Xenical

Xenical stops your body absorbing fat – after ingesting fat from your food, enzymes in your stomach and intestines break the fat down into different smaller components. Fat can only be absorbed into the bloodstream once it has been broken down into these tiny fragments.

These specific enzymes which break the fat down, are called lipases.

Xenical works by binding to lipase enzymes, and stopping them from being able to function. Fat therefore passes onwards, through the gut towards the bowel and out of your body, without being taken up into the bloodstream. This means you absorb less calories from fat and so your overall calorie count is lower. If it regularly stays below the amount of calories your body uses in a day then you could lose weight.

Why fat? – the fat content of your diet is very important. Gram for gram, fat contains more than twice the calorie content of carbohydrate or protein. Lowering the fat content of your diet is likely to speed your weight loss:

• 1 g carbohydrate contains 4 calories
• 1 g protein contains 4 calories
• 1 g fat contains 9 calories

A low fat diet, requires reducing your fat intake to around 20% of your dietary intake:

• To maintain body weight the average woman requires 1,600 - 2,000 calories per day
• To maintain body weight the average man requires 2,000 - 3,000 calories per day
• To lose weight men and women should aim to consume 1,200 - 1,600 calories per day

A healthy diet should contain:

• 45-65% carbohydrate
• 10-35% protein
• 30-35% fat

In addition, think about the types of fat you are eating:

• It’s important to have less saturated fat, (high fat meat, butter, cream, cheese, full fat milk)
• And more unsaturated fat (olive oil, avocado, hummus, seeds and nuts)

It is extremely important that while you are taking xenical – you stick to a low calorie diet, with no more than 30% fat content.

If you don’t do this, xenical will not be effective and you will not lose weight. In addition, you could get digestion-related side effects such as stomach pain, wind, and diarrhoea.

How to reduce your fat intake:

• Stop using butter and swap this for a low fat spread
• Choose lean meat, and when cooking trim off any visible fat
• Don’t eat the skin from chicken for example, or pork (crackling)
• Try not to add fat when cooking. This means, grill, bake, poach or microwave instead of frying or roasting
• Choose low fat milk, yoghurt, reduced fat cheeses or spreads
• If you use a cook-in sauce, always choose the lowest fat option – it should be less than 5g fat per 100g sauce

When should I take xenical?

• Xenical capsules 120 mg, should be taken, one capsule, three times a day
• These capsules should be taken just before, or no longer than one hour after, a meal. They should be swallowed with water
• If the meal is totally fat free, omit the tablet
• There is no additional benefit from increasing the dose
• You may notice changes in your stools within 24-48 hours of starting treatment

Other tips for taking xenical:

• Tip 1 – Make sure you eat 3 meals a day
• Tip 2 – At every meal eat some carbohydrate such as bread, potato, rice or pasta as this helps you to feel full for longer
• Tip 3 – When you look at your plate, at least half of it should be covered with vegetables or salad
• Tip 4 – One suggestion is to have a smaller plate
• Tip 5 – Eat slowly, drink water, don’t give up
• Tip 6 – Shop sensibly. If you don’t buy it, you can’t eat it
• Tip 7 – Eat more fibre
• Tip 8 – Reduce your sugar intake
• Tip 9 – Exercise

When will I see results? – if you are using Xenical successfully, within 12 weeks, you may expect a reduction of 5% of your baseline body weight. By 12 months this may be 10%.

It is important that you continue your low calorie, restricted fat, diet at the same time as taking xenical.

After 12 weeks, if you have not had significant weight reduction, you should stop taking Xenical and get advice from a doctor.

Please note – Xenical is a type of medication, like any other medication your doctor prescribes, and needs to be taken carefully according to the manufacturers’ instructions and the details of the product license.

It can be hard getting Xenical on the NHS – sometimes patients have difficulty obtaining xenical. This is because of local or national prescribing restrictions. The NICE (National Institute for Care and Excellence) recommendation is that patients only qualify for xenical if they have a BMI of over 30.

You can get Xenical online – using an online doctor service like ours means you can get an assessment for weight loss treatment quickly and easily. Simply complete a short assessment so your online doctor can check if Xenical is a good medication for you. Once your request has been approved you can choose to have your medication posted to you or you can collect it from a local post office.

Will Xenical be right for me? – Xenical may be right for you:

• If you are obese, i.e. have a BMI of >30 kg/m2
• If you have a BMI of >28 but have additional risk factors such as diabetes or heart disease

But in both cases, xenical should only be taken in conjunction with a low calorie diet, which contains no more than 30% fat maximum.

Xenical is not right for you if you are taking certain other medication:

• Ciclosporin – lowered ciclosporin levels have been observed in people taking xenical and ciclosporin. This could affect their levels of immunosuppression. Generally this is not recommended, but if it is imperative, ciclosporin blood levels should be checked
• Amiodarone – a slight decrease in amiodarone levels has been reported in patients taking both drugs. Whereas this is unlikely to be clinically significant, careful monitoring including ECGs is recommended
• Anticoagulants – warfarin and oral anticoagulants. Alterations in coagulation have been reported in patients taking both drugs, so regular monitoring of blood clotting and drug dosages will be required
• Epilepsy Medication – convulsions have been observed in epileptic patients using xenical and antiepileptic drugs such as valproate and lamotrigine. These patients should be monitored for changes in the frequency and severity of their convulsions
• Hypothyroidism – rarely hypothyroidism may occur in patients on xenical possibly due to lack of iodine absorption in the gut, or in patients with established hypothyroidism, their condition may worsen
• Anti-HIV drugs, Antipsychotics, Lithium, Antidepressants and Benzodiazepines – all these drugs may potentially be affected by use of xenical. Use of xenical in patients on these treatments needs very careful consideration and monitoring
• Oral Contraception – there is a potential for lack of absorption of the oral contraceptive, and a possible increased chance of contraceptive failure. While on xenical an additional or alternative contraception is recommended

