XENICAL 120MG, ORLISTAT

• Suitable for people with a BMI over 30.
• Xenical pills prevent your body absorbing fat from your diet.

What is Xenical?

Xenical is a weight loss medication that must be prescribed by a doctor. It can accelerate weight loss in certain groups of people in whom dietary changes and exercise have not proven effective. Its main active ingredient is the drug orlistat. Xenical is the brand name given to the medication by its manufacturers, the pharmaceutical company Roche.

Who can take Xenical?

Xenical can be prescribed to patients with a BMI of more than 30. It can also be prescribed if your BMI is greater than 28 in the presence of other risk factors such as type 2 Diabetes, High Blood Pressure or raised Cholesterol.

How does Xenical work?

The active ingredient in Xenical is orlistat. It works by blocking the action of the enzyme lipase which is produced by the pancreas and in the stomach. Lipase usually breaks down fats to its constituent parts so that it can be more easily absorbed by the gut. If this action is prevented, it makes fats harder to digest, so that they pass straight through the gut and are excreted in the stools. Digesting less fat from the diet should, hopefully over time, result in weight loss.

How often should it be taken?

The recommended dose of Xenical is one 120 mg capsule taken with water immediately before, during or up to one hour after each main meal. If a meal is missed or contains no fat, the dose of Xenical should be missed.

Do I need to make any other lifestyle adjustments?

Patients taking Xenical should be on a reduced calorie diet, with daily intake of fats carbohydrates and proteins being equally distributed over three main meals. Ideally only 30% of total calories should come from fats.

Even if the treatment is a success, it’s important to continue making sensible dietary choices and exercise regularly. It is not recommended to continue Xenical indefinitely and implementing healthy lifestyle changes should hopefully help to keep the weight off.

Is Xenical Safe? 

There have been a few cases of severe liver injury which were originally linked to the use of Xenical. However further studies carried out by the FDA and a European review failed to find conclusive evidence of a causal link. It is listed as a rare possible side effect, but this needs to be taken in context, with only about 13 cases reported worldwide between 1999 and 2009 and over 40 million people having used this medication.

Does Xenical work?

One study of 676 patients compared the weight loss achieved with different doses of orlistat with that achieved with a placebo, with 37 % of patients taking 120mg of orlistat achieving more than 10% weight loss over a 24-week period compared with just 19% in the placebo group. (1)

Another study looked at a group of 550 patients with poorly controlled Type 2 diabetes over a 1-year period. They were either treated with 120mg of orlistat or a placebo as well as a low-calorie diet. The orlistat group lost significantly more weight; their diabetes improved to a significantly greater level compared with the placebo group. Their total and LDL cholesterol also reduced to a greater extent. (2)

A 2020 review of 27 randomized controlled trials with a total of more than 8000 patients, found that weight loss induced by Orlistat use contributed to an associated decrease in blood pressure in overweight and obese subjects. (3)

So, Xenical, whose active ingredient is orlistat can have added benefits such as reducing risk of developing diabetes, improving diabetes control and reduction of blood pressure as a result of the weight loss it produces.

Is there any reason not to take Xenical?

You should not take Xenical if:

1) If you have a problem with the normal flow of bile acids, a condition known as ‘cholestasis’. 
2) If you are pregnant or breastfeeding.
3) If you have a problem with your digestive tract known as ‘malabsorption’ this can be caused by a variety of gastrointestinal conditions.
4) If you are taking the drug Ciclosporin or Acarbose.
5) If you are allergic to any of the ingredients (see further down for full list of ingredients).

Also inform your doctor if you are taking any of the following medications: Thyroxine, Amiodarone, the Contraceptive pill, Anti-retroviral treatment for HIV, Epilepsy medication, Warfarin or other blood thinning medication, Antidepressants, Antipsychotics, or Benzodiazepines.

The absorption of these medications may be affected by Xenical and extra monitoring, or precautions may be needed, for example, orlistat may indirectly reduce the availability of oral contraceptives and lead to unexpected pregnancies in some individual cases. An additional contraceptive method is recommended in case of severe diarrhoea.

In addition, if you are taking diabetic or blood pressure medication, Xenical could improve the control of these conditions and a reduction in dose may be needed. It is best to let your doctor know so that this can be monitored.

Because Xenical causes fat not to be absorbed as well, it can also affect the absorption of the ‘fat soluble’ vitamins A, D, E and K. For this reason, it may be advisable to take a supplement of these vitamins at bedtime, they should not be taken at the same time as Xenical.

What are the side effects?

The majority effects are gastrointestinal and mild. However, flatulence, diarrhoea, flatus with discharge and faecal incontinence are potentially embarrassing yet common. As are oily stools, increased stool frequency, and abdominal pain.

Other common side effects can include anxiety, headache, respiratory tract and urinary tract infections, low blood sugar, irregular periods and fatigue.

Rarely, an allergic reaction may occur which could be associated with a rash, tongue swelling, and difficulty breathing. This is a medical emergency and requires an immediate assessment by emergency medical services.

Other rare side effects include:
   Liver failure, frequency rare, discussed in an earlier section.
   Kidney failure: due to increased oxalate levels in the urine, frequency not known.
   Diverticulitis, pancreatitis, gallstones, rectal bleeding and skin reactions, are other rare potential side effects, frequency not known.

How long should Xenical be taken for?

Ideally a 3-month trial is recommended. At the end of this period a 5% reduction in weight would be considered a successful result. If this is not achieved then it may be worth considering if continuation of treatment is beneficial, by weighing up the side effects and any potential risks.