Orlistat weight loss nice cks Reproductive — menstrual irregularities. If pregnancy occurs during treatment in a patient who has reached a stable weight, consider continuing treatment. Uses: For the management of weight loss and weight maintenance when used in conjunction with a reduced calorie diet. See the CKS topic on Obesity for more information. Therefore, a lower dose of insulin or an insulin secretagogue may be required to reduce the risk of People who have had an operation to help them lose weight (called bariatric surgery) have follow-up care from the bariatric surgery service for at least 2 years after their operation. This recommendation is extrapolated from the NICE clinical guideline [NICE, 2017b] and expert opinion in a review article, which recommends referral to a head and neck surgeon for possible imaging and biopsy [Smith, 2019]. Current treatments 2. M. 3. The co-prescribing of Orlistat with other drugs aimed at weight loss is not recommended. Services cited could include walking programmes, slimming clubs or structured weight-loss programmes. Orlistat, like many of the other weight loss medications, are only a tool, and can help you to lose weight, but cannot replace the foundations of proper weight loss, like diet and exercise. Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or This guideline has been updated and replaced by the NICE guideline on overweight and obesity management (NG246) Integrate dietary advice with other aspects of lifestyle modification, such as exercise and weight loss, as appropriate. Authoring team. 4 https://cks. Obesity: identification, assessment and management. Orlistat is With rapid weight loss or severe undernutrition. The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Orlistat can also be used to maintain weight loss after achieving an initial weight loss target. If occlusive dressings or other topical medical preparations are being used. 4 kg, Broom et al. Recommendation. With other types of hair loss, for example when there is no family history of hair loss, hair loss is sudden and/or patchy, hair loss is due to childbirth, or the reason for hair loss is unknown. The aim is to help people lose weight and become more physically active to reduce the risk of diseases associated with obesity. Consider signposting the person and/or carers to the BAPEN Malnutrition self-screening calculator if a person has unexplained weight loss or has a loss of appetite and/or is not eating well. Insulin oedema (rare) — this occurs mostly in people with poor glucose control and progressive weight loss who are treated with relatively high doses of insulin. 1. Primary amenorrhoea is defined as the failure to establish menstruation by the expected age, variably considered to be 15 or 16 years of age in girls with normal secondary sexual characteristics (such as breast development), or 13 or 14 years of age in girls with no secondary sexual characteristics. See the sections on Natural family planning, Barrier methods, and Sterilization for information on these methods of contraception. With slow linear growth or unexplained short stature. That some foods (for example grapefruit juice) and supplements (for example St John's wort) may interact with statins. Possible Cancer. In the high-risk population proposed by the company, liraglutide would be offered through specialist multidisciplinary weight management (tier 3) services. Who have not responded to management in primary care. Providing advice on lifestyle measures, such as weight loss, exercise, stopping smoking, reducing alcohol, and avoiding sleeping supine. CKS is aware that primary care may have a role in engaging with and monitoring this cohort of people. It provides: practical advice on how to Metabolic — such as weight loss. This document offers tips on the short conversations health and care professionals should be having with overweight and obese patients about weight loss. Orlistat is used to manage obesity by reversibly inhibiting gastric and pancreatic lipases within the gut. Menu. Fibrates — concurrent use with ezetimibe is predicted to increase the risk of gallstones. Clinical Knowledge Summaries (CKS) Health topics A to Z; Specialities; What's new; About CKS; About; NICE; CKS; Health topics A to Z; Obesity; Diagnosis; The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). How does orlistat work? Covers the use of the progestogen-only pill (POP), including initial assessment, how to start (or switch to) a POP, possible risks and adverse effects, key drug interactions, information and advice for the woman, how to manage common problems (such as unscheduled bleeding and missed pills), follow-up requirements, and duration of use for this method of contraception. It is also pragmatic, based on what CKS considers to be safe clinical practice. Vasc Health Risk Manag. 2 Information about semaglutide Marketing authorisation indication 2. 