Orlistat

About Orlistat

Orlistat is a reversible inhibitor of the stomach and pancreatic enzymes (lipases) that digest fat, so some of the fat in a meal passes through undigested. Xenical’s label, revised in September 2026, approves it with a reduced-calorie diet and increased physical activity to reduce excess body weight and keep it off long term in adults and children 12 and older with obesity, and in adults with overweight and at least one weight-related condition; safety and effectiveness below age 12 are not established. The dose is one 120 mg capsule three times a day with each main meal that contains fat, during the meal or up to an hour after it, skipped if a meal is missed or has no fat; higher doses have not shown more benefit. The day’s fat, carbohydrate and protein are spread over three main meals. Alli, 60 mg, is labeled for overweight adults 18 and older on a reduced-calorie, low-fat diet: one capsule with each meal containing fat, no more than three a day.

There is no boxed warning. It must not be taken with chronic malabsorption, cholestasis or an allergy to orlistat or an ingredient. Serious outcomes from a loss of effect of cyclosporine, levothyroxine, warfarin, amiodarone, seizure medicines, HIV medicines, some fat-soluble vitamins and beta-carotene have been reported with it, and because it can lower vitamin K absorption, INR changes have been reported with warfarin. Rare severe liver injury has been reported: loss of appetite, itching, yellow skin or eyes, dark urine, light stools or pain in the upper right abdomen mean stopping it and getting liver tests. It can raise urinary oxalate, leading to kidney stones and oxalate kidney damage that can progress to kidney failure, so kidney function is watched in people with kidney disease or past oxalate stones, and gallbladder disease such as gallstones has been reported. Oily spotting, gas with discharge, urgent bowel movements, fatty or oily stools, more frequent bowel movements and loss of bowel control are the most common side effects, and they increase with a high-fat diet.

A daily multivitamin with vitamins A, D, E, K and beta-carotene is taken at least 2 hours before or after orlistat, or at bedtime. The label FDA approved on 30 September 2026 removed pregnancy from the contraindications: published studies have not identified an increased risk of birth defects, miscarriage or other harm, but weight loss offers no benefit in pregnancy and may lead to a baby who is small for gestational age, so Xenical is stopped once a pregnancy is recognized. In October 2026, DailyMed still posted the earlier label, which lists pregnancy as a contraindication, for Xenical and its authorized generic (the same capsule labeled orlistat). There are no data on orlistat in breast milk or on breastfed infants. Alli is a nonprescription product; its label says not to use it after an organ transplant, with cyclosporine, with problems absorbing food, when not overweight, or when pregnant or breastfeeding.

Taking Orlistat

How to take it

One 120 mg capsule with each main meal containing fat, during the meal or up to 1 hour after; skip the dose if a meal is missed or has no fat. Take a multivitamin with vitamins A, D, E, K and beta-carotene once a day, at least 2 hours before or after orlistat or at bedtime.

If you miss a dose

Take the missed dose as soon as you remember, unless it is more than 1 hour since you ate a main meal; then skip it and continue as usual. Do not take a double dose.

Storage

At room temperature in the container it came in, tightly closed, away from excess heat, moisture (not in the bathroom) and light, out of reach of children.

Interactions to know about

Take cyclosporine 3 hours after orlistat, and keep levothyroxine and orlistat at least 4 hours apart. Blood clotting is checked with warfarin, seizure control with seizure medicines and viral load with HIV medicines, and amiodarone’s effect can be reduced.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Orlistat differs from pharmacy to pharmacy

With no rated generic, a 120 mg fill is either Xenical or its authorized generic, both made under the same approval, so quotes differ in which of the two a pharmacy dispenses and in its dispensing fee and markup. The quantity written also changes a quote, and each fill carries its own dispensing fee.

Alli is bought off the shelf, so it is not part of a prescription quote.

Ways to pay less for Orlistat without insurance

• Ask whether the pharmacy can supply the authorized generic, Xenical’s own capsule labeled orlistat.
• Once you are settled on it, ask the prescriber for a ninety-day supply, and compare more than one pharmacy.
• Ask the prescriber whether over-the-counter Alli would suit you instead.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Orlistat

1. 1.How should I time my multivitamin and my other medicines around orlistat?
2. 2.Does it affect my levothyroxine, warfarin, cyclosporine or seizure medicine?
3. 3.Which liver, kidney or gallbladder symptoms should make me stop it and call?
4. 4.Would Alli suit me instead of the prescription strength?

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