Orlistat (Xenical) Drug Study

Generic Name: Orlistat
Brand Name: Xenical
Classifications: gastrointestinal agent; anorectant; antiobesity agent; nonsystemic lipase inhibitor
Pregnancy Category:B

Availability
120 mg capsules

Actions  
Nonsystemic inhibitor of gastrointestinal lipase. Reduces intestinal absorption of dietary fat by forming inactive enzymes with pancreatic and gastric lipase in the GI tract.

Therapeutic effects
Indicated by weight loss/decreased body mass index (BMI). Reduces the intestinal absorption of dietary fat because at least 95% of orlistat is eliminated in the feces; reduces caloric intake in obese individuals.

Uses   
Weight loss and weight maintenance in patients with BMI >=30 kg/m2 or >=27 kg/m2 in patients with other risk factors. Reduce risk for weight regain after prior weight loss.

Contraindicatons
Hypersensitivity to orlistat; malabsorption syndrome; cholestasis; lactation; organic causes of obesity.

Cautious use  
Gastrointestinal diseases including frequent diarrhea; known dietary deficiencies in fat soluble vitamins (i.e., A, D, E); pregnancy (category B). Safety & efficacy in children <18 y are not established.

Route & Dosage  

Weight Loss
adult: PO 120 mg t.i.d. with each main meal containing fat

Administration

Oral

• Give during or up to 1 h after a meal containing fat.
• Omit dose with nonfat-containing meal or if meal is skipped.
• Store at 15°–30° C (59°–86° F). Keep bottle tightly close; do NOT use after the printed expiration date.

Adverse Effects

BodyWhole:Fatigue.
CNS:Headache, dizziness, anxiety.
CV:Hypertension, stroke.
GI:Oily spotting, flatus with discharge, fecal urgency, fatty/oily stool, oily evacuation, increased defecation, fecal incontinence, abdominal pain/discomfort, nausea, infectious diarrhea, rectal pain/discomfort, tooth disorder, gingival disorder, vomiting.
Skin:Rash.
Urogenital:Menstrual irregularity.

Nursing Implications  

Assessment & Drug Effects

• Monitor weight & BMI; closely monitor diabetics for hypoglycemia.
• Co administered drugs: Monitor PT/INR with warfarin.
• Monitor BP frequently, especially with preexisting hypertension.

Patient & Family Education    

• Take a daily multivitamin containing fat-soluble vitamins at least 2 h before/after orlistat.
• Remember common GI adverse effects typically resolve after 4 wk therapy.
• Avoid high fat meals to minimize adverse GI effects. Distribute fat calories over three main meals daily.
• Monitor weight several times weekly. Diabetics: Monitor blood glucose carefully following any weight loss.
• Do not breast feed while taking this drug.