Orlistat Use Research Articles

Current and emerging medications for the management of obesity in adults.

Current and emerging medications for the management of obesity in adults.

Role of Metformin, Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists, and Orlistat based Multidrug Therapy in Glycemic Control, Weight Loss, and Euglycemia in Diabesity: A Real-World Experience.

Background:This study evaluated the real-world weight loss and glycemic outcomes of multidrug therapy (MDT) according to various combinations of metformin, sodium-glucose cotransporter -2 inhibitor (SGLT2i), glucagon-like peptide-1 receptor analogs (GLP1a), and orlistat in diabesity.Methods:Data retrospectively captured from medical records of 2 different centers in New Delhi for patients >35 years-age having prediabetes/diabetes and on at least any one of the 4 above medications with >6-months follow-up was analyzed.Results:In total, 5,336 patient records were screened; 2,442 with prediabetes/diabetes were considered; 1,509 patients who fulfilled all criteria were analyzed. Use of metformin, SGLT2i, sulfonylureas, DPP4i, pioglitazone, orlistat, and GLP1a was 85.35%, 74.95%, 68.32%, 60%, 39.16%, 9.08%, and 4.17%, respectively. However, 365, 970, and 104 patients were on one of 4 concerned medications (Group-1; 24.18%), dual MDT (Group-2; 64.28%), and triple/quadruple MDT (Group-3; 6.89%). Metformin with SGLT2i was most commonly used dual MDT (94.12%). Analysis according to weight-loss quartiles from 558 patients showed 6.9 kg weight-loss in the highest quartile. People losing maximum weight were significantly younger; had higher use of metformin, SGLT2i, GLP1, orlistat, and lower pioglitazone use; greatest HbA1c reduction (–1.3 vs. –0.3; quartile-1 vs. quartile –4; P < 0.001); and significantly higher occurrence of HbA1c<5.7% (16.8% vs. 6.29%; quartile-1 vs. 4; P < 0.001). Patients in Group-3 had the highest baseline BMI and maximum weight loss with highest number of patients with HbA1c<5.7% (19.44% vs. 10.34%; Group-3 vs. Group-1; P < 0.001).Conclusion:Greater weight loss with HbA1c reduction along with a greater number of patients attaining HbA1c <5.7% highlights that MDT is the way forward to tackle diabesity in India.

Effects of Weight-Loss Medications on Cardiometabolic Risk Profiles: A Systematic Review and Network Meta-analysis

We performed a systematic review and network meta-analysis to evaluate the overall and comparative effects of weight-loss medications approved by theFood and Drug Administration for long-term use on cardiometabolic risk profiles of obese adults. We performed a systematic literature review through February 28, 2017 to identify randomized clinical trials of the effects of Food and Drug Administration-approved weight-loss medications (ie, orlistat, lorcaserin, naltrexone-bupropion, phentermine-topiramate, and liraglutide) administered to obese adults for 1 year or more, compared with placebo or another active agent. Outcomes of interest included changes in blood glucose (fasting blood glucose [FBG] and hemoglobin A1c), cholesterol profile (low-density lipoprotein and high-density lipoproteins), blood pressure (BP; systolic/diastolic), and waist circumference (WC). We performed pair-wise and network meta-analyses with outcomes reported as weighted and standardized mean differences. Quality of evidence was rated using GRADE (Grading of Recommendations Assessment, Development and Evaluation). In a meta-analysis of 28 randomized controlled trials (29,018 participants; median body mass index, 36.1 kg/m2), we associated weight-loss medications with a modest decrease in FBG (weighted mean difference, 4.0 mg/dL; 95% confidence interval, -4.4 to -3.6 mg/dL) and WC (weighted mean difference, reduction of 3.3 cm; 95% confidence interval, -3.5 to -3.1 cm), without clinically meaningful changes in systolic/diastolic BP or cholesterol profile vs placebo (standardized mean difference <0.2); effects varied among drugs. Phentermine-topiramate use was associated with a substantial decrease in WC and a modest decrease in FBG, hemoglobin A1c, and BP, and had minimal effect on cholesterol. Liraglutide use was associated with a substantial decrease in FBG, hemoglobin A1c, and WC, and a minimal effect on BP and cholesterol. Naltrexone-bupropion use was associated with moderate increase in high-density lipoprotein cholesterol, buthad a minimal effect on FBG and WC. Orlistat use was associated with a decrease in low-density lipoprotein and high-density lipoprotein cholesterol. No drug improved all cardiometabolic risk factors. In a systematic review and network meta-analysis, we found Food and Drug Administration-approved weight-loss medications to have only modest positive effects on cardiometabolic risk profile. Further research is needed to evaluate the long-term cardiometabolic benefits of these medications. CRD42016039486.