6 kg while Swinburn et al. Other more general symptoms, such as low-grade fever, fatigue, anorexia, weight loss, or depression. Dementia is a progressive, irreversible clinical syndrome with a range of cognitive and behavioural symptoms including memory loss, problems with reasoning and communication, change in personality, and reduction in the person's ability to carry out daily activities. See more here. the co-prescribing of orlistat with other drugs aimed at weight reduction is not recommended; Notes: rates of weight loss may be slower in people with type 2 diabetes, so less strict goals than those for people without diabetes may be appropriate. Type 1 diabetes mellitus. Transdermal preparations may be appropriate if the woman has [Stuenkel, 2015; North Appetite loss or early satiety in adults - NICE urgent cancer referral guidance. Dehydration and electrolyte imbalance. Last reviewed 25 Jun 2021. Symptom and Specific Features. An initial 6–12 month trial is recommended, with regular reviews to assess effectiveness, side-effects and adherence. Assessing weight loss in the early days of life, Diagnosis, Faltering growth, CKS Skip to content; Accessibility help; Search CKS Skip to content. NHS eligibility criteria BNF, Medicines. Find patient medical information for orlistat oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings. If pregnancy occurs during treatment in a patient who is still losing weight, consider reducing dose or discontinuing treatment. This CKS topic does not cover obesity or the management of loss of appetite, psychogenic disturbance of appetite or other conditions that involve significant weight loss but which are due to known physical illness. A working diagnosis of PMR should be made from a combination of the following: Presence of core features of the condition. . Whether you’re just starting with Orlistat — or other weight loss treatments like Wegovy or Mounjaro — remember that slow, steady progress is often the key to long-term success. See the CKS topic on Faltering growth for more information. Pregabalin should be avoided unless the benefit to the mother outweighs the risk to the fetus — exposure during the first trimester may cause major birth defects [ABPI, 2022b]. This topic does not cover the following eating disorders pica, rumination disorder, or avoidant/restrictive food intake disorder. We use the best available evidence to develop recommendations that guide decisions in health, public health and social care. Covers starting the combined oral contraceptive pill, and includes information and advice on the available products; when to start it; the efficacy, advantages and disadvantages, risks and possible adverse effects, and key drug interactions; how to manage common problems (such as missed pills); what to do in the event of vomiting or diarrhoea; and the follow up requirements the co-prescribing of orlistat with other drugs aimed at weight reduction is not recommended; Notes: rates of weight loss may be slower in people with type 2 diabetes, so less strict goals than those for people without diabetes may be appropriate. Provide advice on when they should seek medical advice. People with severe hepatic impairment. The recommendation to assess the person's weight, body mass index (BMI), and trend in unintentional weight loss is based on the NICE guideline. Vitamin A deficiency Suspect in patients with changes in night vision Patients with steatorrhea or those who have had a duodenal switch are at high risk Zinc, copper and selenium deficiency Unexplained anaemia, poor wound healing, hair loss, neutropenia, peripheral neuropathy and Suspect diabetic ketoacidosis (DKA) in a person with known diabetes or significant hyperglycaemia (finger-prick blood glucose level greater than 11 mmol/L) and the following clinical features:. NHS eligibility criteria includes: Age - 18-74 Weight loss reduces the risk of comorbidities and improves long-term survival. org. Orlistat (Xenical) is a drug that can help with weight loss. Examination findings of: Pallor, clubbing, or aphthous mouth ulcers. If weight loss is more than 10% of birth weight or weight does not return to birth weight by 3 weeks of age, this may indicate ineffective establishment of feeding. Dosage in the marketing authorisation . ; The two potential approaches for withdrawal are slow dose reduction of the person's current benzodiazepine or z-drug, or switching to an approximately equivalent dose of diazepam, which is then tapered down. Breastfeeding women — it is not known whether orlistat is secreted into human milk. Aim To explore associations between patient characteristics and orlistat prescribing, and to determine associations of orlistat with weight loss in T2DM and prediabetes. ) Improper dosing. ; NUH use only: Ask about red flag symptoms such as weight loss, rectal or vaginal bleeding, changes in bowel habits, urinary symptoms, pelvic pain, or night sweats. Suitable goals may be to slow the rate of weight loss, control symptoms, and optimize quality of life. Risk factors for nausea and vomiting include increased placental mass (molar gestation, multiple pregnancy); first pregnancy; history of hyperemesis gravidarum; family history of nausea and vomiting in pregnancy or hyperemesis