Medications

Orlistat (“Xenical”)

Who can have Orlistat?

Orlistat is available on the NHS for people with a BMI over 29 kg/m2 or a BMI over 27 kg/m2 with other conditions such as type 2 diabetes, high blood pressure, or high cholesterol.

How is Orlistat taken?

Orlistat is a tablet (120 mg) taken three times a day along with an over-the-counter A-Z multivitamin.

How does Orlistat work?

Orlistat works in the intestine, reducing the absorption of fat from the diet by a third.

When might Orlistat be considered?

Orlistat is a useful addition to changes in diet and lifestyle for people who are motivated to lose weight. Orlistat reduces the amount of fat absorbed in the intestine. Fat not absorbed in the gut will come out in poo, so it is important to reduce the total amount of fat in the diet. Continuing to eat a diet that is high in fat whilst taking Orlistat results in unpleasant side effects such as bloating, loose, oily bowel motions, and occasionally fecal incontinence.  Orlistat may also reduce the absorption of some vitamins, so people on Orlistat should also take over-the-counter A-Z multivitamins.

 Most people can expect to lose on average around 5-10% of their starting body weight.

Treatment can only continue after 3 months if weight loss since start of treatment exceeds 5% of starting body weight.

When should Orlistat not be used?

Orlistat should not be used by people with untreated binge eating disorder or people with chronic malabsorptive problems.

Liraglutide (“Saxenda”)

Who can have Liraglutide?

Liraglutide is available on the NHS only via specialist weight management clinics for people with a BMI over 34 kg/m2 and

• Pre diabetes

and

• Those at high risk for cardiovascular disease such as high blood pressure or high cholesterol

How is Liraglutide taken?

Liraglutide is given once a day as an injection under the skin using an injectable pen device. The starting dose is 0.6 mg. This is increased by 0.6 mg every week until the maintenance dose of 3 mg.

How does Liraglutide work?

Liraglutide acts in the same way as a naturally occurring hormone called Glucagon-like peptide-1 (GLP-1). It works within the area of the brain that controls appetite and also keeps food in the stomach for longer. The combination of the separate effects on the brain and the stomach makes you feel full much earlier. People taking Liraglutide typically lose about 8-10% of their body weight.

When might Liraglutide be considered?

Many people find Liraglutide a useful addition to increasing physical activity and reducing calorie intake. Liraglutide is especially helpful for people with cardiovascular risk factors or people who have cardiovascular disease.

The common side effects of Liraglutide include bloating, abdominal pains, nausea, vomiting and diarrhoea.

Treatment can only continue after 3 months if weight loss since the start of treatment exceeds 5% of body weight, and can only continue for 2 years.

When should Liraglutide not be used?

Liraglutide is NOT recommended for:

• women of childbearing age unless they are using highly effective contraception
• people who have had medullary thyroid cancer, or if anyone in the family has had this.
• people who have Multiple Endocrine Neoplasia Type 2 (MEN2), or if anyone in the family has this

Liraglutide should be used with caution in people who have had pancreatitis or chronic gastrointestinal problems.

Semaglutide (“Wegovy”)

Who can have Semaglutide?

Semaglutide is available on the NHS only via specialist weight management clinics for people with a BMI over 34kg/m² and at least one other weight-related medical condition

or

BMI 30-34.9 kg/m² and who meet the criteria for referral to a specialist weight management service. People prescribed Semaglutide must also be following a low-calorie diet and increasing their physical activity.

How is Semaglutide taken?

Semaglutide is given once a week as an injection under the skin using an injectable pen device as follows:

How does Semaglutide work?

Semaglutide works in the same way as Liraglutide but has greater effects on appetite and stays in the bloodstream for longer, meaning it can be injected once a week.

People taking Semaglutide typically lose about 15% of their body weight.

When might Semaglutide be considered?

Many people find Semaglutide a useful addition to increasing physical activity and reducing calorie intake. Semaglutide is especially helpful for people with cardiovascular risk factors or people who have cardiovascular disease.

The common side effects of Semaglutide include bloating, abdominal pains, nausea, vomiting, and diarrhoea.

Treatment can only continue after 3 months if weight loss since the start of treatment is more than 5% of body weight, and can only continue for 2 years.

When should Semaglutide not be used?

Semaglutide is NOT recommended for

• women of childbearing age unless they are using highly effective contraception.
• people who have had medullary thyroid cancer, or if anyone in the family has had this.
• people who have Multiple Endocrine Neoplasia Type 2 (MEN2), or if anyone in the family has this.

Semaglutide should be used with caution in people who have had pancreatitis or chronic gastrointestinal problems.