(Xenical and Alli): Orlistat reduces intestinal absorption of fats from the diet and thereby reduces calorie intake. It has been available for many years as a prescription only drug under the trade name Xenical (120 mg tablet). More recently an over the counter version has been available under the trade name Alli (60 mg tablet). Now that the use of sibutramine has been suspended Orlistat remains the only available prescription drug specifically for the management of weight loss on the UK formulary.

The easy availability of over the counter Orlistat has generated quite a lot of controversy. Many doctors are concerned that potential serious side effects such as liver toxicity may occur unmonitored. There are also drug interactions to consider such as the altered metabolism of the anti-transplant rejection drug cyclosporine or the anti-arrhythmic heart drug amiodarone. Also the absorption of fat-soluble vitamins is inhibited by Orlistat raising concerns about vitamin deficiencies in people taking the drug over long periods of time.

Orlistat is effective in promoting weight loss. Statistics indicate an extra 2-3 Kg weight loss over time in people taking the drug compared to those just following the recommended changes in diet and exercise. Although this effect cannot be considered particularly dramatic, a large-scale clinical trial also indicated a significant reduction in the incidence of diabetes in obese subjects taking Orlistat. The main barrier to using Orlistat is the well-known gastrointestinal side effect of oily loose stools and in some cases urgent bowel movements or even faecal incontinence. This results from the decreased fat absorption and therefore increased fat load in the intestine. Knowledge of this encourages the user to follow a lower fat diet.

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