gravidarum; and obesity. Unitentional weight loss (Accessed 29/12/2020). nice. A weight trajectory refers to a general pattern of weight gain or weight loss over many years. Includes any guidance and quality standards. Weight loss, nausea, vomiting, and vague abdominal pain may be confused with symptoms of an eating disorder. ; Semaglutide has been licensed for managing overweight and obesity in line with the NICE technology appraisal guidance [TA875]. For further information, see the CKS topic on Obesity. Follow-up care includes regular health check-ups, tests to make sure they are getting the nutrients they need, support with their diet, help to increase physical activity and During the first three months of taking Orlistat, your weight loss will be monitored and if you have achieved a 5% loss in body weight during those first 12 weeks, you may continue to use Orlistat. The typical induction dose of warfarin is 10 mg daily for 2 days, but this should be tailored to individual requirements. See the CKS topic on Alcohol - problem drinking for more information. Advice in the perioperative period Elective and emergency surgery . For more information, see the CKS topic on Eating disorders. Faltering growth in older infants and children is caused by inadequate calorie intake (the most common cause), inadequate nutrient absorption, and/or increased calorie demand or expenditure. NICE TA664 - Liraglutide (Saxenda) for managing overweight and obesity. The degree of unintentional weight loss has been defined in case series as being between 5% and 10% weight loss compared with usual body weight. The following ideas should help you achieve weight loss and help you keep your weight stable long term. , showed weight loss of 5. 2 (obesity), or ≥27 kg/m. NICE; CKS; Health topics A to Z; Back pain - low (without radiculopathy) Back pain - low (without radiculopathy) Last revised in October 2024. sleep paralysis: a temporary inability to move or speak when waking up or falling asleep weight management in an appropriate multidisciplinary setting. NICE. Skip to main content. Chronic kidney disease (CKD) is an abnormality of kidney function or structure that is present for more than 3 months, with implications for health There is no formal consensus definition of unintentional weight loss; however, the weight loss must be considered unintentional by the patient and treating practitioner. This guideline has been updated and replaced by the NICE guideline on overweight and obesity management (NG246) Significant unintentional weight loss is defined as (1): unintentional loss of more than 5% of body weight over 6 to 12 months; Reference: NHS Choices. However, the National Institute for Health and Care Excellence (NICE) recommends gabapentin as a first-line treatment option for adults with all neuropathic pain (except trigeminal neuralgia) [NICE, 2019a]. Bariatric surgery is recommended as a treatment option in some people who have a BMI of 40 kg/m2 or more. Clinical trial evidence shows that liraglutide with lifestyle measures is more effective for weight loss and delaying the development of type 2 diabetes than lifestyle measures alone. Fatigue, unexplained weight loss, and thirst may occur in either condition, however, blood glucose is usually normal or low in adrenal failure. 1 Semaglutide (Wegovy, Novo Nordisk) is ‘indicated as an adjunct to a reduced-calorie diet and increased physical activity for weight management, including weight loss and weight maintenance, in adults Orlistat might affect the absorption of concurrently administered oral drugs—consider separating administration. Use topical minoxidil with caution in: Weight loss (usually at least 5% of pre-pregnancy body weight). Arrange emergency hospital admission or specialist referral, the urgency depending on clinical judgement, if: There are red flag symptoms or signs suggesting a potentially serious underlying cause. Potential problems with toileting in post-operative patient if continued. Psychiatric — may induce mania. 2 December 2010. SGLT-2 inhibitors, Prescribing information, Diabetes - type 2, CKS. For further information on contraindications, cautions, drug interactions, and adverse effects, see the electronic Medicines Compendium (eMC) or the British National Formulary (BNF). Some people aim to get down to a perfect weight. Particular care should be taken with antiepileptics, antiretrovirals, oral contraceptives, and drugs that have a narrow therapeutic index. Increased thirst and urinary frequency. Effect on BMI in orlistat The aim of laxatives is to increase stool frequency or ease of stool passage by increasing stool water content (directly by osmotic or intestinal secretory mechanisms) or by accelerating bowel transit. See also, the section on healthy eating, physical activity Weight loss in adults - NICE urgent cancer referral guidance. You may find it helpful to break up your weight loss goal. General — such as headache, flushing, sweating, fever, heat intolerance. Ask about: The timing and pattern of hair loss, including onset, speed of progression (which is usually gradual), scalp areas affected, and the history of Weight loss with splenomegaly (unexplained) in children and young people 1: Non-Hodgkin's lymphoma: Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment. Skin rashes — rashes can occur in up to 10% of people taking carbamazepine, phenytoin, or lamotrigine. Women of childbearing potential — advise that effective contraception should be used: During treatment with exenatide or lixisenatide. Post-operative advice 1. Ask about previous interventions on the veins (including varicose vein surgery) as well as a history of trauma, DVT, ulcerations, or bleeding from varicose veins. Offer advice and information about self-care, including: Smoking cessation (if appropriate). The NICE guideline notes that if there is confirmed or suspected clinically significant portal hypertension, a person with cirrhosis may be offered specialist treatment with carvedilol or propranolol for the primary prevention of decompensation. For further information, see the CKS topic on Smoking cessation; Healthy eating, activity, and weight loss (if appropriate). Prostate cancer is multifocal — the different foci may be caused by different genetic mutations, which can differ greatly in growth rate and ability to metastasize. measures with orlistat, or bariatric surgery. A BMI of less than 20 kg/m 2 and unintentional weight loss greater than 5% within the last 3–6 months. realistic targets for weight loss; for adults, see NICE's guideline on managing overweight and obesity in adults. Unintended weight loss occurs in over 50% of people with Parkinson's disease. Genes are thought to contribute to 25–70% of the variation in adiposity between different people [ Maffeis, 2000 ; BMJ, 2016 ]. uk, NICE CKS. 2] [1. An associated family history of inflammatory bowel disease, coeliac disease, or colorectal cancer. Advise people that the benefits of increasing dietary fibre may take several weeks to achieve, and if tolerated, a high-fibre diet should be maintained for life. If the person is overweight or obese, set an initial body weight loss target of 5–10% (smaller weight losses may still be beneficial). Weight loss is not recommended during pregnancy, even if you are overweight. calorie diet and increased physical activity for weight management, including weight loss and weight maintenance, in adults with an initial Body Mass Index (BMI) of ≥30 kg/m. Treatment with a diuretic is not indicated. Guidance The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). The use of liraglutide for this indication is restricted to prescribing in secondary care by a specialist multidisciplinary Tier 3 weight management service with a commercial agreement in place. Oestrogen-only preparations are given to women without a uterus, and combined oestrogen and progestogen preparations are given to women with an intact uterus []. o Understanding of the expected weight loss and their individual 5% weight loss target they need to achieve in 3 months. 5] There are a range of specific genes associated with excess weight. Weight loss. 1 One-year Results: Weight Loss, Weight Maintenance, and Risk Factors. Avoid initiation during pregnancy—weight loss during pregnancy may cause fetal harm. 3 The NICE guideline on obesity recommends a multicomponent approach involving dietary advice, exercise, lifestyle changes and medication. (See recommendations 1. Reduce the risk of type 2 diabetes and CVD. Sibutramine It brings together and updates all NICE's previous guidelines on overweight and obesity. Elderly people — may cause weight loss (exenatide). Smoking cessation if appropriate. However, this may be a lot of weight to lose for you and you may become fed up about poor progress, and give up. These goals should be agreed with the person and reviewed regularly; Reference: NICE. 3 In the past, an absolute weight loss of 10 pounds (4. Exclusion of differential diagnoses, such as rheumatoid arthritis and fibromyalgia. 5kg weight loss prior to prescription but adherence to a reduced fat diet before starting orlistat may assist in the reduction of unwanted GI side effects. Persistent vomiting and/or diarrhoea. If the woman is overweight or obese, explain that weight loss may: Reduce hyperinsulinism and hyperandrogenism. Design and setting Cohort study using anonymised health records Weight loss in adults - NICE urgent cancer referral guidance. Assessment and Identification Prescribe Orlistat ONLY as part of a weight Carbimazole should not be prescribed to: People with severe blood disorders. Marton KI, Sox HC, Krupp JR. Published guidance on this topic (13) Weight loss. Appetite loss or early satiety. uk/obesity Accessed Provide advice on diet and lifestyle, fluid intake, stopping smoking, weight loss and exercise as for people with diverticulosis. See the CKS topic on Smoking cessation for more information. These lipases play a crucial Reduction in intentional weight loss (due to increased dietary fat absorption) if omitted. ; Another underlying cause for symptoms is suspected. Prostate cancer is a malignant tumour of the prostate. Access to tier 3 weight management services varies . Orlistat works by blocking chemicals (enzymes) in your gut which digest fat. 1 to 1. 