Orlistat (Xenical)

Orlistat 120mg is a prescription weight loss capsule. It stops about a third of the fat you eat from being absorbed, and is taken with each main meal alongside a reduced-calorie, lower-fat diet. Xenical is the original brand. At MedsRus, a UK prescriber registered with the General Pharmaceutical Council reviews a short online consultation, including your weight and health, before supplying it.

Orlistat at a glance

A lower strength, orlistat 60mg, is sold in pharmacies without a prescription.

How orlistat works

Orlistat blocks lipase, an enzyme in your gut that breaks down fat. Undigested fat can't be absorbed, so it passes out in your stools instead of adding calories. Orlistat doesn't affect appetite, and it only works on the fat in a meal, which is why the diet matters.

How much weight can I expect to lose?

In studies, people taking orlistat with a reduced-calorie diet lost more weight than people who followed the diet alone. On average that's a few extra kilograms over a year, but results vary a lot. If you haven't lost at least 5% of your starting weight after 12 weeks, the prescriber will usually stop treatment, because it's unlikely to help more after that.

How to take orlistat

• Take one 120mg capsule with water during each main meal, or up to 1 hour after.
• If you miss a meal, or the meal contains no fat, skip that capsule.
• Don't take more than 3 capsules a day. More won't help you lose more weight, but it will make side effects worse.
• Take a multivitamin at bedtime, at least 2 hours after your last capsule.

Diet tips

Spread your fat, carbohydrate and protein across three meals. Keeping fat to about 30% of the calories in each meal reduces side effects; a high-fat meal is the most common cause of oily, urgent stools. Our page on weight loss treatments has more advice on diet and activity.

Side effects

• Common, especially after fatty meals: oily or fatty stools, wind with oily spotting, an urgent need to go to the toilet, loose stools and tummy pain. These usually ease as you adjust your diet.
• Other side effects include headache, anxiety, and cold or flu-like symptoms.
• Rare: bleeding from the bottom, liver problems (yellow skin or eyes, itching, dark urine) or a severe skin reaction. Stop taking it and get medical help.

Who shouldn't take orlistat?

• Anyone who is pregnant or breastfeeding.
• People with cholestasis (a problem with bile flow from the liver) or chronic malabsorption syndrome.
• Anyone allergic to orlistat or any of the other ingredients.

Medicines to check

• Diabetes medicines: your blood sugar may improve as you lose weight, so they may need adjusting.
• The contraceptive pill: if orlistat gives you severe diarrhoea, use extra contraception, such as condoms, and follow the advice in your pill's leaflet.
• Ciclosporin: orlistat can lower ciclosporin levels, so they're not usually taken together.
• Levothyroxine: take it at least 4 hours apart from orlistat.
• Epilepsy medicines: tell us, because seizure control can be affected.
• Warfarin and other anticoagulants: your INR may need checking more often.
• Amiodarone, acarbose, HIV medicines and iodine salts: tell the prescriber, as orlistat may affect them.

Orlistat and weight loss injections

Orlistat works in the gut. Newer medicines such as Mounjaro injections and Wegovy tablets act on appetite hormones, and weight loss with them is usually greater. They're not suitable for everyone, and orlistat can be a good option if you'd rather avoid injections. Read about how long weight loss medicines take to work.

How to get orlistat from MedsRus

1. Answer a few questions about your weight, your health and any medicines you take.
2. A UK prescriber registered with the General Pharmaceutical Council reviews them and, if orlistat is suitable, issues a prescription.
3. Our UK pharmacy sends it in discreet packaging.

Orlistat FAQs

How quickly does orlistat work?

It starts working on the fat in your next meal, so you may notice changes in your stools within a day or two. Weight loss is gradual. The prescriber will check your progress at 12 weeks.

Can I take orlistat with the pill?

Yes. Orlistat doesn't stop the pill working, but severe diarrhoea can. If orlistat gives you severe diarrhoea, use extra contraception, such as condoms, and follow the advice in your pill's leaflet for vomiting and diarrhoea.

Do I need a multivitamin with orlistat?

Yes. Orlistat reduces how well you absorb vitamins A, D, E and K. Take a multivitamin at bedtime, at least 2 hours after your last orlistat capsule.

Can I take orlistat if I have diabetes?

Yes, orlistat can be prescribed for people with type 2 diabetes. As you lose weight your blood sugar may improve, so your diabetes medicines may need adjusting. Tell the prescriber about all your diabetes medicines.

Orlistat or a weight loss injection?

They work differently. Orlistat stops some of the fat you eat being absorbed; injections such as Mounjaro and Wegovy reduce appetite. Weight loss with the injections is usually greater, but they aren't suitable for everyone. The prescriber will help you choose.

Is Xenical the same as orlistat?

Yes. Xenical is a brand of orlistat 120mg. Generic orlistat 120mg contains the same medicine at the same strength.

Sources:

• NHS: Orlistat
• NICE: Overweight and obesity management (NG246)