Pharmacist intervention enhances adherence to orlistat therapy.

Malone M, Alger-Mayer SA.

Department of Pharmacy Practice, Albany College of Pharmacy, Albany, NY 12208, USA. malonem acp.edu

BACKGROUND: Pharmacists, especially those in community practice, should increase their level of intervention in dealing with the nationwide epidemic of obesity since they interact with large numbers of the public on a regular basis. We hypothesized that patients who receive medication for weight loss may have an improved therapeutic outcome if they received additional support from their community pharmacist. OBJECTIVE: To evaluate the impact of pharmacist support on patient persistence with orlistat. METHODS: Pharmacists were trained in basic obesity management skills. Patients who were prescribed orlistat and attending an outpatient nutrition program were invited to participate in the study. All patients agreed to receive pharmaceutical care. Those who lived where the service was available were assigned to the intervention (I) group and those who did not were assigned to the control (C) group. All patients received usual care provided by the outpatient clinic. RESULTS: Thirty patients, 15 in the I group and 15 in the C group, were recruited. Both groups were predominantly women (87%) with a mean +/- SD age of 43.8 +/- 9.7 years. Patients in the I group had significantly greater persistence with orlistat therapy as assessed by duration of therapy (p = 0.006) and number of patients completing the 26-week study (7 I, 2 C; p = 0.046). There was no significant difference in percent of weight loss between groups (p > 0.05). CONCLUSIONS: In this pilot study, patients receiving pharmaceutical care took orlistat longer than the controls and had improved outcome with orlistat therapy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14565841&dopt=Abstract orlistat Xenical online refs
xenical (orlistat)


Orlistat. No hurry....

[Article in English, French]

[No authors listed]

Treatments for obesity are disappointing. None has yet shown an effect on morbidity and mortality. Nondrug treatments are poorly assessed. Stable long-term weight loss necessitates long-term management. Orlistat (Xenical, Hoffman-La Roche), a gastrointestinal lipase inhibitor, is indicated, in combination with a low-calorie diet, for management of obesity. The assessment file is bulky and methodologically sound, at least in terms of the weight loss end point. During medium-term trials (12 to 24 months), orlistat administered at a dose of 120 mg three times daily and combined with dietary intervention had a moderate positive effect on body weight (-3.5 kg on average). No longer-term trials have been done. It is unknown whether this drug affects morbidity and mortality linked to obesity. In clinical trials, patients treated with orlistat had an increased frequency of breast cancer. This potential risk is currently being assessed in a specific trial. Gastrointestinal adverse effects are frequent. Treatment is costly.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10540693&dopt=Abstract orlistat Xenical online refs
xenical (orlistat)


[Long-term drug therapy of obesity in 2002--pharmacoeconomic aspects]

[Article in Czech]

Minarcikova I.

Ustavni lekarna Fakultni nemocnice, Brno. iminarcikova hotmail.com

A growing number of obese people throughout the world have become a health-economic problem. Obesity and overweight are significant risk factors causing increased morbidity and mortality in obese people. Nevertheless, a marked improvement in the prognosis is achieved by a 5-10% decrease in body weight. Since 1 July 2002, two preparations for long-term therapy of obesity have been registered in the Czech Republic: Xenical (orlistat) and Meridia (sibutramin). Long-term randomized double-blind studies have shown that a decrease of 4.4 kg in weight within a year is achieved by 10 mg sibutramin administration, a decrease of 3.2-6.4 kg in weight within a year is achieved by 15 mg sibutramin administration, a decrease of 7.4-9.1 kg in weight within a year is achieved by orlistat administration, and placebo administration causes changes in weight ranging from -6.5 kg to +0.94 kg. A cost-to-effectiveness comparison has revealed that in one year the direct costs (ORC) of a decrease in body weight by 1 kg after deduction of the placebo effect make 9,817 CZK to 22,078 CZK (the supplementary payment of the patient being 2698 CZK to 7722 CZK) in sibutramin treatment, and 9101 CZK to 13,085 CZK (the supplementary payment of the patient being 632 CZK to 909 CZK) in orlistat treatment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14619705&dopt=Abstract orlistat Xenical online refs
xenical (orlistat)


Effect of orlistat on fat absorption in rats: a comparison of normal rats and rats with diverted bile and pancreatic juice.