3. Almost all cancers of the prostate (95%) are adenocarcinomas. Clinical Knowledge Summaries (CKS) Health topics A to Z; Specialities; What's new; About CKS; About; NICE; CKS; Specialities; Drugs and devices; Drugs and devices. Key drug interactions with atorvastatin include: Amlodipine — atorvastatin concentrations may be increased by amlodipine; a case of rhabdomyolysis has been reported. Encouraging adherence to specialist treatments such as continuous positive airway pressure (CPAP) therapy and/or intra-oral devices. achieving at least 5 and 10% weight loss compared with placebo. Please Orlistat (Xenical®) and sibutramine (Reductil®) are agents used for the management of obesity. Obesity management: update on orlistat. Causes may include involuntary movements (dyskinesia) leading to increased energy expenditure, dysphagia, anxiety and depression, and malnutrition related to Parkinson's disease; or other underlying causes such as malignancy and endocrine disease. M Baseline prothrombin measurements should be taken before starting treatment with warfarin. See the CKS topic on Obesity for management information. Have I Amenorrhoea is the absence or cessation of menstruation. Published products on this topic (16) Guidance. View rosuvastatin information, including dose, uses, side-effects, renal impairment, pregnancy, breast feeding, monitoring requirements and important safety information. 14. A low starting dose (5 mg) is often more suitable for frail or elderly people, people with a low body weight, people with liver disease or cardiac failure, and people at high risk of If a person presents with low back pain following a risk stratification assessment in primary care:. With safeguarding concerns. Most rashes are weight management in an appropriate multidisciplinary setting. Rectal examination may show a prostate that is hard and irregular. . Important aspects of prescribing information relevant to primary healthcare are covered in this section specifically for the drugs recommended in this CKS topic. NHS eligibility criteria includes: Age - 18 cataplexy: temporary loss of muscle control resulting in weakness and possible collapse, often in response to emotions such as laughter and anger. , showed mean weight loss of 5. Pregnancy. Research has shown that taking this medication along with eating a healthy diet and keeping active can help with losing weight. 2007;3(6):817-21. 1. Includes dosages for Obesity; plus renal, liver and dialysis adjustments. The best way to lose weight is to eat a healthy diet and to keep active. ; Insulin and insulin secretagogues such as sulphonylureas, cause hypoglycaemia. Last edited 25 Sept 2020. People having treatment outside o Weight and BMI to calculate 5% weight loss goal o Understanding of the pros and cons of using Orlistat o Understanding of a low-fat diet and recommend starting on a low-fat diet before starting on Orlistat. Musculoskeletal — such as arthralgia and muscle weakness. These vitamins are important if you are nursing a baby. 2 Prescribe semaglutide as part of a specialist weight management service with multidisciplinary input (such as a tier 3 or tier 4 service). HEALTHY EATING LONG TERM AFTER WEIGHT LOSS SURG Healthy diet and lifestyle is key to long term weight loss success. 14. Do not use orlistat if you are pregnant. Please see Appendix 1 for further guidance on prescribing and reviewing Orlistat. Offer a combined oral contraceptive (COC) pill, provided there are no contraindications (off-label use). 4 These recommendations are not intended to affect treatment with semaglutide that was started in the NHS before this guidance was published. For all people undergoing assisted withdrawal, provide appropriate information and advice. Low back pain affects the lumbosacral area of the back, between the bottom of the ribs and the top of the legs. Most infants will return to their birth weight by 3 weeks of age. Weight loss with cough or fatigue or shortness of breath or chest pain or appetite loss (unexplained), 40 and over, never smoked Lung or mesothelioma Offer an urgent chest X‑ray (to be done within 2 weeks) [1. Clinical Knowledge Summaries (CKS) Health topics A to Z; Specialities; What's new; About CKS; About; NICE; CKS; Health topics A to Z; Obesity; Background information; The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). Bulk-forming laxatives (containing soluble fibre) act by retaining fluid within the stool and increasing faecal mass, stimulating peristalsis; also have stool-softening properties. There are limited data on the use of pregabalin in women who Absolute weight reduction in orlistat group in this study was 4. ; Offer advice on sources of Liraglutide (Saxenda ®) (Weight loss) Formulary: Injection. Who are pregnant or breastfeeding. Hormone replacement therapy (HRT) is available as oral or transdermal preparations, depending on the woman's preferences. This gradual increase in weight will be lower for someone who has lost weight during a lifestyle weight management programme, if they have not regained any of that lost weight. This includes coronary heart disease, stroke, type 2 disease, osteoarthritis and some cancers. 