The decrease in body weight with orlistat treatment was less in type II diabetic patients than in non-diabetic patients. Antidiabetic medicinal product treatment may have to be closely monitored when taking orlistat. Co-administration of orlistat with ciclosporin is not recommended. Patients should be advised to adhere to the dietary recommendations they are given. The possibility of experiencing gastrointestinal adverse reactions may increase when orlistat is taken with a diet high in fat (e.g. in a 2000 kcal/day diet, >30% of calories from fat equates to >67 g of fat). Cases of rectal bleeding have been reported with orlistat. Prescribers should investigate further in case of severe and/or persistent symptoms. The use of an additional contraceptive method is recommended to prevent possible failure of oral contraception that could occur in case of severe diarrhoea. Coagulation parameters should be monitored in patients treated with concomitant oral anticoagulants. The use of orlistat may be associated with hyperoxaluria and oxalate nephropathy in patients with underlying chronic kidney disease and/or volume depletion. Rare occurrence of hypothyroidism and/or reduced control of hypothyroidism may occur. Orlistat may unbalance anticonvulsant treatment by decreasing the absorption of antiepileptic drugs, leading to convulsions.
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