Candis M. Morello, PharmD & Laura Lafranchise, Pharmacist Student
TCOYD Newsletter, Vol. 21, 2007

Have you ever had a tough time losing weight? This is a common challenge for many people, including those with type 2 diabetes. alli™ (orlistat), pronounced Al-eye, is the first over the counter (OTC) weight loss medication that has ever been approved by the FDA. Combined with a healthy meal plan and regular physical activity (like dancing, walking, swimming, biking, etc.), alli may help people with type 2 diabetes achieve their metabolic goals.

What is Alli?
Simply stated, alli is a “fat absorption blocker.” You may have heard of the prescription drug called Xenical 120 mg capsule, which has been available since 1999. On February 7, 2007, the FDA approved alli (orlistat) in a 60 mg capsule for OTC use by the general public at half the dose of Xenical. Marketed by GlaxoSmithKlein, alli became available in June 2007.

How Does Alli Work?
When you eat a meal, stomach and intestinal enzymes break down the food so it can be absorbed and used by your body. alli prevents intestinal enzymes from digesting about 25% of the fat you consume. This undigested fat keeps traveling along the intestines and is passed out of the body through the stool.

As you may imagine from the way alli works, most adverse or “treatment” effects are related to the gut. Abdominal discomfort, greasy stools, loose or more frequent stools that may be hard to control, urgency, or gas with oily spotting are a few effects associated with orlistat use. The more fat you eat, the more likely you will experience these effects. On the bright side, these symptoms may help you select foods that contain less fat, which will also contribute to weight loss.

How Is Alli Used?
alli is not just a weight loss pill— it is part of a bigger “plan” that also combines healthy eating habits and increased activity. To help develop this plan, you will receive access to free internet resources at http://myalli.com when you purchase alli. The website will guide you as you create an individually tailored weight loss plan, developed by nutritional and weight management experts. This plan includes recipes, menus, interactive tools, as well as immediate feedback on your progress with alli, and specific guidance for future steps.

alli can be taken up to three times a day before each meal containing at least fifteen grams of fat. If you miss a meal or eat a meal with less than 15 grams of fat, you should skip the alli dose since it will not be effective. Higher doses do not improve weight loss, but instead may cause more undesirable side effects.

Since alli is a fat absorption blocker, the absorption of fat soluble vitamins in your food like Vitamins A, D, E, and K may also be reduced. For this reason, a multivitamin supplement is recommended for alli users, taken at least 2 hours before or after the alli dose, preferably at bedtime.

Is Alli Right for Me?
Combined with eating for a healthier lifestyle and an increased activity level alli can be a key component in assisting people with type 2 diabetes reach their weight loss goals. It has been shown that orlistat can help people with diabetes lose weight, reduce triglycerides, and improve insulin sensitivity. Improving insulin sensitivity can result in less insulin resistance, better glucose control and lower risk of developing diabetesrelated complications.

By following the alli program you can expect to lose 50% more weight. For example if you lost 10 pounds while incorporating a more nutritious meal and exercise program you would lose 15 pounds when alli is added. The majority of weight will be lost in the first six months of the program. If or when alli is stopped, your healthy eating and exercise program should be continued in order to maintain the weight lost while on the plan.

Alli is not for everyone, especially not people with organ transplants, who are taking cyclosporine, those diagnosed with problems absorbing food, those who are pregnant or breastfeeding, under 18 or not overweight. People who are currently taking warfarin, have thyroid disease, kidney stones, gallbladder problems, or pancreatitis should talk to their doctor before using alli.

alli is not a quick fix for losing weight—just like with other great things in life, it involves time and commitment. The goal of the alli plan is to lose weight gradually and during the process adjust to a healthier lifestyle in order to maintain the weight loss. To find more information about alli talk to your pharmacist, or visit the company’s website at http://myalli.com .

Candis M. Morello, PharmD, CDE, FCSHP, Assistant Professor of Clinical Pharmacy at UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences.

Laura Lafranchise, 2nd Year Student Pharmacist, UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences.

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