Slimcare

Indications

Orlistat is used, together with a reduced-calorie, lower-fat diet, to help adults lose weight and keep it off when:

• Body mass index (BMI) is 30 or more, or
• BMI is 28 or more and there are weight-related health problems such as type 2 diabetes, high blood pressure or high cholesterol.

How It Works

Orlistat blocks lipase, an enzyme in the gut that breaks down fat from food. About a quarter to a third of the fat you eat is then not absorbed and passes out in the stool. This reduces the calories you take in. It works only on fat in food and does not reduce appetite.

Dosage and Administration

• Adults (prescription strength): 120 mg three times a day, taken with each main meal that contains fat, either during the meal or up to 1 hour after it.
• Lower-strength 60 mg capsules are also used, three times a day with meals.

If you miss a meal, or the meal contains no fat, skip that dose. Spread daily fat, carbohydrate and protein over three main meals, with about 30% of calories from fat. Take a multivitamin at bedtime (at least 2 hours after a dose) to replace vitamins A, D, E and K. If you have not lost at least 5% of your starting weight after 12 weeks, see your doctor about whether to continue. Not for children under 18 unless a specialist prescribes it.

Interactions

• Ciclosporin: levels may fall; doses should be separated and levels checked.
• Levothyroxine: take at least 4 hours apart; thyroid levels should be monitored.
• Warfarin: effect may change as vitamin K absorption falls; INR should be checked more often.
• Seizure medicines (antiepileptics): seizures have been reported; tell your doctor if your seizures change.
• HIV medicines (antiretrovirals) and Amiodarone: may be less effective.
• Diabetes medicines: weight loss can improve blood sugar, so doses may need lowering.
• Fat-soluble vitamins and beta-carotene: absorption is reduced.

Contraindications

• Allergy to orlistat.
• Long-term malabsorption syndrome (poor absorption of food from the gut).
• Cholestasis (reduced bile flow from the liver).
• Pregnancy and breastfeeding.

Side Effects

Common, especially after high-fat meals: oily spotting from the bottom, wind with oily discharge, urgent or frequent need to open the bowels, fatty or oily stools, loose stools, tummy pain and, sometimes, difficulty controlling the bowels. These lessen with a lower-fat diet. Headache and anxiety can also occur.

Get urgent medical help if you have:

• Signs of an allergic reaction (rash, swelling of the face or throat, difficulty breathing).
• Severe tummy pain, yellow skin or eyes, dark urine or pale stools (rare liver problems).
• Bleeding from the back passage.
• Severe pain in the side or back, or blood in the urine (possible kidney stones).

Pregnancy and Lactation

Do not use during pregnancy; weight loss is not advised in pregnancy. Do not use while breastfeeding, as safety is not known.

Precautions and Warnings

• Use with a healthy diet and more physical activity; the medicine alone is not enough.
• If you take hormonal contraceptive pills and get severe diarrhoea, use an extra method of contraception, as the pill may not be absorbed well.
• Tell your doctor if you have kidney disease or a history of kidney stones.
• People with diabetes may need their medicines adjusted.

Overdose

Single large doses are not expected to cause serious harm, but gut side effects are likely to be stronger. Seek medical advice if a large amount has been taken.

Therapeutic Class

Anti-obesity medicine (gastrointestinal lipase inhibitor).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Keep the container tightly closed.