Question 1

What counts as a meal containing fat?

Accepted Answer

The labels do not set a gram threshold, so we will not invent one. What the Xenical label does describe is the diet it expects alongside the drug: nutritionally balanced, reduced-calorie, with approximately 30% of calories from fat, distributed over three main meals. It also says gastrointestinal effects increase when orlistat is taken with a diet or a single meal high in fat.

Question 2

Why do the labels insist on a multivitamin?

Accepted Answer

Because orlistat reduces the absorption of some fat-soluble vitamins and beta-carotene. The Xenical label says patients should be strongly encouraged to take a multivitamin containing vitamins A, D, E, K and beta-carotene once a day, at least 2 hours before or after orlistat, such as at bedtime. The Alli label says the same thing in shorter form: take a multivitamin once a day, at bedtime.

Question 3

What are the bowel changes people talk about?

Accepted Answer

The Alli label describes them directly, and frames them as a consequence of how the drug works: orlistat prevents the absorption of some of the fat you eat, and that fat passes out of your body. It lists gas with oily spotting, loose stools, and more frequent stools that may be hard to control — and says that eating a low-fat diet lowers the chance of these bowel changes.

Question 4

Which medicines need to be spaced apart from orlistat?

Accepted Answer

The label names two by the clock: cyclosporine, given 3 hours after orlistat, and levothyroxine, kept at least 4 hours apart with thyroid function monitored. It also asks for close monitoring of coagulation parameters with warfarin, monitoring of HIV RNA levels with antiretroviral drugs, and monitoring for changes in convulsion frequency or severity with antiepileptic drugs.

Question 5

Can I take Alli if I have had an organ transplant?

Accepted Answer

No. The Alli Drug Facts label carries an organ transplant alert: do not use if you have had an organ transplant, because orlistat interferes with the medicines used to prevent transplant rejection. It also says not to use it if you are taking cyclosporine.

Question 6

How soon does orlistat start working?

Accepted Answer

The label says that, based on fecal fat measurements, the effect is seen as soon as 24 to 48 hours after dosing, and that after stopping, fecal fat content usually returns to pre-treatment levels within 48 to 72 hours.

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