12 years or older: Discover NHS weight loss programmes in Stoke, including lifestyle advice, Orlistat Orlistat blocks some of the fat you eat from being absorbed by your body. the distinction between losing weight and maintaining weight loss, and the importance of developing skills for both; advise them that the change from losing weight to maintenance typically happens after 6 to 9 months of treatment Treatment should be started and monitored in a specialist paediatric setting by experienced multidisciplinary teams. Tailor goals and adjust management depending on the person's phase of illness, wishes, and needs. This medication is a saturated derivative derived from the endogenous lipstatin found in Streptomyces toxytricini. Eat 3 meals per day. Without continuing a balanced diet and being active weight regain can occur. Unintentional weight loss greater than 10% within the last 3–6 months. Appetite loss (unexplained) with cough or fatigue or shortness of breath or chest pain or weight loss (unexplained), 40 and over. Many adults gradually put on weight as they get older. Monitor ciclosporin concentrations closely. Summary. Clinically important weight loss is traditionally defined as loss of more than 5 percent of usual body weight over six months. Orlistat acts locally by blocking fat absorption from the gastro-intestinal tract. 5 kg) or more was also accepted as a criterion for significant weight loss. Side effects of orlistat. For more information, see the CKS topic on Child maltreatment - recognition and management. Treatment may also be used to maintain weight loss rather than to continue to lose weight. That routine follow-up is not necessary if there is no progression to Weight loss with lymphadenopathy (unexplained) in children and young people Non-Hodgkin's lymphoma or Hodgkin's lymphoma Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment in children and young people. Saxenda Saxenda is a daily injection that helps you feel full and eat less. Stop taking this medicine and tell your doctor right away if you become pregnant. Weight gain or loss — associated with some antiepileptic drugs; consider this when discussing treatment with the person . Do not prescribe orlistat to: People with chronic malabsorption syndrome or cholestasis — dietary absorption of fat is already impaired in these people. Orlistat’s license no longer requires a 2. Result in menstrual regularity. , reported 4. Neurological — such as anxiety, tremor, restlessness, excitability, insomnia. Most of the complications of obesity can be reduced by weight loss [FPH, 2008; Farooqi, 2010]. The recommendation to use patient-reported values if a face-to-face assessment is not possible or practical is based on the Malnutrition Pathway consensus document [Holdoway, 2021]. Female pattern hair loss (or female androgenetic alopecia) is a genetically determined, patterned, progressive hair loss from the scalp. 1 July 2008 For patients with diabetes: Weight loss may result in an improvement in your condition, and your doctor may need to change your dose of oral diabetes medicine or insulin. This guideline covers multi-component lifestyle weight management services including programmes, courses, clubs or groups provided by the public, private and voluntary sector. People having treatment outside Providing primary care practitioners with a readily accessible summary of the current evidence base and practical advice on best practice Discover NHS weight loss programmes in Cardiff, including lifestyle advice, Orlistat Orlistat blocks some of the fat you eat from being absorbed by your body. Explain that this would involve an individual assessment and tailored advice about diet, physical activity and behaviour change. Presenting features of interstitial lung disease such as dyspnoea, non-productive cough, and deterioration in general health (for example fatigue, weight loss, and fever). 11. In addition to emphasising realistic weight loss (to achieve a reduction in health risks) and advising on prevention of weight regain, appropriate goals of weight management should View orlistat information, including dose, uses, side-effects, pregnancy, breast feeding, contra-indications and drug action. Drinking alcohol within recommended limits. to <30 kg/m. Do not prescribe an SGLT-2 inhibitor to people with: Diabetic ketoacidosis (DKA) — serious and potentially life-threatening cases of DKA have been reported in people taking SGLT-2 inhibitors. See the CKS topic on Palliative care - general issues for more information. Background Orlistat is recommended as an adjunct to diet and exercise for weight loss in the treatment of type 2 diabetes mellitus (T2DM). Inability to tolerate fluids. The clinical experts explained that weight management follows NICE's guideline on identification, assessment and management of obesity. Drug