Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Paper
  • Published:

Gastrointestinal side effects of orlistat may be prevented by concomitant prescription of natural fibers (psyllium mucilloid)

Abstract

OBJECTIVES: This placebo-controlled open study was designed to test the hypothesis that most of the gastrointestinal (GI) side events induced by treatment of obese patients with orlistat (a gastrointestinal lipase inhibitor) could be prevented or ameliorated by concomitant use of natural fibers (psyllium mucilloid).

DESIGN: Two groups of obese women (BMI>27 kg/m2) were treated with orlistat 120 mg three times a day. One group (A, n=30) was randomized to receive orlistat and, approximately 6.0 g of orange-flavored psyllium mucilloid dissolved in water and the other group (B, n=30) received orlistat and orange-flavored placebo. At the end of 30 days and 2 weeks of washout, group A switched to placebo and group B received psyllium while continuing orlistat three times a day.

SUBJECTS: Sixty professional women, more than 21-y-old with a body mass index (BMI) between 27.3 and 48.0 kg/m2, who were not receiving any other medication.

MEASUREMENTS: Assessments included weekly visits to attending physician, filling a form in which GI events were recorded, monthly measurements of body weight, blood pressure and serum lipids. The frequency and severity of GI events were evaluated by a score system, based on information provided by the patients.

RESULTS: Both groups A and B significantly lost (P<0.01) weight after 60 days of orlistat (A=96.8 to 94.9 kg and B=98.7 to 96.5 kg). Similarly, BMI values declined significantly in both groups. While in the psyllium plus orlistat group (group A) the mean ±s.e.m. of the scores reflecting GI events was 13.0±1.8, the placebo plus orlistat group (B) had a value of 35.9±2.7 (P<0.01). When the reverse situation was instituted the placebo and orlistat group presented a mean score of 36.1±3.6 and the psyllium plus orlistat a mean score of 8.9±1.5 (P<0.01).

CONCLUSIONS: Psyllium hydrophilic mucilloid concomitantly prescribed to obese patients receiving 120 mg of orlistat three times a day is an effective and safe adjunct therapy that is helpful in controlling the GI side effects of this pancreatic lipase inhibitor.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. James WPT, Avenell A, Broom J, Whitehead J . A one year trial to assess the value of orlistat in the management of obesity Int J Obes Relat Metab Disord 1997 21 (Suppl 3): S24–S30.

    CAS  PubMed  Google Scholar 

  2. Sjöström L, Rissanem A, Andersen T, Boldrin M, Golay A, Koppeschaar HPF, Krempf M . Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients Lancet 1998 352: 167–173.

    Article  Google Scholar 

  3. Drent ML, Larsson I, William-Olsson T, Quaade F, Czubayko F, von Bergmann K, Strobel W, Sjöström L, van der Veen EA . Orlistat, a lipase inhibitor, in the treatment of human obesity: a multiple dose study Int J Obes Relat Metab Disord l995 19: 221–226.

    Google Scholar 

  4. Davidson MH, Hauptman JB, Digirolamo M, Focyt JP, Halsted CH, Heber D, Heimburger DC, Lucas CP, Robbins DC, Chung J, Heymsfield SB . Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat JAMA 1999 281: 235–241.

    Article  CAS  Google Scholar 

  5. Bray GA, Greenway FL . Current and potential drugs for treatment of obesity Endocr Rev 1999 20: 805–875.

    Article  CAS  Google Scholar 

  6. Hauptman J, Lucas C, Boldrin MN, Collins H, Segall KR . Orlistat in the long-term treatment of obesity in primary care settings Arch Farm Med 2000 9: 160–167.

    Article  CAS  Google Scholar 

  7. Everson GT, Daggy BP, McKimley C, Story JA . Effects of psyllium hydrophillic mucilloid on LDL-cholesterol and bile acid synthesis in hypercholesterolemic men J Lipid Res 1992 33: 1183–1192.

    CAS  PubMed  Google Scholar 

  8. Levin EG, Miller VT, Muesing RA, Stoy DB, Balm tK, LaRosa JC . Comparison of psyllium hydrophillic mucilloid and cellulose as adjuncts to a prudent diet in the treatment of mild to moderate hypercholesterolemia Arch Intern Med 1990 150: 1822–1827.

    Article  CAS  Google Scholar 

  9. Bell LP, Hectorme K, Reynolds H, Balm TK, Hunninghake DB . Cholesterol-lowering effects of psyllium hydrophilic mucilloid JAMA 1989 261: 3419–3423.

    Article  CAS  Google Scholar 

  10. Vahouny GV, Krutchevsky M (eds) . Dietary fiber: basic and clinical aspects Plenum Press: New York 1986 pp 181–209.

    Google Scholar 

  11. Kesaniemi YA, Tarpila S, Miettinem L . Low vs. high dietary fiber and serum, biliary and fecal lipids in middle-aged men Am J Clin Nutr 1990 51: 1007–1012.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We acknowledge the help of Creusa R Dal Bó in the statistical analysis of the data. This study was supported by Roche Pharmaceutical Co. and Procter & Gamble (Brazil). The expert secretarial work of Maria Suzette Pott is gratefully acknowledged. Part of this work was reported at the 9th European Congress on Obesity, Milan, Italy (1999).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to G Medeiros-Neto.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cavaliere, H., Floriano, I. & Medeiros-Neto, G. Gastrointestinal side effects of orlistat may be prevented by concomitant prescription of natural fibers (psyllium mucilloid). Int J Obes 25, 1095–1099 (2001). https://doi.org/10.1038/sj.ijo.0801645

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0801645

Keywords

This article is cited by

Search

Quick links