Orlistat

GENERIC AND PROPRIETARY NAMES
- Orlistat.

- Xenical.

ACTION
- A lipase inhibitor, it reduces the absorption of dietary fat.

CLASSIFICATION
- Anti-obesity drug acting on the gastrointestinal tract.

INDICATIONS
- Adjunct in obesity.

- It is used in conjunction with a mildly hypocaloric diet in individuals with a BMI of 30 or more, or in individuals with a BMI of 28 or more in the presence of other risk factors such as type 2 diabetes, hypertension or hypercholesterolaemia.

- Orlistat should only be prescribed to people aged 18-75.

CONTRAINDICATIONS
- Not recommended in children.

- Chronic malabsorption syndrome.

- Cholestasis.

- Pregnancy.

- Breastfeeding.

CAUTIONS
- Diabetes mellitus.

- May impair absorption of fat-soluble vitamins.

COMMON SIDE-EFFECTS
- Oily leakage from rectum.

- Flatulence.

- Faecal urgency.

- Liquid or oily stools.

- Faecal incontinence.

- Abdominal distension and pain.

- Tooth and gingival disorders.

- Respiratory infections.

- Anxiety.

- Headache.

- Menstrual disturbances.

- Urinary tract infection.

- Fatigue.

RARE SIDE-EFFECTS
- Diverticulitis.

- Cholelithiasis.

- Hepatitis.

- Hypersensitivity reactions.

- Bullous eruptions.

INTERACTIONS
- Lipid-lowering drugs.

ADMINISTRATION
- Capsules.

NURSING CONSIDERATIONS
- Orlistat should be used in conjunction with other measures to manage obesity.

- Monitoring should take place on a regular basis.

- Continue treatment beyond 12 weeks only if weight loss since start of treatment exceeds 5%.

- Treatment should be continued beyond six months only if at least 10% of body weight has been lost since the start of treatment.

- Some of the weight loss in those taking orlistat probably results from individuals reducing their fat intake to avoid severe gastrointestinal effects.

- Vitamin supplementation (especially of vitamin D) may be considered if there is concern about deficiency of fat-soluble vitamins.

- On stopping orlistat there may be a gradual reversal of weight loss.

- Severe obesity should be managed in an appropriate setting by staff who have been trained in the management of obesity.

PATIENT TEACHING
- If a meal is missed or contains no fat, the dose of orlistat should be omitted.

- If a multivitamin supplement is required, it should be taken at least two hours after an orlistat dose or at bedtime.

Nurses should refer to manufacturer's summary of product characteristics and to appropriate local guidelines

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