The role of anti-obesity drugs in the management of obese diabetics

Obesity contributes to type 2 diabetes and worsens its control. 5-10% weight loss among obese diabetics significantly improves glucose control, lipids and blood pressure. Weight loss should be a key goal of diabetes care for all overweight and obese patients with type 2 diabetes. Adjunctive therapy with weight loss drugs is indicated among obese diabetics who can not achieve weight maintenance with lifestyle alone. Metformin use is associated with weight loss during management of diabetics. Metformin may reduce BMI by 5.3 % in comparison with placebo and it is considered as first-line agent in obese patient with type 2 diabetes. SGLT-2 inhibitors may reduce body weight for 3 to 5 kg during management of type 2 diabetes. Orlistat use resulted in a significant reduction of cumulative incidence of type 2 diabetes after 4 years of treatment of obese subjects. Phentermine and topiramate combination use in patients with diabetes and prediabetes results in greater reduction in HbA1c values and fewer prediabetes patients progression to type 2 diabetes. Therapy with combination of bupropione and naltrexone sustained-release among diabetic patients with obesity resulted in reduction of HbA1c and improvements in triglycerides and HDL cholesterol values. In BLOOM-DM study lorcaserin decreased weight by 4.5-5 % together with reductions in HbA1c . Liraglutide has a therapeutic potential for both obesity and type 2 diabetes, due to its dual benefits on body weight and glycemic control. Semaglutide is a new GLP-1 analogue that reduces HbA1c and body weight and improves obesity related complications. Combination of GLP-1/glucagon dual agonist theoretically may decrease food intake and body weight according the preclinical experience. In case where patient does not lose 5 % or more of his body weight on prescribed drug, after three months of treatment, therapy with this drug should be stopped and changed with some other.

Effects of orlistat on blood pressure: a systematic review and meta-analysis of 27 randomized controlled clinical trials

Obesity and high blood pressure (BP) are strongly related and weight loss is mightily associated with a significant BP decrease. The aim of the present meta-analysis was to evaluate and quantify the BP decrease associated with orlistat use in randomized controlled trials. The search included PubMed-Medline, Scopus, Web of Science and Google Scholar databases by up to June 05, 2017, to identify randomized controlled trials investigating the impact of orlistat on blood pressure. Quantitative data synthesis was performed using a random-effects model, with weighed mean difference and 95% confidence interval as summary statistics. Meta-regression and leave-one-out sensitivity analyses were performed to assess the modifiers of treatment response. Our meta-analysis included 27 randomized controlled clinical trials which comprehended overall 8150 subjects (4419 in the orlistat group and 3731 in the control one). We observed a statistically significant decreasing effect of orlistat on both systolic BP (−1.15 mmHg [−2.11, −0.19]) and diastolic BP (−1.07 mmHg [−1.69, −0.45]), regardless of its dosage. Significant associations were found between changes in systolic BP and diastolic BP with treatment duration but not with corresponding baseline BP values. In conclusion, Orlistat use contributes weight loss associated decrease in BP in overweight and obese subjects.

