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Obesity - Management
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What are the criteria for starting orlistat?
- Orlistat is licensed for adults aged between 18 and 75 years who meet one of the following criteria:
- Body mass index (BMI) greater than or equal to 30 kg/m2, or
- BMI greater than or equal to 28 kg/m2 with comorbidities.
In depth
Who should avoid taking orlistat?
- Do not prescribe orlistat for someone with a chronic malabsorption syndrome or cholestasis.
In depth
What important interactions are associated with orlistat?
- Fat-soluble vitamins or multivitamin supplements: if needed, they should be given at least 2 hours after a dose of orlistat or at bedtime.
- Ciclosporin: if concomitant use is unavoidable, monitor ciclosporin levels frequently, especially when starting or stopping orlistat.
- Warfarin: monitor international normalized ratio (INR) closely, especially when starting or stopping orlistat.
- Levothyroxine: consider giving at least 2 hours after a dose of orlistat or at bedtime.
- Antiepileptic drugs: consider giving at least 2 hours after a dose of orlistat or at bedtime.
In depth
Can orlistat be used during pregnancy and breastfeeding?
- Orlistat is not recommended for use during pregnancy.
- Orlistat is contraindicated during breastfeeding.
In depth
What adverse effects are associated with orlistat?
- Gastrointestinal adverse effects are common (e.g. oily spotting, abdominal discomfort, faecal urgency, fatty stools). These usually reduce with continued use of orlistat and can often be reduced by limiting fat intake.
In depth
What advice should I give to someone who has been prescribed orlistat?
- Take orlistat immediately before, during, or up to 1 hour after each main meal (up to a maximum of three times a day).
- Omit the dose of orlistat if a meal is missed, or if the meal contains little or no fat.
- If a woman who is taking an oral contraceptive experiences severe diarrhoea whilst taking orlistat, advise her to use an additional method of contraception.
In depth
For how long should treatment with orlistat continue?
- Only continue orlistat beyond 3 months if the person has lost at least 5% of their body weight, as measured at the start of drug treatment.
- There is no restriction on how long orlistat may be prescribed. After 12 months, a decision to continue treatment should be taken on an individual basis, weighing up the benefits, costs, and risks for that person. Review at regular intervals.
In depth
Prescriptions
Orlistat
Age from 18 to 75 years
Orlistat capsules: 120mg three times a day
Orlistat 120mg capsules
Take one capsule with each main meal. Maximum of 3 capsules in 24 hours. (Take each capsule just before, during, or up to 1 hour after a main meal.)
Supply 84 capsules.
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