OTC - orlistat

Question 1

Orlisat criteria?

Answer 1

• 18+

- BMI >/=28

Question 2

Referral criteria?

Answer 2

DO NOT GIVE IF TAKING:

• levothyroxine (reduced control of hypothyroidism)
• amiodarone (decreased plasma levels)
• ciclosporin (decreased plasma levels)
• warfarin + NOACS (INR affected by low vitamin K)
• acarbose (not recommended for use)
• AEDs (increased risk of convulsions)

CAUTION IN

• oral contraceptive: advise additional protection if severe diarrhoea present
• ADEK vitamin deficiency: impaired absorption of fat-soluble vitamins - take vitamin supplements at night or 2 hours after orlistat dose

REFER IN:
- diabetes mellitus
- hypertension
- high cholesterol
These conditions improve with weight loss, lower doses of rxed meds may be needed 

• chronic malabsorption syndrome
• cholestasis (flow of bile from liver is blocked)
• pregnancy or breastfeeding
• kidney disease
• failure to lose weight after 3 months

Question 3

OTC product for obesity?

Answer 3

ORLISTAT (Alli) POM to P

• licensed in 18+ and BMI>28
• 6 months inconjuction with a mildly hypocaloric lower-fat diet

Question 4

How does orlistat work?

Answer 4

• potent lipase inhibitor; prevents absorption of dietary fat

Question 5

How to take orlistat?

Answer 5

• Take one 60mg capsule TDS before three main meals or up to 1 hour after
• omit dose if missed meal or meal contained no fat

Side effects:
- oily stools and faecal incontinence

Question 6

Advice?

Answer 6

• orlistat is not a substitute for a healthy diet or exercise
• 5 portions of fruit and veg a day
• 18-30g fibre per day
• 2.5L of fluids
• exercise 30mins 5 days a week
• alcohol 2-3 units a day interspersed with several alcohol free days. max 14 units (men and women)

Question 7

SCENARIO:
Glenda is a 39yr old women with obesity. BMI = 30.5 and she wishes to purchase orlistat. She has previously purchased it from another pharmacy 4 months ago. She has recently started simvastatin and regularly takes paracetamol, codeine and quinine. What is the best course of action?

Answer 7

Cholesterol levels can improve with weight loss and therefore lower doses may be required - refer to GP for medication review