Гендерні особливості функціонального стану нирок щурів із експериментальним ожирінням за умов профілактичного введення Орлістату й біонанокомпозиту на основі фенугреку

Гендерні особливості функціонального стану нирок щурів із експериментальним ожирінням за умов профілактичного введення Орлістату й біонанокомпозиту на основі фенугреку

Toxicity and Safety Concerns in Orlistat Therapy for Obesity: A Critical Evaluation

Orlistat is a selective inhibitor of gastric and pancreatic lipase indicated for the treatment of obesity. It is also known to significantly reduce risk of associated co-morbidities such as heart attack, type-2 diabetes mellitus, hypertension and stroke. Recent reports have raised concerns on the possible occurrence of serious adverse effects with prolonged use. Orlistat has been shown to inhibit carboxylesterase-2, a major detoxification enzyme, predisposing to severe liver, pancreatic and kidney damage. Orlistat alters the pharmacodynamic response of some drugs when co-administered leading to severe toxicity and reduced efficacy. Safety is a major concern considering the widespread use of this drug both as a prescription and over-the-counter medication. There is need for large-scale observation studies on orlistat use to generate appropriate data that will guide the regulatory agencies in taking relevant decision on continued use of orlistat as anti-obesity drug.

Risk of colorectal cancer after initiation of orlistat: matched cohort study

Objective To examine the risk of colorectal cancer after orlistat initiation in the UK population.Design Retrospective matched cohort study.Setting Data from the UK Clinical Practice Research Datalink from September 1998...

Orlistat Probably Doesn't Cause Acute Liver Injury

Orlistat (Alli; Xenical), which inhibits gastric and pancreatic lipase and prevents some dietary fat absorption, is one of only a few drugs available for treating obesity. In 2009, the FDA issued a warning about possible association between orlistat use and liver injury. In this population-based study, U.K. investigators used several large databases to …

Acute Oxalate Nephropathy Associated with Orlistat: A Case Report with a Review of the Literature

Orlistat is a gastrointestinal lipase inhibitor used for weight reduction in obese individuals. Enteric hyperoxaluria caused by orlistat leads to oxalate absorption. Acute oxalate nephropathy is a rare complication of treatment with orlistat. Herein we report a patient presenting with acute renal failure which improved minimal with intravenous hydration. She was found to have oxalate crystals on renal biopsy. Patient admitted orlistat use over the counter for weight reduction on further questioning. The purpose of this case review is to increase awareness among patients since they are more focused on losing weight. This case also calls for the provider attention to educate patients regarding side effects of orlistat because of easy availability of orlistat over the counter.

Study shows no link between orlistat use and colorectal cancer

Study shows no link between orlistat use and colorectal cancer

Liver Failure Requiring Transplantation After Orlistat Use

Orlistat is a United States Food and Drug Administration (FDA)‐approved drug indicated for the management of obesity. The FDA has issued a warning of rare, but severe, reports of liver injury after orlistat use. We describe a 40‐year‐old woman with no significant medical history who experienced fulminant liver failure after orlistat use. Two weeks after taking the drug at a low dosage of 60 mg/day for 4 days, she developed significant fatigue, nausea, right upper abdominal discomfort, and icterus, and her liver enzyme panel showed significant abnormalities. Five weeks later, after further deterioration in her clinical status, she was transferred to our medical center with severe cholestasis and coagulopathy Liver ultrasonography, serologies for viral hepatitis, and autoimmune markers were unremarkable. Early cessation of the drug was not sufficient to stop the progression of liver injury, and she required an orthotopic liver transplant. Two weeks after transplantation, she was discharged in good condition. Published reports of liver injury associated with orlistat use describe a presentation similar to that of our patient. Although use of the Naranjo adverse reaction probability scale indicated a possible relationship (score of 3) between the patient's development of fulminant liver failure and orlistat, we believe this was a drug‐induced case and is consistent with previous reports. To our knowledge, this is the first published report of orlistat‐induced liver failure in the United States. Although orlistat may be a useful drug for weight loss, clinicians should be aware that its use can rarely cause idiosyncratic hepatotoxicty characterized by subacute hepatitis, which may progress to serious injury.

Orlistat use needs to be monitored

Orlistat use needs to be monitored

Izbytochnyy ves i ozhirenie - problema meditsinskaya, a ne kosmeticheskaya

The article covers the issues of epidemiology, considering the classification of obesity, the risks of development of various somatic diseases related to overweight and obesity. The results of clinical studies of orlistat use in the treatment of obese patients are reported.

