Pharmacist intervention enhances adherence to Orlistat ( Xenical ) therapy.

BACKGROUND: Pharmacists, especially those in community practice, should increase their level of intervention in dealing with the nationwide epidemic of obesity since they interact with large numbers of the public on a regular basis. We hypothesized that patients who receive medication for weight loss may have an improved therapeutic outcome if they received additional support from their community pharmacist. OBJECTIVE: To evaluate the impact of pharmacist support on patient persistence with Orlistat ( Xenical ). METHODS: Pharmacists were trained in basic obesity management skills. Patients who were prescribed Orlistat ( Xenical ) and attending an outpatient nutrition program were invited to participate in the study. All patients agreed to receive pharmaceutical care. Those who lived where the service was available were assigned to the intervention (I) group and those who did not were assigned to the control (C) group. All patients received usual care provided by the outpatient clinic. RESULTS: Thirty patients, 15 in the I group and 15 in the C group, were recruited. Both groups were predominantly women (87%) with a mean +/- SD age of 43.8 +/- 9.7 years. Patients in the I group had significantly greater persistence with Orlistat ( Xenical ) therapy as assessed by duration of therapy (p = 0.006) and number of patients completing the 26-week study (7 I, 2 C; p = 0.046). There was no significant difference in percent of weight loss between groups (p > 0.05). CONCLUSIONS: In this pilot study, patients receiving pharmaceutical care took Orlistat ( Xenical ) longer than the controls and had improved outcome with Orlistat ( Xenical ) therapy.

Long-term drug therapy of obesity in 2002--pharmacoeconomic aspects

A growing number of obese people throughout the world have become a health-economic problem. Obesity and overweight are significant risk factors causing increased morbidity and mortality in obese people. Nevertheless, a marked improvement in the prognosis is achieved by a 5-10% decrease in body weight. Since 1 July 2002, two preparations for long-term therapy of obesity have been registered in the Czech Republic: Xenical (Orlistat ( Xenical )) and Meridia (sibutramin). Long-term randomized double-blind studies have shown that a decrease of 4.4 kg in weight within a year is achieved by 10 mg sibutramin administration, a decrease of 3.2-6.4 kg in weight within a year is achieved by 15 mg sibutramin administration, a decrease of 7.4-9.1 kg in weight within a year is achieved by Orlistat ( Xenical ) administration, and placebo administration causes changes in weight ranging from -6.5 kg to +0.94 kg. A cost-to-effectiveness comparison has revealed that in one year the direct costs (ORC) of a decrease in body weight by 1 kg after deduction of the placebo effect make 9,817 CZK to 22,078 CZK (the supplementary payment of the patient being 2698 CZK to 7722 CZK) in sibutramin treatment, and 9101 CZK to 13,085 CZK (the supplementary payment of the patient being 632 CZK to 909 CZK) in Orlistat ( Xenical ) treatment.

Effect of short-term weight loss on the metabolic syndrome and conduit vascular endothelial function in overweight adults.

Impaired vascular endothelial function may be an important mechanism linking obesity to increased cardiovascular risk. We investigated whether short-term weight loss improves conduit artery endothelial dysfunction in overweight adults. Forty-three otherwise healthy overweight patients with a body mass index > or =27 kg/m(2) completed an open-label 3-month trial consisting of a calorie-restricted diet and 120 mg of Orlistat ( Xenical ) taken 3 times daily with meals. Endothelial function and parameters of the metabolic syndrome were measured before and after intervention. Subjects lost 6.6 +/- 3.4% of their body weight. Low-density lipoprotein cholesterol, low-density lipoprotein concentration, fasting insulin, and leptin decreased significantly (all p <0.009), and C-reactive protein decreased (p = 0.22). Conduit vascular function did not change as assessed by flow-mediated dilation (3.86 +/- 3.54 vs 3.74 +/- 3.78%, p = 0.86) and nitroglycerin-mediated dilation (17.18 +/- 5.89 vs 18.87 +/- 7.11%, p = 0.13) of the brachial artery. A moderate degree of weight reduction over 3 months improved the metabolic syndrome profile but not the vascular dysfunction associated with uncomplicated obesity.

Fat malabsorption induced by gastrointestinal lipase inhibitor leads to an increase in urinary oxalate excretion.

BACKGROUND: Unabsorbed fat and bile acids may react with calcium in the intestinal lumen, limiting the amount of free calcium binding with oxalate and thereby raising intestinal oxalate absorption leading to hyperoxaluria. The aim of the present study was to determine whether Orlistat ( Xenical ) , a gastrointestinal lipase inhibitor, might increase urinary oxalate in an experimental rat model. METHODS: Thirty-nine male adult Wistar rats were fed a standard diet alone (controls) or supplemented with either 2% sodium oxalate (NaOx) or 3.2 mL of soy oil, or with both (NaOx + soy oil) for 4 weeks (diet period). Orlistat ( Xenical ) (16 mg/day) was added to the diet from the 5th to the 8th week (diet + Orlistat ( Xenical ) period). Urinary oxalate (uOx), calcium (uCa), magnesium (uMg), and citrate (uCit) were determined and the ion-activity product of calcium oxalate [AP (CaOx) index(rat)] was estimated. RESULTS: Compared to baseline uOx significantly increased after diet + Orlistat ( Xenical ) in controls (0.64 +/- 0.1 mg/24 hours vs. 0.56 +/-0.1 mg/24 hours), soy oil (0.80 +/- 0.3 mg/24 hours vs. 0.49 +/-0.2 mg/24 hours), and NaOx (2.48 +/- 0.8 mg/24 hours vs. 0.57 +/- 0.2 mg/24 hours), but the most marked increase occurred in NaOx + soy oil (3.87 +/- 0.7 mg/24 hours vs. 0.47 +/- 0.1 mg/24 hours). All groups except controls presented a significant reduction in uCa and uMg. Orlistat ( Xenical ) induced a significant increase in AP (CaOx) index(rat) compared, respectively, to baseline and to the diet period in NaOx (4.52 +/- 2.34 mg/24 hours vs. 0.94 +/- 0.86 and 1.53 +/- 0.93 mg/24 hours) and NaOx + soy oil (6.49 +/- 4.03 mg/24 hours vs. 0.54 +/- 0.17 and 1.76 +/- 1.32 mg/24 hours). CONCLUSION: These data suggest that the use of lipase inhibitors, especially under a diet rich in oxalate alone or associated with fat, leads to a significant and marked increase in urinary oxalate and a slight reduction in uCa and uMg that, taken together, resulted in an increase in AP (CaOx) index(rat), elevating the risk of stone formation.