Xenical is a powerful, specific and reversible gastrointestinal lipase inhibitor with long-lasting effects. Its therapeutic effect is carried out in the lumen of the stomach and small intestine and consists in the formation of a covalent bond with the active serine part of the stomach and pancreatic lipase.
The inactivated enzyme loses the ability to break down food fats in the form of triglycerides into absorbed free fatty acids and monoglycerides. Since undissolved triglycerides are not absorbed, the resulting decrease in calorie intake leads to a decrease in body weight. Thus, the therapeutic effect of the drug is carried out without absorption into the systemic blood flow.
Judging by the results of the fat content in the feces, the effect of the eagle begins 24-48 hours after intake. After cancellation of the drug, the fat content in the stools after 48-72 hours usually returns to the level that occurred before the start of therapy.
Long-term treatment of obese or overweight patients, including those with obesity-related risk factors, combined with a moderately hypocaloric diet. In combination with hypoglycemic drugs (metformin, sulfonylurea derivatives and/or insulin) or a moderately hypocaloric diet in overweight or obese patients with type 2 diabetes mellitus.
In combination with hypoglycemic drugs (metformin, sulfonylurea derivatives and/or insulin) or a moderately hypocaloric diet in overweight or obese patients with type 2 diabetes mellitus: In adults, the recommended dose of orlistate is one capsule of 120 mg with each meal (with meals or no later than one hour after meals). If a meal is missed, or if the meal does not contain fat, Xenical can also be missed. The drug should be taken in combination with a balanced, moderately hypocaloric diet containing no more than 30% calorie in the form of fat. The daily intake of fats, carbohydrates and proteins should be distributed over three main methods.
The increase in the dose of orlistate above the recommended one (120 mg 3 times a day) does not increase its therapeutic effect. Efficacy and safety of Xenical in patients with liver and/or kidney dysfunction, as well as in elderly and children (under 12 years of age) were not studied. During Xenical therapy, the patient should receive a balanced, moderately hypocaloric diet containing no more than 30% calories in the form of fat. A higher fat content in the diet increases the likelihood of gastrointestinal adverse reactions. Weight loss in patients may improve metabolism in patients with diabetes mellitus and require a reduced dose of oral antidiabetic drugs. In clinical trials, the majority of patients who received Xenical for 2 full years, concentrations of vitamins A, D, E, K and beta-carotene remained within normal limits. In some cases, for adequate intake of all nutrients into the body can be prescribed multivitamins, which should be taken at least 2 hours after taking Xenicals or before bedtime.
No interaction with amitriptyline, atorvastatin, biguanides, digoxin, fibrates, fluoxetine, losartan, phenytoin, oral contraceptives, phentermine, right-statin, warfarin was revealed, nifedipine GITS (gastrointestinal therapy system) and nifedipine with slow release, sibutramine or alcohol (based on studies of drug interactions). However, MNRs should be monitored for concomitant therapy with warfarin or other oral anticoagulants. In concomitant administration with Xenical, there was a decrease in absorption of vitamins D, E and beta-carotene. If multivitamins are recommended, they should be taken at least 2 hours after taking Xenical or before bedtime. In concomitant administration of Xenical and cyclosporine there was a decrease in plasma concentrations of cyclosporine, so it is recommended to determine more often the concentrations of cyclosporine in plasma with simultaneous administration of cyclosporine and Xenical. In case of oral administration of amiodarone during Xenical treatment, the decrease in systemic exposure of amiodarone and deethylamiodarone (by 25-30%) was noted, but due to complex pharmacokinetics of amiodarone, the clinical significance of this phenomenon is not clear. Adding Xenical to long-term amiodarone therapy may reduce the therapeutic effect of amiodarone (no studies have been conducted). Simultaneous administration of Xenical and acarboses should be avoided due to the lack of pharmacokinetic studies. In concomitant administration of orlistate and antiepileptic drugs, cases of seizures were observed. The causal link between seizures and orlistatom therapy has not been established. However, the condition of patients should be monitored for possible changes in frequency and/or severity of the seizure syndrome.