Orlistat Insulin

Orlistat improved glycaemic control, which resulted in the need to reduce the dose of glibenclamide (glyburide) or glipizide in almost half the patients in one study. In other studies, orlistat also reduced the dose requirement for metformin and for insulin. Orlistat did not alter the pharmacokinetics of glibenclamide or metformin. Orlistat and cimetidine may have contributed to a case of metformin-associated lactic acidosis. The manufacturers recom-... 

Diabetic patients Weight-loss induction by orlistat may be accompanied by improved metabolic control in diabetic patients, which might require a reduction in dose of oral hypoglycemic medication (eg, sulfonylureas, metformin) or insulin. Misuse potential As with any weight-loss agent, the potential exists for misuse of orlistat in inappropriate patient populations (eg, patients with anorexia nervosa or bulimia). 

The observation that sibutramine, which blocks the re-uptake of noradrenaline and serotonin and to a lesser extent dopamine (6), causes a raised blood pressure has been a cause of concern (1,16). Some insight into this problem and its magnitude comes from two recent studies (17,18). Most studies have shown a positive relation between blood pressure and weight (19). The failure of the blood pressure to fall with weight loss in normotensive and hypertensive patients treated with sibutramine differs from the fall seen with orlistat (20-22) or weight loss induced by life-style modifications (23,24). In the case of sibutramine, the potentially detrimental effect due to the failure of the blood pressure to fall with weight loss may be offset by the reductions in lipids, insulin, and uric acid that occur with weight loss (25). 

Kelley, D.E., Bray, G.A., Pi-Sunyer, F.X., Klein, S., Hill, J., Miles, J. and Hollander, P. (2002) Clinical efficacy of orlistat therapy in overweight and obese patients with insulin-treated type 2 diabetes A 1-year randomized controlled trial. Diabetes Care 25, 1033-1041. 

Orlistat, a GI lipase inhibitor used for weight loss, was administered over a 4-year period that resulted in a 37% reduction in the progression of type 2 diabetes mellitus in a group of insulin-resistant obese patients. Finally, although... 

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