Medicine used in the Treatment of Obesity

Elaine NeilLead Pharmacist

North Aberdeenshire LCHP

Medicine At one time 3 medicines licensed

• Orlistat

Xenical - POM

Alli - OTC

Orlistat• Promotes loss of weight by preventing the

digestion and absorption of fat

• Inhibitor of GI lipases acting in stomach and small intestine

• Reduces absorption of dietary fat by around 25-30%

• The unabsorbed fat is excreted in the stool.

ContraindicationsSee BNF/SPC

• Hypersensitivity

• Chronic malabsorption

• Cholestasis

• Breast-feeding

• Caution in pregnant women

• The effect of orlistat in patients with hepatic and/or renal impairment, children and elderly patients has not been studied.

Side – effectsSee BNF/SPC

• Liquid or oily stools / Oily leakage from rectum • Flatulence and Bloating/ abdominal pain • Faecal urgency• Faecal incontinence

• Dyspepsia Menstrual disturbances• Headache Tooth disorder • Anxiety Gingival disorder• Fatigue Influenza • Respiratory infection Urinary tract infection• Hypoglycaemia

Drug InteractionsSee BNF/SPC

• Ciclosporin Anti-epileptics

• Fat soluble vitamins Amiodarone• Levothyroxine

• Warfarin – monitor INR• Oral contraceptives – diarrhoea

Orlistat - Xenical

Dose • 120mg taken with water immediately

before, during or up to one hour after main meals.

• Max dose 360mg daily.

• Doses above 120 mg three times daily have not been shown to provide additional benefit.

Orlistat• Take with calorie controlled diet, 30% calories

from fat, distributed over 3 main meals.

• Omit dose if no main meal taken or no fat content.

• Increase in faecal fat 24 to 48 hours after dosing, levels return to pre-treatment levels, within 48 - 72 hours.

Eligible Patients• BMI 30kg/m2 or greater

• BMI 28kg/m2 or greater with risk factors

diabetescoronary heart diseasehypertensionhypercholestraemia

Additional “treatment”Orlistat must be prescribed in conjunction with other measures to support weight loss

• Diet modification• Increase in physical activity• Behaviour modification• Appropriate support and encouragement

Weight Monitoring• Serious attempts to lose weight before

starting

• Monitor weight loss during treatmentWeight loss – 5% over 3 months(lower in patients with type 2 diabetes)

Weight Monitoring• Treatment with orlistat should be discontinued after 12

weeks if patients have not lost at least 5 % of the body weight measured at the start of therapy.

• Stop therapy if weight loss inadequate

• May get weight gain on stopping Long-term maintenance of weight loss after a period of obesity is difficult and often unsuccessful, and thus may require sustained support.

Outcomes• Pooled data from five 2 year studies with orlistat and a

hypocaloric diet showed that 37 % of orlistat patients and 19 % of placebo patients demonstrated a loss of at least 5 % of their baseline body weight after 12 weeks of treatment.

• Of these, 49 % of orlistat treated patients and 40 % of placebo treated patients went on to lose 10 % of their baseline body weight at one year.

• Overall, after one year of treatment, the percentage of patients taking 120 mg orlistat who lost 10 % or more of their body weight was 20 % compared to 8 % of patients taking placebo.

• The mean difference in weight loss with the drug compared to placebo was 3.2 kg.

Xenical – prescription (POM)• Xenical 120mg capsules

Alli – over the counter (OTC)

• Alli 60mg capsules• Maximum 60mg three times daily• Use for 6 months• Discard any capsules

stored in the carry

case for more than

one month.

Costs• Orlistat (Xenical) – 120mg x 3

daily28 days supply £31.63

• Alli 60mg x 3 daily28 days supply £15- £35 Pharmacy or Internet supply

NHS Grampian SpendNHS Grampian

GIC (Dispensed) - Orlistst

0

20000

40000

60000

80000

100000

120000

2008/09Q1

2008/09Q2

2008/09Q3

2008/09Q4

2009/10Q1

2009/10Q2

2009/10Q3

2009/10Q4

2010/11Q1

2010/11Q2

2010/11Q3

2010/11Q4

2011/12Q1

NHS Grampian Spend

2010/11

• 9126 prescriptions

• £338,643

NHS Grampian SpendGIC per 1000 weighted patients - Orlistat

0.00

100.00

200.00

300.00

400.00

500.00

600.00

2010/11 Q1 2010/11 Q2 2010/11 Q3 2010/11 Q4

ABERDEEN CITY COMMUNITY HEALTH PARTNERSHIP ABERDEENSHIRE COMMUNITY HEALTH PARTNERSHIP

MORAY COMMUNITY HEALTH & SOCIAL CARE PARTNERSHIP

NHS Grampian SpendGIC per 1000 weighted patients - Orlistat

0.00

50.00

100.00

150.00

200.00

250.00

2010/11 Q1 2010/11 Q2 2010/11 Q3 2010/11 Q4

ABERDEENSHIRE - CENTRAL LOCALITY ABERDEENSHIRE - NORTH LOCALITY ABERDEENSHIRE - SOUTH LOCALITY