Orlistat: current status in clinical therapeutics

Background: Obesity has rapidly become a life-threatening epidemic worldwide. There are a plethora of obesity-related co-morbidities and complications that increase morbidity, mortality and cost of care associated with obesity. Orlistat is approved for the treatment of obesity and has been evaluated both in obesity and in the several obesity-related co-morbidities. Objective: The purpose of this article is to provide detail of the pharmacotherapeutic role of orlistat in obesity, describe orlistat and its pharmacological properties, critique the evidence for orlistat's use in obesity and obesity-related co-morbidities, and define the role of orlistat in clinical practice. Methods: A thorough, all-inclusive literature search was conducted to isolate clinical trials, case reports and meta-analyses evaluating the safety and efficacy of orlistat in various patient populations. Results: Orlistat's unique mechanism of action, beneficial effects on multiple co-morbidity surrogates and relatively mild adverse effect and drug interaction profile position it favorably as the first option for pharmacotherapy in comprehensive obesity management of adults and children.

Effects of Orlistat on Visceral Fat After Liposuction

Liposuction can aggravate metabolic complications associated with obesity. It has been shown that the recovery of weight lost through these interventions is associated with body fat redistribution toward the visceral cavity, increasing metabolic risk factors for coronary heart disease such as insulin resistance and high triglyceride levels. The aim of this study was to evaluate the consequences of liposuction on body mass redistribution and metabolic parameters 6 months after surgery and to evaluate the use of orlistat treatment (tetrahydrolipstatin) in controlling these parameters. A population of 31 women with a mean body mass index of 26.17+/-3.9 kg/m(2) and undergoing liposuction of more than 1,000 cm(3), was studied. Twelve of them were treated postsurgery with 120 mg of orlistat every 8 hours for the following 6 months. Anthropometric, analytical, and radiological (computed tomography) tests were performed to quantify visceral fat area before surgery and 6 months after surgery. Despite weight loss after liposuction, visceral fat was not modified. Patients treated with orlistat showed a greater reduction in visceral fat, although not statistically significant. Orlistat use induced a reduction in low-density lipoprotein cholesterol values of 20.0+/-22.5 mg/dL, compared with an increase of 8.46+/-20.1 mg/dL in controls (p=.07). Visceral fat does not decrease despite weight loss after liposuction. Orlistat use postliposuction might be a useful tool because it shows a tendency to reduce visceral fat and improve blood lipids profile.

Furosemide, orlistat and non-steroidal anti-inflammatory agents-too much for the kidneys to handle!

Drug-induced acute kidney injury (AKI) is commonplace. The drugs involved are numerous, and their nephrotoxicities can take on various histopathological patterns that include acute tubular necrosis, renal vasculitis, glomerular disease and acute/chronic tubulo-interstitial disease. Renal prognosis may be improved by the discontinuation of the offending agent, but this is not always the case. This presented patient is unique for two reasons. First, the renal toxicities of chronic furosemide abuse and orlistat use have received only scant attention in the adult nephrology literature [1–4]. Secondly, this patient, once again, demonstrates that the renal dangers of prolonged nonsteroidal anti-inflammatory drug (NSAID) therapy should never be diminished in importance, especially in the setting of chronic kidney disease (CKD).

OTC orlistat use results in high consumer satisfaction, excellent dosing compliance, and use of in-package materials,

OTC orlistat use results in high consumer satisfaction, excellent dosing compliance, and use of in-package materials,

Orlistat for the management of overweight individuals and obesity: a review of potential for the 60-mg, over-the-counter dosage

Orlistat, in the 60-mg over-the-counter dose, was recently approved by the FDA. This lipase inhibitor blocks absorption of ~ 25% of ingested fat and has ~ 85% of the efficacy of the 120-mg dose for weight loss. Over 16 weeks weight loss with diet and orlistat 60 mg averages ~ 5% of initial body weight. The 60-mg dose is better tolerated than the 120-mg dose and the gastrointestinal side effects are minimal when individuals consume < 30% of their energy from fat. In addition to facilitating modest weight loss, orlistat use decreases serum LDL-cholesterol values by ~ 10%. When taken three times daily before meals, orlistat 60 mg modifies lifestyle behavior, encourages lower fat-consumption and sets the stage for other healthy lifestyle changes.

Treatment of Obesity

Treatment of Obesity