Orlistat is a lipase inhibitor indicated for weight management in adults with a body mass index (BMI) of 30 kg/m² or greater, or 27 kg/m² or greater in the presence of other risk factors such as hypertension, diabetes, or dyslipidemia. It functions by inhibiting the absorption of dietary fats in the gastrointestinal tract, thereby reducing caloric intake. This medication is intended for use in conjunction with a reduced-calorie diet and should be administered under appropriate medical supervision to optimize therapeutic outcomes and monitor for potential adverse effects.

Features

• Contains orlistat as the active pharmaceutical ingredient
• Available in 60 mg (over-the-counter) and 120 mg (prescription-only) formulations
• Lipase inhibitor class; acts locally within the gastrointestinal lumen
• Not systemically absorbed; exerts effect within the gut
• Requires concomitant hypocaloric diet for efficacy
• Typically packaged in blister packs or HDPE bottles

Benefits

• Supports clinically significant weight loss when combined with lifestyle modification
• Reduces absorption of dietary fat by approximately 30%
• May improve metabolic parameters such as LDL cholesterol and fasting blood glucose
• Non-systemic mechanism minimizes risk of cardiovascular or central nervous system effects
• May assist in weight maintenance after initial loss
• Can be integrated into long-term weight management strategies under medical guidance

Common use

Orlistat is commonly used as an adjunct to a reduced-calorie diet for obesity management. It is indicated for individuals seeking pharmacological support to achieve and sustain weight loss, particularly those with obesity-related comorbidities. It is often incorporated into multidisciplinary weight management programs that include dietary counseling, physical activity, and behavioral therapy. Use is generally recommended after non-pharmacological interventions have been attempted without sufficient success.

Dosage and direction

The recommended dosage of orlistat is one 120 mg capsule taken three times daily with each main meal containing fat. Administration should occur during the meal or up to one hour after eating. If a meal is missed or contains no fat, the dose should be omitted. The capsule should be swallowed whole with water. Daily fat intake should be distributed evenly over three main meals. Dosage adjustment is not typically required for special populations, though clinical monitoring is advised.

Precautions

Patients should be advised to follow a nutritionally balanced, reduced-calorie diet with approximately 30% of calories from fat. Higher fat intake may increase gastrointestinal adverse effects. Use with caution in patients with chronic malabsorption syndromes or cholestasis. Monitor for potential decreases in fat-soluble vitamin levels (A, D, E, K); a daily multivitamin supplement containing these vitamins should be taken at least 2 hours before or after orlistat administration. Not recommended for use beyond two years without reassessment.

Contraindications

Orlistat is contraindicated in patients with chronic malabsorption syndrome or cholestasis. It should not be used during pregnancy or breastfeeding. Hypersensitivity to orlistat or any component of the formulation prohibits use. It is not indicated for use in pediatric populations or underweight individuals. Patients with anorexia nervosa or bulimia should not use this medication. Concomitant use with cyclosporine is contraindicated due to altered absorption.

Possible side effects

The most common adverse effects are gastrointestinal in nature and result from increased fat excretion: oily spotting, flatus with discharge, fecal urgency, fatty/oily stool, oily evacuation, increased defecation, and fecal incontinence. These effects are generally mild to moderate, decrease with continued use, and are associated with high-fat meals. Other reported effects include abdominal pain/discomfort, nausea, vomiting, and headache. Rare cases of hepatic injury, oxalate nephropathy, and hypersensitivity reactions have been reported.

Drug interaction

Orlistat may reduce absorption of fat-soluble vitamins and some lipophilic drugs. Concurrent use with cyclosporine is contraindicated. Monitor levels of warfarin (INR), amiodarone, antiepileptic drugs, levothyroxine, and oral contraceptives; administer these medications at least 2 hours before or after orlistat. May potentially affect absorption of antiretroviral medications. Orlistat does not interact with cytochrome P450 system. Use caution with other weight loss medications.

Missed dose

If a dose is missed, it should be skipped and the regular dosing schedule resumed with the next meal. Do not double the dose to make up for a missed administration. The medication is only effective when taken with meals containing fat, so taking it without food provides no therapeutic benefit and may increase side effects without efficacy.

Overdose

Cases of overdose have reported with gastrointestinal effects such as abdominal discomfort, oily spotting, and diarrhea. There is no specific antidote for orlistat overdose. Treatment should be symptomatic and supportive. Maintain hydration and electrolyte balance. Given its local action in the GI tract and minimal systemic absorption, serious systemic toxicity is not expected. Medical attention should be sought for severe symptoms or concerning presentations.

Storage

Store at room temperature between 15-30°C (59-86°F). Keep container tightly closed and protect from moisture and light. Do not freeze. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Properly discard any unused medication according to local regulations.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Orlistat is a medication that should be used under appropriate medical supervision. Individual results may vary. Consult a healthcare professional before starting any weight management medication to determine if it is appropriate for your specific health situation. Not all possible uses, precautions, side effects, or interactions are listed here.

Reviews

Clinical trials demonstrate that orlistat plus diet produces significantly greater weight loss than placebo plus diet at 1 year (approximately 5-10% total body weight loss). Many patients report successful weight management when combined with lifestyle changes, though gastrointestinal side effects are frequently noted. Long-term studies show maintenance of weight loss for up to 2 years with continued use. Patient satisfaction often correlates with adequate education about expected effects and dietary compliance.