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, type 2 diabetes, or dyslipidemia. It functions by inhibiting the absorption of dietary fats in the gastrointestinal tract, thereby reducing caloric intake. When used as part of a comprehensive weight management program that includes a reduced-calorie diet and exercise, orlistat has been shown to produce significant and sustained weight loss, improve obesity-related comorbidities, and support long-term weight maintenance goals under medical supervision.

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 in the gastrointestinal tract
• Not systemically absorbed; exerts effect within the gut lumen
• Typically supplied in capsule form for oral administration
• Manufactured under strict pharmaceutical quality control standards

Benefits

• Promotes clinically meaningful weight loss when combined with lifestyle modifications
• Reduces absorption of dietary fat by approximately 30%, supporting caloric deficit
• Improves metabolic parameters including blood pressure, lipid profiles, and glycemic control
• Supports development of healthier eating patterns through physiological feedback
• Provides non-central mechanism of action without CNS side effects
• Facilitates long-term weight maintenance when used as part of comprehensive management

Common use

Orlistat is indicated for obesity management in adults with BMI ≥30 kg/m², or ≥27 kg/m² with comorbidities. It is used adjunctively with a mildly hypocaloric diet containing approximately 30% of calories from fat. Treatment should be continued beyond 12 weeks only if patients have lost at least 5% of their initial body weight. The medication is typically prescribed as part of a comprehensive weight management strategy that includes nutritional education, behavioral modification, and increased physical activity.

Dosage and direction

The recommended dosage is one 120 mg capsule taken three times daily with each main meal containing fat, or within one hour of meal completion. If a meal is missed or contains no fat, the dose should be omitted. The capsule should be swallowed whole with water. Doses exceeding 120 mg three times daily have not been shown to provide additional benefit. For optimal effect, the daily fat intake should be distributed evenly over three main meals.

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 side effects. Orlistat may reduce absorption of fat-soluble vitamins (A, D, E, K) and beta-carotene; patients should take a daily multivitamin supplement containing these nutrients at least 2 hours before or after orlistat administration. Use with caution in patients with history of hyperoxaluria or calcium oxalate nephrolithiasis. Not recommended for use during pregnancy or breastfeeding.

Contraindications

Chronic malabsorption syndrome, cholestasis, known hypersensitivity to orlistat or any component of the formulation. Should not be used by patients with organ transplant receiving cyclosporine, or those taking antiretroviral medications containing rilpivirine. Contraindicated in patients with anorexia nervosa or bulimia. Not recommended for use in pediatric populations.

Possible side effects

Common gastrointestinal effects include 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 related to fat content of diet. Other reported effects include abdominal pain/discomfort, nausea, infectious diarrhea, rectal pain/discomfort, tooth/gum disorder, headache, upper respiratory infection, lower respiratory infection, influenza, back pain, and anxiety.

Drug interaction

Orlistat may reduce absorption of fat-soluble vitamins and other lipophilic drugs. Cyclosporine levels should be monitored when co-administered with orlistat. May increase the effects of warfarin; INR should be monitored frequently. May reduce absorption of amiodarone, anticonvulsants, antiretroviral therapies, and thyroid hormones. Patients taking levothyroxine should separate administration by at least 4 hours. Orlistat may affect the efficacy of oral contraceptives; additional contraceptive methods are recommended.

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 dose. The medication is only effective when taken with meals containing fat, so taking it without food provides no therapeutic benefit.

Overdose

No serious adverse events have been reported with overdoses up to 800 mg daily. Based on its mechanism of action, significant overdose would be expected to produce increased gastrointestinal effects. Management should be symptomatic and supportive. Medical attention should be sought if severe gastrointestinal symptoms occur or if the overdose involves other medications whose absorption might be affected.

Storage

Store at room temperature between 15-30°C (59-86°F). Keep container tightly closed and protect from moisture. Keep out of reach of children. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Orlistat should be used only under the supervision of a healthcare professional. Individual results may vary. Patients should consult with their healthcare provider before starting any weight management medication to discuss potential benefits and risks based on their individual health status.

Reviews

Clinical studies demonstrate that orlistat produces approximately 2.5-3.5 kg greater weight loss than placebo at 1 year when combined with lifestyle modification. In the XENDOS study, orlistat plus lifestyle intervention reduced the incidence of type 2 diabetes by 37% compared to lifestyle changes alone in obese patients with impaired glucose tolerance. Long-term data show maintained weight loss superiority over placebo for up to 4 years. Patient-reported outcomes indicate improvements in quality of life measures, particularly in physical function and self-esteem domains.