Managing CMR

Managing Cardiometabolic Risk in Abdominally Obese Patients

Pharmacotherapy

Orlistat

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Adverse Side Effects
The main adverse effects of orlistat are gastrointestinal. Fatty and oily stool, fecal urgency, and oily spotting occur in 15 to 30% of orlistat-treated patients (2 to 7% with placebo) (25). Fecal incontinence is observed in 7% of orlistat-treated patients vs. 1% in those receiving placebo (13, 25). These gastrointestinal symptoms are common initially but subside as patients learn to use the drug (23). To prevent possible deficiencies in fat-soluble vitamins, the absorption of which is also reduced by orlistat, prescription of a daily multivitamin is recommended. Because gut absorption of orlistat is minimal, there are virtually no systemic adverse effects. Past concerns regarding increased risk of breast cancer in orlistat-treated patients are no longer considered relevant (20).

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13. Padwal R, Li SK and Lau DC. Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis of randomized controlled trials. Int J Obes Relat Metab Disord 2003; 27: 1437-46.
20. McNeely W and Benfield P. Orlistat. Drugs 1998; 56: 241-9.
23. Bray GA and Greenway FL. Current and potential drugs for treatment of obesity. Endocr Rev 1999; 20: 805-75.
25. Padwal R, Li SK and Lau DC. Long-term pharmacotherapy for obesity and overweight. Cochrane Database Syst Rev 2003; CD004094.
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