastrointestinal side effects (40%)Flatus with discharge Oily stool with spotting Fecal urgency Fecal Incontinence Abdominal Pain Fat soluble Carotenoid (fruit, vegetable) malabsorption Fat soluble vitamin malabsorption: No supplement neededVitamin A Vitamin D Vitamin E Vitamin K
Drug InteractionsDoes not interfere with absorption of other medicationsCoumadin Oral Contraceptive sAntihypertensives
DosingTake three times daily with each meal containing fat Prescription dose: 120 mg orally three times daily OTC dose: 60 mg orally three time daily
PrecautionsAvoid fat-soluble vitamins within 2 hours of Orlistat Maintain Dietary Fat intake <30% of calories
References(1999) Med Lett Drugs Ther 41(1055):55-6