Who should take orlistat?
Alli should only be used in patients over 18 who have a BMI of 28kg/m2 or more (Electronic Medicines Compendium (EMC), 2009a). A height measure and calibrated weighing scales are needed to calculate a patient’s BMI. Xenical has been reviewed in a NICE clinical guideline, and should be used in patients with a BMI of 30kg/m2 or more, or in patients with a BMI of 28kg/m2 or more with associated risk factors (NICE, 2006). There is no information on the use of orlistat when pregnant or breastfeeding, so it should be avoided in these patients. It should also not be used in patients with cholestasis or chronic malabsorption syndrome. Orlistat should be used in conjunction with a lower-fat, mildly hypocaloric diet. This diet should be nutritionally balanced, with fat providing 30% of the calorie intake, distributed over three main meals per day. It is recommended that the diet and an exercise programme should be started before beginning treatment with Alli, and this programme should continue o
