Myths and Facts About Generic Drugs

Unless you want to waste a large amount of money—often hundreds of dollars a year—by using brand-name instead of generic drugs, you should ask for the generic version, especially if you are starting on a drug for the first time. (See table below.) One of the few bits of comparative information about prescription drugs readily accessible to consumers is the retail price of brand-name versus generic drugs. You can get this information easily by asking your pharmacist. The table below was prepared by simply phoning a local pharmacy.

In 1984, generic drugs accounted for less than 19% of all prescriptions filled. Today, generic drugs represent more than 54% of all prescriptions dispensed in the United States. In addition, even though generics account for more than half of prescriptions dispensed, generics account for less than 16 cents of every dollar spent on prescription drugs.2 Today there are more than 7,800 generic versions of the approximately 10,668 FDA-approved pharmaceuticals.3

Brand-name drug manufacturers have gone to extraordinary lengths to mislead doctors, pharmacists, and the public into believing that their products are produced to higher standards, and thus are safer and more effective than the same drugs produced by generic companies. These strategies have included setting up sham patient groups to lobby state legislatures to protect their brand-name drugs, and the suppression of scientific research by at least one brand-name company that showed their brand-name product was no better than those of generic companies.

The quality of prescription drugs, brand-name or generic, does not depend solely on the manufacturer but also on a strong and vigilant FDA. Both brand-name and generic drug companies are regulated by the FDA using the same standards for manufacturing facilities, quality and purity, and content of prescription drugs.

The Question of Brand-Name Quality

Many brand-name drug companies such as Warner-Lambert and its subsidiary, Parke-Davis, denigrate the quality of generic drugs in an attempt to hold market share from generics and protect profits. However, the facts about this brand-name manufacturer bear examining.

From 1990 to the end of 1995, there were a total of 64 recalls of Warner-Lambert products as listed in FDA recall reports. In 1990, there were 3 recalls, 1 in 1991, 3 in 1992, 24 in 1993, 13 in 1994, and 20 in 1995. For their brand of phenytoin (DILANTIN) alone—a drug used primarily for treating seizure disorders and one where the amount of drug in the blood is critical—there have been 12 recalls during this period. Nine of these involved problems with dissolving of the drug, which can result in an insufficient amount being absorbed by the body. More than 975,000 bottles (some of which contained 1,000 capsules) and more than 30,000 injectable doses of Dilantin were affected by these recalls.4

In this case, Warner-Lambert officials pleaded guilty to criminal charges for withholding important information about sloppy manufacturing practices from the FDA.

FDA Repels Attacks on Generic Drugs

As discussed above, it is in the first seven years after approval—when there is never any generic equivalent available because the patent has not yet expired, that most drugs are found to cause serious problems, not infrequently leading to their removal from the market.

Examples of such disasters, which collectively have killed hundreds of Americans and injured thousands more, have involved the arthritis drugs or painkillers Oraflex, Suprol, and Zomax; the antidepressant Merital; the high blood pressure drug Selacryn; the diet drugs Pondimin, one-half of the once popular “fen/phen” combination, and its close chemical cousin Redux; Posicor, a drug for high blood pressure and chest pain; the diabetes drug Rezulin; and the painkiller Duract. Because of the serious dangers of these 10 drugs, all were taken off the market.

But what about those drugs that have been on the market for a long enough time for the patents to have expired and that are available in both brand-name and generic versions? Which version is safer or more effective? It has always been our position that there is no difference between generic and brand-name drugs as far as the odds that there will be something found wrong with the amount of active ingredient or the purity. Over the years, there have been recalls because of these kinds of problems with both generic and brand-name drugs.

A 1990 study by FDA laboratories from all over the country found that for those classes of prescription drugs that theoretically could be most likely to pose safety or effectiveness problems if they were not manufactured properly, the generic drug met the applicable standards in virtually all cases. The classes of drugs tested included contraceptives, antibiotics, and medications prescribed for asthma, epilepsy, high blood pressure, and abnormal heart rhythms. Of the 429 samples of the 24 different drugs tested, including both brand-name and generic drugs, there were no samples tested that posed a health hazard to patients when examined for potency and, where applicable, dissolution rate and content uniformity.

The reason that these 24 different drugs were chosen is that they all have a narrow therapeutic range. This means that unlike with most kinds of drugs, for which there is a relatively large range of dosages that are both effective and relatively safe, the amount of these drugs that gets into the body must be more tightly controlled. If it is not, the drug may too easily lose its effectiveness (if the dose is too low) or become toxic (if the dose is too high).

The drugs that tested included six asthma drugs, four for treating epilepsy, four high blood pressure drugs, four drugs for treating heart arrhythmias, a birth control pill, one antibiotic, a drug for treating depression, and a so-called blood-thinning drug. In six categories of drugs, both brand-name and generic versions were tested. In the case of the birth control pill, all of the major brand names, but no generic version, were tested.

