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Decreases in the absorption of vitamin D, E and β-carotene have been observed when co-administered with Orlistat (Xenical). If a multivitamin supplement is recommended, it should be taken at least two hours after the administration of Orlistat (Xenical) or at bedtime.
A reduction in cyclosporin plasma levels has been observed when Orlistat (Xenical) is co-administered (see General under Precautions). Therefore it is recommended to monitor more frequently than usual the cyclosporin plasma levels when Orlistat (Xenical) is co-administered (see General under Precautions).
In a PK study, oral administration of amiodarone during orlistat treatment demonstrated a 25-30% reduction in the systemic exposure to amiodarone and desethylamiodarone. Due to the complex pharmacokinetics of amiodarone, the clinical effect of this is unclear. The effect of commencing orlistat treatment in patients on stable amiodarone therapy has not been studied. A potential reduced therapeutic effect of amiodarone is possible.
Convulsions have been reported in patients treated concomitantly with orlistat and antiepileptic drugs. A causal relationship has not been established however patients should be monitored for possible changes in the frequency and/or severity of convulsions.
No interactions based on specific drug-drug-interaction studies with amitriptyline, atorvastatin, biguanides, digoxin, fibrates, fluoxetine, losartan, phenytoin, oral contraceptives, phentermine, pravastatin, warfarin, nifedipine. Gastrointestinal Therapeutic System (GITS), nifedipine slow release, sibutramine or alcohol have been observed.
However, when warfarin or other oral anticoagulants are given in combination with orlistat, international normalised ratio (INR) values should be monitored.
