Transcript Orlistat (Alli, Xenical)

Obesity Management
• Dr . Mouna Dakar
Orlistat (Xenical, Alli)
Type: lipase inhibitor
Mechanism of action: inhibits the breakdown of triglycerides into absorbable free fatty acids by
lipase enzymes in the stomach and pancreas, resulting in less fat being absorbed
Year of approval: 1999 (Xenical – prescription 120 mg TID), 2007 (Alli – OTC 60 mg)
FDA approved indication: as an adjunct to a reduced-calorie and low-fat diet for weight loss or to
lower the risk of regaining weight after prior weight loss
Efficacy: 2.9 kg mean weight loss (Xenical) beyond that achieved by placebo at one year (metaanalysis of 15 trials; Ann Intern Med 2005;142:532-46)
Adverse effects: significant diarrhea, fecal incontinence, oily spotting, flatulence, bloating,
dyspepsia (all can be reduced with avoidance of fat-rich foods), reduced absorption of fat-soluble
vitamins, serious liver injury (rare)
Contraindications: malabsorption, cholestasis, impaired liver function, pancreatic disease,
pregnancy (added in 2012)
Orlistat is a gastrointestinal lipase inhibitor that
induces weight loss by inhibiting nutrient
absorption.
it may reduce the absorption of some fat-soluble
vitamins (A, D, E, K) and beta-carotene.
Administer a daily oral multivitamin supplement
containing fat-soluble vitamins 2 hours before
meals or 1 hour after meals.
Lorcaserin (Belviq)
Type: serotonin agonist
Mechanism of action: activates 5-HT2C receptors in the hypothalamus, resulting in increased
proopiomelanocortin (POMC) production, which promotes satiety
Year of approval: 2012
FDA approved indication: treatment of obesity for adults with BMI ≥ 30 or ≥ 27 in the presence
of other risk factors such as hypertension, diabetes or hyperlipidemia
Efficacy: 3.6 kg mean weight loss beyond that achieved by placebo (5.8 kg vs. 2.2 kg) at one year
(Phase 3 RCT; N Engl J Med 2010; 363:245-256)
Adverse effects: headache, nasopharyngitis
Contraindications: pregnancy, MAOIs, SSRIs (caution)
Phentermine-topiramate (Qsymia)
Year of approval: 2012
FDA approved indication: chronic weight management, as an adjunct to a reduced-calorie diet
and exercise, for BMI ≥ 30 or ≥ 27, in the presence of other risk factors such as hypertension,
diabetes or hyperlipidemia
Efficacy: 10.7 kg mean weight loss beyond that achieved by placebo (12.6 kg vs. 1.9 kg) at one
year (Phase 3 RCT; Obesity (2012); 20 2, 330–342)
Adverse effects: tachycardia, insomnia, paresthesias, dizziness, distorted taste sensation,
constipation, dry mouth, anxiety, suicidality (rare), acute angle closure glaucoma (rare), metabolic
acidosis (rare), increased serum creatinine (rare)
Contraindications: pregnancy, glaucoma, hyperthyroidism, MAOIs, history of suicide attempt
Phentermine (Adipex-P)
http://phentermine-hcl.info/
Sibutramine (Meridia)
http://www.sibutramineonline.org/
Orlistat (Alli, Xenical)
http://www.nhplus.com/product_detail_e.cfm?I
D=16111
Comparative Drug Efficacy
Pharmacologic Agents
for the Treatment of Obesity
http://www.weightlossdietwatch.com/diet-pills-andsupplements/can-phentermine-diet-pills-really-help-you-tolose-weight/