Alli (orlistat) is an over-the-counter drug designed for overweight adults who are looking to lose weight. It's a 60-milligram version of the prescription drug Xenical (orlistat), which comes in 120-milligram doses. Both medications work by reducing the amount of dietary fat absorbed by the body. While Alli can aid in weight loss, it's essential to understand its potential side effects and risks.
How Alli Works
The active ingredient in Alli, orlistat, inhibits lipase, an enzyme in the digestive tract responsible for breaking down dietary fat. By blocking lipase, orlistat prevents about 25% of the fat consumed from being broken down and absorbed. This unabsorbed fat is then eliminated from the body through stool.
Alli is available in 60mg capsules and is sold over-the-counter. Like Xenical, Alli is also taken with meals that contain fat. The total daily dose of Alli is 120mg. Xenical is usually taken three times a day with meals that contain about 30% of their calories from fat. The total daily dose of Xenical is 360 mg. The capsule should be taken with water.
Potential Benefits of Orlistat
- Weight Loss: Orlistat can help individuals lose weight by reducing the absorption of dietary fats, leading to a decrease in calorie intake. In some studies, more than 40% of people taking Alli while following a calorie-restricted diet and increasing physical activity lost 5% or more of their body weight within a year.
- Lower Cholesterol Levels: Orlistat may help reduce levels of total cholesterol and low-density lipoprotein (LDL) cholesterol.
- Diabetes Management: Prescription orlistat is used in overweight people who may also have high blood pressure, diabetes, high cholesterol, or heart disease.
Dosage and Administration
You take one 60-milligram Alli pill within an hour of a fat-containing meal up to three times a day. You should spread your daily fat intake over the three main meals. Fat intake should be no more than 30% of total calories. If you eat a meal that has no fat, then you don't need a dose of Alli. Divide your daily intake of fat, carbohydrates, and protein evenly over your 3 main daily meals. If you miss a dose, you can take it within 1 hour following the meal that contains fat. However, if it is almost time for your next dose, take only that dose.
Common Side Effects
The active ingredient in Alli, orlistat, causes digestive side effects related to undigested fats passing through your digestive system. They generally lessen over time and with proper use of the drug. The most common side effect of orlistat is changes in bowel movement (BM) habits. This generally occurs during the first weeks of treatment; however, it may continue throughout your use of orlistat.
Read also: Does Alli Work for Weight Loss?
These diet-related side effects are gastrointestinal (GI) and are related to the way you take the product and how much fat you consume when taking alli capsules. These effects tend to occur early on when you first start taking alli, as your body adjusts to your diet and alli, and then subside with continued use. 90% of people who have used alli and eat a low-fat diet were able to stay on their diet for over 3 months.
Common side effects include:
- Oily spotting on underwear or clothing
- Gas with oily spotting
- Urgent need to have a bowel movement
- Loose stools
- Oily or fatty stools
- Increased number of bowel movements
- Difficulty controlling bowel movements
- Pain or discomfort in the rectum (bottom)
- Stomach pain
- Irregular menstrual periods
- Headache
- Anxiety
Serious Side Effects and Risks
In rare cases, Xenical and Alli have been linked to severe liver injury. However, the risk of liver injury is very low; it is estimated to be less than one case per million users. Some people who took orlistat developed severe liver damage. There is not enough information to tell whether the liver damage was caused by orlistat.
Other serious side effects and risks include:
- Liver Damage: Symptoms include nausea or vomiting, stomach or belly pain, fever, weakness or unusual tiredness, itching, loss of appetite, light-colored poop, dark-colored urine, and yellowing skin or eyes (jaundice).
- Kidney Problems: Orlistat may cause kidney stones and kidney damage that can lead to renal failure. Symptoms include decreased or no urine, nausea or vomiting, loss of appetite, pain when urinating, increased need to urinate, blood in the urine, and back, belly, or groin pain.
- Gallbladder Problems: Taking orlistat may cause cholelithiasis, also known as gallstones. Symptoms include pain in the upper stomach area, nausea, and vomiting.
- Severe Allergic Reactions: Symptoms include breathing problems or wheezing, racing heart, fever or general ill feeling, swollen lymph nodes, swelling of the face, lips, mouth, tongue, or throat, trouble swallowing or throat tightness, itching, skin rash, or pale red bumps on the skin called hives, nausea or vomiting, dizziness, feeling lightheaded, or fainting, stomach cramps, and joint pain.