Xenical might not be right for you based on other personal circumstances – Xenical should not be taken if you have:

• An allergy to xenical or any of the ingredients fo the capsules
• Chronic malabsorption
• Jaundice or liver abnormalities
• Pregnancy or are breastfeeding
• Chronic kidney disease – xenical may rarely increase the risk of a rare kidney nephropathy, oxalate nephropathy

Xenical does come with a risk of some side effects – the most common side effects are gastrointestinal. These may occur in between 1/10 and 1/100 users:

• Stomach/tummy pain
• Discharge from the back passage
• Bloating/distension
• Flatulence/wind
• Soft/loose stools
• Urgent need to have your bowels open
• More frequent bowel motions
• Pain/discomfort in the back passage

Other very common/common side effects of Xenical include:

• Headache
• Infections of the upper respiratory tract
• Urinary tract infections
• Tiredness/fatigue
• Menstrual disturbance
• Low blood sugar – only reported in those with type 2 diabetes

Other conditions have been reported which may be associated with use of Xenical, but it's not clear if Xenical causes them, so their frequency is unknown. These include:

• Disturbance of liver function, gallstones and hepatitis
• Abnormalities of blood clotting
• Pancreatitis
• Diverticulitis
• Blistering skin
• Rare kidney disease – oxalate nephropathy

What to do about side effects – Xenical is not absorbed into the bloodstream - it works only because of a local action in the bowel to block the absorption of dietary fat. Therefore serious side effects are rare. Any initial side effects are likely to be mild, and to improve with time.

It is important to take xenical exactly as you have been advised, at regular intervals before or with your meals.

The most common side effects are gastrointestinal as outlined above. To reduce the chance of these occurring, the most important thing to do, is to stick closely to the low calorie, restricted fat diet. If you do not do this, there will be a surplus of fat in the bowel and this is likely to be the cause of any stomach upset. Try to stick to your special diet as strictly as you can.

What to do in case of emergency? – the most serious side effect of xenical is a sudden allergic reaction to taking these capsules. Usually this would become apparent within minutes of swallowing them. This type of reaction, called anaphylaxis, is very rare with xenical.

Symptoms of anaphylaxis include:

• Shortness of breath/wheezing/tight chest
• Facial swelling/mouth/face/tongue
• Blotchy skin rashes/itchy skin/urticaria
• Confusion/altered consciousness
• With/without chest pain, fast heartbeat, feeling faint/dizzy and unwell, sweating

Anaphylaxis to any medication is an acute emergency. You, or a carer/relative or friend, should call 999 without delay. In the meantime, try to keep calm, breathe slowly and deeply, and do not take any more capsules without medical advice.

Xenical could be right for you if you are trying to lose weight and you want the support of medication to help you achieve your weight loss goals. In particular you might find Xenical more helpful than dieting alone.

Needing extra support is normal – being overweight can be difficult. Many of us have tried dieting numerous times, with limited success. In fact in a 2013 survey, 2 out of 5 dieters will quit within 7 days, and only 1 in 5 will make it to week 4. Overall 95% of diets are said to fail, and only 1% of dieters manage to lose weight permanently.

Why is controlling weight important? – being overweight increases your risk significantly of conditions such as type 2 diabetes, heart disease and stroke, arthritis and some types of cancer. Weight loss will have very important benefits for your health.

What are the risks of being overweight, especially over time? – obesity is increasingly common. Currently, 1 in 4 adults and 1 in 5 children in the UK are said to be ‘obese.’ It is estimated that being obese can reduce your life expectancy by 3-10 years.

Xenical can be part of a general weight loss strategy – to lose weight, you first need to assess your weight and general health, set realistic goals and then plan your weight loss strategy. Weight loss can be approached in the following way:

• A low calorie diet
• Increased exercise
• Consideration of other options e.g. weight loss capsules

Sustained weight loss is very unlikely to be achieved by any one of these 3 factors, on their own.

Xenical is NHS approved – most NHS doctors would agree that xenical (orlistat) is the preferred choice for anyone who needs to take a weight losing drug. This is because it only works locally - inside your intestines - and it is not absorbed into your bloodstream like all the other drugs used to treat obesity.

Xenical is different from historical weight loss capsules – in the past, other types of weight losing drugs have been abused, with serious outcomes. It is uncommon for these drugs now to be available for this purpose, as capsules like Xenical represents a much safer alternative.

Treating obesity with xenical, a drug that is merely blocking fat absorption, and not affecting brain function in any way, has to be a much safer alternative.

Providing you have a proper health consultation, and are fully informed about xenical, this well researched, safe and effective weight loss medication, has every possibility of helping you achieve your weight loss goals.

Sources:

Cheplapharm Arzneimittel GmbH (2017). Xenical 120 mg hard capsules. EMC. [online] Available at: https://www.medicines.org.uk/emc/medicine/33323 [accessed 29th January 2018].

Padwal R. Li S. K. and Lau D. C. (2003). Long-term pharmacotherapy for obesity and overweight. Cochrane Database Syst Rev; 4: CD004094.