orlistati

Orlistati, known in Italian as orlistati, is a medication used to aid weight management in adults and, in some settings, adolescents. It functions as a lipase inhibitor, acting in the gastrointestinal tract to reduce the breakdown and absorption of dietary fats.

Mechanism and effects

Orlistati reversibly inhibits pancreatic and gastric lipases in the intestinal lumen. By blocking triglyceride hydrolysis, it decreases fat absorption by about 30%. This reduction in dietary fat intake can contribute to weight loss when combined with a reduced-calorie diet and physical activity. The drug does not suppress appetite.

Indications and use

Orlistati is indicated as an adjunct to a reduced-calorie diet for long-term treatment of obesity or overweight with weight-related health risks (for example, a high body mass index). It is typically considered for adults with a body mass index of 30 or higher, or 27 or higher with weight-related comorbidities. In some regions, lower-dose formulations are available over the counter.

Administration and lifestyle considerations

Orlistati is taken with meals containing fat, usually up to three times daily. If a meal is skipped or contains no fat, the dose can be skipped. To minimize nutritional deficiencies, a multivitamin supplement containing fat-soluble vitamins (A, D, E, K) should be taken separately from orlistati, typically at least two hours before or after. Fat-soluble vitamin supplements may be needed long-term.

Safety and interactions

Common adverse effects are gastrointestinal, including oily stools, flatulence with discharge, and frequent or urgent bowel movements. Orlistati can reduce absorption of some medications and fat-soluble vitamins; it may interact with cyclosporine, warfarin, and levothyroxine, among others. It is contraindicated in chronic malabsorption syndromes and in pregnancy where alternatives exist.

History

Orlistati was developed in the 1990s and has since become a widely used pharmacological option for obesity management.