- Malabsorption: Orlistat can interfere with the absorption of fat-soluble vitamins (A, D, E, and K) and beta-carotene.
- Pancreatitis
- Increased risk of osteoporosis
- Anal fissures
Interactions with Other Medications
Xenical and Alli can interact with certain medications and supplements, which can affect their efficacy and safety.
Read also: Your Alli Diet Questions Answered
Orlistat may interact with:
- Amiodarone
- Certain antivirals for HIV or hepatitis
- Certain medications that treat or prevent blood clots like warfarin, enoxaparin, dalteparin, apixaban, dabigatran, edoxaban, and rivaroxaban
- Cyclosporine
- Medications for diabetes
- Medications for seizures
- Other medications or herbal and dietary supplements for weight loss
- Supplements like vitamins A, beta-carotene, D, E and K
- Thyroid hormones
- Warfarin
- Levothyroxine, take it at least 4 hours apart from orlistat.
Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking orlistat. Do not start any of these medications while taking orlistat without discussing with your healthcare provider.
Precautions
- Allergies: People who are allergic to orlistat or any of the ingredients in Alli or Xenical should not take these medications.
- Pregnancy and Breastfeeding: Orlistat should not be taken during pregnancy or breastfeeding.
- Malabsorption Syndrome: Orlistat should not be used by people with malabsorption syndrome.
- Gallbladder Problems: Orlistat should not be used by people with cholestasis, a problem where bile does not flow well.
- Organ Transplant: Do not use this medication if you have had an organ transplant. This medication interferes with some medications used to prevent transplant rejection.
- Eating Disorders: tell your doctor if you have or have ever had an eating disorder such as anorexia nervosa or bulimia.
Important Considerations
- Diet and Exercise: Alli isn't an easy answer to weight loss. A weight-loss plan with diet, exercise and drug therapy is generally considered successful if you lose about 1 pound (0.5 kilogram) a week during the first month. If the treatment is successful, you are more likely to keep weight off or lose more weight if you continue with the diet, exercise and drug treatment plan.
- Multivitamins: Alli and Xenical can cause decreased absorption of some vitamins. You should talk to your provider about taking a daily multivitamin that contains normal amounts of vitamins D, E, K, and beta-carotene or vitamin A. You should take a multivitamin once per day at bedtime unless instructed otherwise by your provider. Alli can reduce the absorption of fat-soluble nutrients, including beta carotene and vitamins A, D, E and K. Take a multivitamin at least two hours after your last dose of Alli.
- Low-Fat Diet: You should use this medication with a reduced-calorie diet that contains no more than about 30 percent of the calories from fat. Divide your daily intake of fat, carbohydrates, and protein evenly over your 3 main meals. Follow a well-balanced, reduced-calorie, low fat diet. Try starting this diet before taking this medication. Following a low fat diet can help reduce the possible side effects from this medication.
- Regular Monitoring: It is very important that your doctor check your or your child's progress at regular visits, to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.
Overdose
Theoretically, itâs possible to overdose on orlistat, but there isnât much research available about specific doses or dangers. Most orlistat overdose cases that have been reported have been asymptomatic or have included side effects that are similar to those associated with taking the recommended dose. If you or someone you know takes more than the recommended dose of Alli or Xenical, call 911 or seek medical attention right away. Some of the side effects associated with using the recommended dose can include severe liver damage, so itâs essential to get immediate care.
Alli and Eating Disorders
Taking a weight loss or diet pill like orlistat could indicate that someone is struggling with disordered eating or an active eating disorder, especially when other symptoms are present like body dissatisfaction, restricted eating, a fear of gaining weight, purging, excessive exercise, and more. People with eating disorders or who struggle with disordered eating sometimes use weight loss medications like Alli or Xenical. Some studies have confirmed this, with reports of participants with eating disorders using Alli weight loss pills.
During one study, nearly 58% of individuals who used Alli or Xenical for weight loss met the criteria for an eating disorder, including bulimia nervosa, binge eating disorder, and anorexia nervosa. Additionally, case reports have revealed that people with bulimia may misuse orlistat as a purging mechanism.
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