interactions with SGLT2 inhibitors include: Diuretics SGLT2 inhibitors may add to the diuretic effect of thiazide and loop diuretics and may increase the risk of dehydration and hypotension. Orlistat is a lipase inhibitor which can also be used to maintain weight loss after achieving an initial weight loss target, rather than to continue to lose weight. ) Discuss whether they would like to join a structured weight-loss programme. Based on the recommended rate of weight loss explained above, set yourself a clear weight loss goal with a realistic timescale. It does not cover pregnancy. Monitoring for and managing any associated conditions. Visual disturbance. About the benefits of exercise, and weight loss if they are overweight or obese, and stopping smoking, in reducing the risk of developing acute diverticulitis and symptomatic disease. Common side effects of orlistat include: fatty or oily poo; needing the toilet to poo urgently; pooing more frequently Tirzepatide (Mounjaro®) for weight management, including weight loss and weight maintenance, as an adjunct to a reduced-calorie diet and increased physical activity in adults with an initial BMI of 30 kg/m 2 or more, or 27 kg/m 2 to less than 30 kg/m 2 in the presence of at least one weight-related co-morbid condition (June 2024) However, it may be useful in primary prevention of gallstones in high-risk groups, such as obese people undergoing rapid weight loss through dietary caloric restriction or bariatric surgery [EASL, 2016; BMJ Best Practice, 2024]. Published: 27 November 2014 Last updated: 26 the co-prescribing of orlistat with other drugs aimed at weight reduction is not recommended; Notes: rates of weight loss may be slower in people with type 2 diabetes, so less strict goals than those for people without diabetes may be appropriate. 1 Semaglutide (Wegovy, Novo Nordisk) is ‘indicated as an adjunct to a reduced-calorie diet and increased physical activity for weight management, including weight loss and weight maintenance, in adults If some weight loss occurs but the target is not achieved, the opportunity should be given for a further 3 months attempt with diet alone. The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). Azole antifungals — atorvastatin concentrations may be increased by azole antifungals (such as fluconazole, ketoconazole, the co-prescribing of orlistat with other drugs aimed at weight reduction is not recommended; Notes: rates of weight loss may be slower in people with type 2 diabetes, so less strict goals than those for people without diabetes may be appropriate. Summary points of the guidance on the use of orlistat for the treatment of obesity in adults: orlistat should be prescribed only as part of an overall plan for managing obesity in adults who meet Orlistat is a lipase inhibitor which can also be used to maintain weight loss after achieving an initial weight loss target, rather than to continue to lose weight. Weight loss (unexplained) Several, including colorectal, gastro-oesophageal, lung, prostate, pancreatic or urological cancer. The manufacturer advises that women of childbearing potential should use effective contraception during treatment [ABPI, 2022b]. Abdominal pain. Orlistat can also be used to maintain weight loss after achieving an initial weight loss target. NHS eligibility criteria includes: Age - 18 MHRA has authorised the diabetes drug Mounjaro (tirzepatide) for weight management and weight loss. Usual Pediatric Dose for Obesity. Taking orlistat can make it harder for your body to absorb certain vitamins. 65 kg which is comparable with the previous studies; Bakris et al. Weight loss associated with This weight loss usually stops after about 3 or 4 days of life. Weight loss if the person is overweight or obese. Discontinue treatment if gallstones develop. Hair loss typically presents as diffuse reduction in the density of hair over the crown and frontal scalp, and widening of Provide education to the person and their carer regarding how to adjust the dose according to changes in weight, avoiding excessive fluid intake, and avoiding dehydration (thirst, dizziness, and fatigue). , found mean weight loss of 5. When considering referral, take into account any associated symptoms: Weight loss with unexplained lymphadenopathy in adults Orlistat (tetrahydrolipstatin) is an anti-obesity medication approved by the US Food and Drug Administration (FDA). However, since obesity is a chronic disease, weight management needs to be lifelong [Yumuk, 2014]. 250nmol/L post weight-loss surgery. During treatment with modified-release exenatide injection, and continued for 12 weeks after discontinuation of treatment. Related pages. See the section on Assessment for contraception for information on general assessment for all women requesting contraception. Pooled data from five clinical trials indicated that the overall mean weight loss from randomization to the end of 1 year of treatment in the intent-to-treat Gabapentin is licensed for the treatment of peripheral neuropathic pain such as painful diabetic neuropathy and postherpetic neuralgia in adults [ABPI, 2020a]. See the CKS topic on Obesity for further information on weight management. 