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INTRODUCTION

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orlistat (or-li-stat)

Xenical

Classification

Therapeutic: weight-control agents

Pharmacologic: lipase inhibitors

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Indications
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Obesity management (weight loss and maintenance) when used in conjunction with a reduced-calorie diet in patients with an initial BMI ≥30 kg/m2 or ≥27 kg/m2 in the presence of additional risk factors (diabetes, hypertension, hyperlipidemia). Reduces the risk of weight regain after prior loss. May delay onset of type 2 diabetes in prediabetic patients.

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Action
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Decreases the absorption of dietary fat by reversibly inhibiting enzymes (lipases), which are necessary for the breakdown and subsequent absorption of fat. Therapeutic Effects: Weight loss and maintenance in obese patients. Delayed onset of type 2 diabetes.

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Adverse Reactions/Side Effects
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With initial use; incidence decreases with prolonged use

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GI: fecal urgency, flatus with discharge, increased defecation, oily evacuation, oily spotting, fecal incontinence.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Periodically assess body weight and other anthropometric measures (body mass index, body composition). Document whether drug therapy is helping reduce body weight and decrease percentage of body fat.

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Interventions
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  • Design and implement aerobic exercise and endurance training programs to help decrease obesity and maintain weight loss.

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Patient/Client-Related Instruction
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  • Counsel patients about additional interventions to help control obesity and improve cardiovascular health, including dietary modification, regular exercise, moderation of alcohol consumption, and smoking cessation.

  • Advise patient about the likelihood of GI problems, including increased bowel movements, flatulence, and possible incontinence. Instruct patient to report severe or prolonged GI problems.

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Pharmacokinetics
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Absorption: Minimal systemic absorption.

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Distribution: Action is local, within the GI tract.

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Protein Binding: Minimally absorbed drug is >99% bound to plasma proteins.

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Metabolism and Excretion: Major route is fecal elimination of unabsorbed drug.

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Half-life: 1–2 hr.

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TIME/ACTION PROFILE (effects on fecal fat)

ROUTE ONSET PEAK DURATION

PO

24–48 hr

unknown

48–72 hr*

*Following discontinuation.

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Chronic malabsorption syndrome or cholestasis; OB: Pregnancy or lactation.

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Use Cautiously in: Pedi: Children <16 yr (safety not established).

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Interactions
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Drug-Drug: Reduces the absorption of some fat-soluble vitamins and beta-carotene.

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Route/Dosage
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PO (Adults and adolescents ≥16 yr): 60–120 mg tid with each meal containing fat.

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Availability
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Capsules: 120 mg, 60 mg OTC.

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