OTC - Orlistat

Question 1

What qualifies as obesity

Answer 1

BMI > 30

Question 2

Criteria for orlistat OTC

Answer 2

Must have BMI of 28 or more
AND
be 18+

Question 3

Orlistat Contraindcations

Answer 3

Do not give orlistat if patient is taking:

levothyroxine - reduced control of hypothyroidism Amount
Amiodarone - decreased plasma levels
Ciclosporin - decreased plasma levels
Warfarin + NOAC’s -INR affected by low vitamin K
Acarbose - not recommended
Anti-epileptics - increased risk of seizures

OR

if the patient has
- diabetes
- hypertension
- high-cholesterol
As weight loss improves glycemic control, therefore the patients would require a dose reduction initiated by prescriber. Leave Orlistat prescribing to prescriber

Question 4

Orlistat caution

Answer 4

Oral contraceptives, recommend additional protection

Question 5

Orlistat and fat-soluble vitamins

Answer 5

Vitamin A
Vitamin D
Vitamin E
Vitamin K

Orlistat impairs absorption of fat-soluble vitamins, therefore vitamin supplements should be taken at night or 2 hours after orlistat dose

Question 6

Orlistat referral

Answer 6

Patients pregnant or breastfeeding
Patients with kidney disease
Patients that have failed to lose weight after 3 months should be reviewed

Question 7

Orlistat counselling

Answer 7

Orlistat must be taken with a mild hypo caloric lower fat diet

It works by preventing the absorption of dietary far. It should be taken TDS before three main meals or up to 1 hour after.

If a meal is missed or the meal contained no fat, miss the dose.

Question 8

Orlistat side effects

Answer 8

Oily stools

Incontinence

Question 9

It is important to remind patients

Answer 9

Must still maintain a healthy diet,
e.g 5 portions of fruit and veg, 2.5l of fluids, exercise 30 mins/5 days a week