2 (overweight) in the presence of at least one weight-related comorbidity'. If suspected, refer the man using a suspected cancer pathway referral (for an appointment within 2 weeks). All NICE products on obesity. Key drug interactions of ezetimibe include: Ciclosporin — ciclosporin moderately increases the exposure to ezetimibe, and ezetimibe slightly increases the exposure to ciclosporin. Orlistat Scenario: Management: Covers the management of a person who is overweight or obese. 7 kg mean weight loss. 2. Who develop new clinical symptoms or signs after the initial assessment. 1 Semaglutide is recommended as an option for weight management, including weight loss and weight maintenance, alongside a reduced-calorie diet and increased physical activity in adults, only if: • it is used for a maximum of 2 years, and within a specialist weight management service providing multidisciplinary management of Discover NHS weight loss programmes in Manchester, including lifestyle Orlistat Orlistat blocks some of the fat you eat from being absorbed by your body. NICE specifically recommends that treatment is discontinued in such patients. Urological cancer — may present with unexplained haematuria, lower back pain, bone pain, and weight loss. 3 . 8 kg, Lindgarde et al. People with acute pancreatitis — carbimazole should be stopped immediately and permanently if acute pancreatitis occurs. This guideline has been updated and replaced by the NICE guideline on overweight and obesity management (NG246) If you have type 2 diabetes, it may take you longer to lose weight using orlistat, so your target weight loss after 3 months may be slightly lower. A recent small study found that two thirds of adults in one GP practice who were taking orlistat for obesity continued to be prescribed the drug beyond three months even though they had failed to achieve sufficient weight loss. Bariatric surgery, where indicated, is the most effective treatment for obesity in terms of long-term weight loss, improvements of comorbidities and quality of life, and decreasing The term 'dyspepsia' is used to describe a complex of upper gastrointestinal tract symptoms, which are typically present for four or more weeks, including upper abdominal pain or discomfort, heartburn, acid reflux, nausea and/or vomiting. So, stay committed, keep those high-fat foods in check, and let Orlistat work its magic — one step at a time. But its long-term effectiveness, particularly on the risk of cardiovascular disease, is unknown. Miss dose(s) of orlistat while the patient is fasting. Detailed Orlistat dosage information for adults and children. Advise the person to report any muscle pain, tenderness, or weakness. The co-prescribing of Orlistat Orlistat is a medicine which can help you to lose weight if you have overweight or obesity. 3 Only use semaglutide for a maximum of 2 years. Clinical guideline CG189. Managing unexplained lymphadenopathy Use patient-reported values of current weight, height, and previous weight if a face-to-face assessment is not possible or practical [Holdoway, 2021]. Reassure the person that the oedema should resolve within 3–4 days after reduction of the insulin dose. Take a detailed history to assess the severity and impact of hair loss and to identify possible risk factors. Weight loss, faltering growth, or delayed puberty in children. Nutrition support should be considered in people at risk of malnutrition, defined as those who have: For further details, see the CKS topic on Analgesia - mild-to-moderate pain. Action Healthcare professionals should continue to If weight loss is more than 10% of birth weight or weight does not return to birth weight by 3 weeks of age, this may indicate ineffective establishment of feeding. 26 During a 4-week, single-blind, placebo lead-in period the subjects were instructed to consume an approximately 500-kcal/day caloric-deficit diet that provided 30% of total daily calories in the Orlistat for the treatment of obesity in adults Technology appraisal guidance; Reference number: TA22 Published: 27 March 2001 This section covers the UK Medical Eligibility Criteria (UKMEC) for hormonal and intrauterine methods of contraception. Weight trajectory. 2 120 mg up to 3 times a day, dose to be taken immediately before, during, or up to 1 hour after each main meal, continue treatment beyond 12 weeks only under specialist supervision, if a meal is missed or contains no fat, the dose of orlistat should be omitted. If weight loss is more than 10% of birth weight or the infant has not returned to its birthweight by 3 weeks of age: Assess the The former compared orlistat with placebo for weight loss and weight maintenance in 892 obese patients (average weight 100 kg, average BMI 36 kg/m 2) who were otherwise healthy. the co-prescribing of orlistat with other drugs aimed at weight reduction is not recommended; Reference: Drew BS, Dixon AF, Dixon JB. onsv mwru emxcb yjle gum mbz eiuxgn kmgjhx soyka ftgbub