Porsgaard T, Straarup EM, Mu H, Hoy CE.

BioCentrum-DTU, Biochemistry and Nutrition Group, Center for Advanced Food Studies, Technical University of Denmark, DK-2800 Lyngby, Denmark. tpo biocentrum.dtu.dk

Orlistat is a specific inhibitor of pancreatic and gastric lipases leading to decreased absorption of fat. In the present study, we measured the effect of orlistat on lymphatic fat transport in rats following intake of oils very different in FA composition and TAG structure, and compared this with the transport in normal rats and rats with fat malabsorption. Rats were subjected to cannulation of the main mesenteric lymph duct, and a feeding catheter was inserted into the stomach. In addition, malabsorbing rats were cannulated in the common bile and pancreatic duct. Emulsified safflower, fish, and randomized oils were administered, and lymph was collected for 24 h and analyzed for FA composition. Administration of 25 mg orlistat together with the dietary oils resulted in very small changes from baseline lymphatic transport, indicating that inhibition of the fat absorption was almost complete and furthermore that the source of fat had no influence on the inhibitory effect of orlistat. Orlistat did not interfere with the absorption of the hydrolysis products, since high absorption of sn-2 MAG and FFA (oleic acid) mixed with orlistat was observed. The baseline lymphatic transport in the orlistat group was higher than in the malabsorbing group, but this was the result of generally lower transport of endogenous FA in the malabsorbing group, presumably caused by the absence of bile FA. The transport of FA in normal rats was several-fold higher than the transport after orlistat addition and in malabsorbing rats. Thus, this study showed that orlistat inhibited fat hydrolysis, and thereby lymphatic absorption, almost completely independently of the fat administered.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14669968&dopt=Abstract orlistat Xenical online refs
xenical (orlistat)


Screening for pancreatic exocrine insufficiency in patients with diabetes mellitus.

Nunes AC, Pontes JM, Rosa A, Gomes L, Carvalheiro M, Freitas D.

Department of Gastroenterology, University Hospitals of Coimbra, Avenida Urbano Duarte, Quinta da Estrela, Lote 7, 6o B, Coimbra, Portugal.

OBJECTIVES: Fecal elastase 1 (E1) is a relatively sensitive and specific indirect test of pancreatic exocrine function. Despite the high functional reserve of the pancreas, it is recognized that a significant proportion of diabetic patients may also have a deficit of the exocrine function. The aim of this study was to screen patients with diabetes mellitus (DM) for pancreatic exocrine insufficiency. METHODS: A total of 80 patients were enrolled in this prospective study, including 42 patients with DM and 38 nondiabetic controls. Exclusion criteria were as follows: age >75 yr; alcohol intake >40 g/day; intake of orlistat or acarbose; and history of diarrhea, pancreatitis, GI surgery, immunodeficiency, or cancer. All patients underwent the same study protocol, which included clinical evaluation, determination of fecal E1, plain x-rays of the abdomen, and abdominal ultrasound. An immunoenzymatic method (ScheBoTech, Wettenburg, Germany) was used for E1 determination. Diagnosis of pancreatic insufficiency was established for a fecal E1 <200 microg/g. RESULTS: The DM and control groups were comparable regarding age (62 +/- 10 yr vs 56 +/- 10 yr), sex (18 men and 24 women vs 15 men and 23 women), and proportion of patients with excess weight (50% vs 42%). Patients had DM diagnosed for 11.5 +/- 8 yr, with structural changes of the pancreas detected on ultrasound in three cases and calcifications in one case. There was no relationship between E1 determination <200 microg/g and the duration or the type of therapy for DM. Fifteen patients (36%) in the DM group had a fecal E1 <200 microg/g, compared with two patients (5%) in the control group (p < 0.05). In the DM group (n = 42), 11 patients with excess weight presented a fecal E1 <200 microg/g, whereas four patients with a BMI <25 presented this result (p < 0.05). CONCLUSIONS: Pancreatic exocrine insufficiency occurs more frequently in diabetic patients than in controls. Diabetic individuals with excess weight (BMI >25) may be at increased risk for underlying exocrine pancreatic insufficiency.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14687815&dopt=Abstract orlistat Xenical online refs
xenical (orlistat)