Xenical, containing the active ingredient orlistat, is a medication designed to aid weight loss. It functions as a gastrointestinal lipase inhibitor, which means it prevents the absorption of some dietary fats. This article examines the effectiveness, risks, and considerations associated with using Xenical and its over-the-counter counterpart, Alli, for weight loss.
What is Orlistat?
Orlistat is a medication intended for overweight or obese individuals. It is available in two forms:
- Xenical: A prescription drug containing 120mg of orlistat.
- Alli: An over-the-counter version with a lower dose of 60mg of orlistat.
Both Alli and Xenical are approved for use in conjunction with a low-calorie diet and exercise program.
How Orlistat Works
Orlistat works by inhibiting lipase, an enzyme in the digestive tract that breaks down dietary fat. By blocking this enzyme, orlistat prevents about 25% of the fat consumed from being absorbed by the body. This undigested fat is then eliminated through bowel movements.
Dosage and Administration
Xenical is provided as a turquoise, hard-gelatin capsule for oral administration. The typical dosage is one 120 mg capsule taken with a glass of water, with each main meal that contains about 30 percent of the calories from fat, or within 1 hour after each meal. If a meal is occasionally missed or does not contain fat, the dose can be skipped. Alli, the over-the-counter version, is taken as one 60-milligram pill within an hour of a fat-containing meal, up to three times a day. Daily fat intake should be distributed evenly over the three main meals and should not exceed 30% of total calories.
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Benefits of Orlistat
When combined with exercise and dietary changes, orlistat can lead to modest weight loss. Studies have shown that individuals taking orlistat may experience a 5% to 10% decline in body weight. In clinical trials involving obese patients with and without type 2 diabetes, those taking orlistat lost an average of 19 pounds compared to 12 pounds with a placebo, over one year.
Orlistat may also have other health benefits, such as reducing cholesterol and blood pressure levels and improving glycemic control.
Risks and Side Effects
Taking Alli or Xenical can cause several adverse and unwanted effects:
- Loose stools
- Increased frequency of bowel movements
- Difficulty controlling bowel movements
- Rectal pain
- Abdominal pain
- Oily spotting on clothes or underwear
- Anxiety
- Headaches
- Irregular menstruation
- Anal fissures
In clinical trials of Xenical, during the first year of use, a significant percentage of people experienced the following:
- 27% experienced oily underwear staining
- 24% had gas with involuntary discharge of stool
- 22% experienced fecal urgency
- 11% had an increased number of bowel movements
- 8% suffered fecal incontinence
These side effects can often be reduced by limiting fat intake to 30% or less of the diet.
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Severe Side Effects
In rare cases, orlistat can cause severe side effects, including:
- Swallowing or breathing difficulties
- Extreme or persistent stomach pain
- Weakness and fatigue
- Dark-colored urine
- Yellowing of the eyes or skin
- Hives
- Rash
- Severe liver injury
- Acute kidney injury
- Increased risk of osteoporosis
- Impaired absorption of vital vitamins and nutrients
If you experience any severe side effects, it is crucial to seek immediate medical attention.
Overdose
While research on orlistat overdose is limited, most reported cases have been asymptomatic or have involved side effects similar to those associated with the recommended dose. However, due to the potential for severe liver damage, it is essential to seek medical help immediately if an overdose is suspected.
Interactions
Orlistat can interact with several medications, including:
- Amiodarone
- Certain antivirals for HIV or hepatitis
- Medications that treat or prevent blood clots (e.g., warfarin, enoxaparin)
- Cyclosporine
- Diabetes medications
- Seizure medications
- Other weight loss medications or supplements
- Vitamins A, beta-carotene, D, E, and K supplements
- Thyroid hormones
- Warfarin
It is important to inform your healthcare provider of all medications, herbs, and supplements you are taking before starting orlistat.
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Precautions
Before taking orlistat, inform your healthcare team if you have any of the following conditions:
- Eating disorders (e.g., anorexia or bulimia)
- Diabetes
- Gallbladder disease
- History of irregular heartbeat
- HIV or AIDS
- Kidney stones
- Liver disease
- Organ transplant
- Pancreatic disease
- Problems absorbing food
- Seizures
- Stomach or intestine problems
- Thyroid disease
- Allergies to orlistat or other substances
Orlistat should be used with caution in children and is not approved for use without a prescription in those under 18 years of age. It is also not advised for pregnant women, as weight loss during pregnancy can be harmful to the unborn child.
Orlistat and Eating Disorders
The use of orlistat as a "weight loss" medication can be particularly risky for people with disordered eating behaviors or a clinical eating disorder. Orlistat can be misused as a purging mechanism, especially by those with bulimia nervosa. Eating disorders and orlistat both can cause malabsorption, leading to undernutrition and nutritional deficiencies.
The Role of Diet Culture
Diet culture, anti-fat bias, and weight stigma contribute to the popularity of medications like orlistat. Societal ideals around body size and shape can lead to body dissatisfaction, distorted body image, and eating disorders. It is important to address these underlying issues and promote a healthy relationship with food and body image.
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Predictors of Weight Loss
A study exploring the predictors of weight loss following orlistat found that patients who lost the most weight showed a decrease in beliefs in a medical solution, a decrease in unhealthy eating, an increased belief in treatment control, and an increased belief that the unpleasant consequences are both due to their eating behaviour and just part of the drug. The unpleasant side effects of orlistat, such as anal leakage and oily stools, may encourage some patients to focus on the behavioural aspects of their weight problem, thus promoting the dietary changes needed for both short and longer term weight loss. When prescribing orlistat, clinicians should encourage patients to see the consequences as an education as a means to promote the effectiveness of this form of medical management.
Important Considerations
- Vitamin Supplementation: Orlistat can reduce the absorption of fat-soluble nutrients like vitamins A, D, E, and K. Therefore, it is recommended to take a daily multivitamin at least two hours after the last dose of orlistat.
- Dietary Fat Intake: It is essential to follow a reduced-calorie diet with no more than 30% of calories from fat.
- Regular Monitoring: Regular check-ups with your healthcare team are necessary to monitor your progress and address any potential issues.
- Effectiveness: Weight loss with orlistat is typically modest, and most weight loss occurs within the first few months. If you haven't lost 5% of your body weight within a year, discontinuing the drug may be a reasonable choice.
- Long-Term Data: It's important to note that the evidence does not definitively show that orlistat reduces premature death and disability.