For 23 of the 24 different drugs, there was no difference between the brand-name and the generic versions in the FDA laboratory tests for purity or quality. For aminophylline, an asthma drug that we do not recommend as a first-line treatment, five batches from two manufacturers failed to meet the FDA standards. Although none of these five batches posed a health hazard, all were recalled.5

Listed below are the names, both brand-name and generic, by therapeutic class, of all the drugs studied except for the birth control pill (because no generic version was studied) and aminophylline (AMOLINE, SOMOPHYLLIN, SOMOPHYLLIN-DF). As indicated in the table, many of these manufacturers have changed since the 1990 study because of mergers and acquisitions within the drug industry.

As can be seen in the above table, over the course of a year, for drugs such as the high blood pressure drug lisinopril, which must be taken daily, the savings—365 times $.57 per day—are a hefty $208 in one year; and the savings are hundreds more for others that many people may be using.

Myths and Facts About Generic Drugs⁶

Myth: Generics take longer to act in the body.

Fact: The firm seeking to sell a generic drug must show that its drug delivers the same amount of active ingredient in the same time frame as the original product.

Myth: Generics are not as potent as brand-name drugs.

Fact: FDA requires generics to have the same quality, strength, purity, and stability as brand-name drugs.

Myth: Generics are not as safe as brand-name drugs.

Fact: FDA requires that all drugs be safe and effective and that their benefits outweigh their risks. Since generics use the same active ingredients and are shown to work the same way in the body, they have the same risk-benefit profile as their brand-name counterparts.

Myth: Brand-name drugs are made in modern manufacturing facilities, and generics are often made in substandard facilities.

Fact: The FDA won’t permit drugs to be made in substandard facilities. The FDA conducts about 3,500 inspections a year in all firms to ensure standards are met. Generic firms have facilities comparable to those of brand-name firms. In fact, brand-name firms account for an estimated 50% of generic drug production. They frequently make copies of their own or other brand-name drugs but sell them without the brand name.

Myth: Generic drugs are likely to cause more side effects.

Fact: There is no evidence of this. The FDA monitors reports of adverse drug reactions and has found no difference in the rates between generic and brand-name drugs.

What Is Bioequivalence?

Generics are not required to replicate the extensive clinical trials that have already been used in the development of the original, brand-name drug. These tests usually involve a few hundred to a few thousand patients. Since the safety and efficacy of the brand-name product has already been well established in clinical testing and frequently many years of patient use, it is scientifically unnecessary, and would be unethical, to require that such extensive testing be repeated in human subjects for each generic drug that a firm wishes to market. Instead, generic applicants must scientifically demonstrate that their product is bioequivalent (i.e., performs in the same manner) to the pioneer drug.

One way scientists demonstrate bioequivalence is to measure the time it takes the generic drug to reach the bloodstream and its concentration in the bloodstream in 24 to 36 healthy, normal volunteers. This gives them the rate and extent of absorption—or bioavailability—of the generic drug, which they then compare to that of the pioneer drug. The generic version must deliver the same amount of active ingredients into a patient’s bloodstream in the same amount of time as the pioneer drug.

Using bioequivalence as the basis for approving generic copies of drug products was established by the Drug Price Competition and Patent Term Restoration Act of 1984, also known as the Hatch-Waxman Act. Brand-name drugs are subject to the same bioequivalency tests as generics when their manufacturers reformulate them.

The FDA has a public obligation to investigate thoroughly all allegations of drug product defects or failures. The agency has not found any of the allegations raised thus far in the brand-name versus generic drug controversy to be valid. The FDA also has an obligation to make known to health care professionals and to the public its conclusions that false or misleading reports are being generated.

The Levothyroxine (SYNTHROID) Scandal

Boots Pharmaceuticals, which became the Knoll Pharmaceutical Company of Mt. Olive, New Jersey, in March 1995, suppressed publication of scientific research for more than two years in order to perpetuate the incorrect public impression that their brand-name version of levothyroxine (SYNTHROID) was more reliable than generic levothyroxine products from three competing companies. The cost to the American public in excessive charges for Synthroid over these two years has been estimated to be $800 million.

Research that contradicted the Boots/Knoll superiority claim was finally published in the April 16, 1997, issue of the Journal of the American Medical Association. It found four generic and brand-name drugs—Synthroid and the three competing levothyroxines—to be bioequivalent by current FDA standards and interchangeable without loss of therapeutic efficacy in the majority of patients for treatment of hypothyroidism (low thyroid).⁷

Knoll’s predecessor, Boots, contracted with a faculty member and researchers at the University of California at San Francisco (UCSF) in 1987 for a bioequivalence study comparing Synthroid with three competitors’ levothyroxine products. The company paid the researchers $250,000 to do the study. In this case, a finding of bioequivalence would justify the use of less-expensive, equally effective generic products instead of Synthroid. Boots’s expectation was that the study would find Synthroid to be superior to the generics.

The contract contained a clause giving Boots veto power over publication of the study’s results. The problems began in late 1990, when it became known that Synthroid and the other three levothyroxines were the same.

Over the next four years, Boots waged a calculated campaign to discredit the researchers and their work. Once it was clear that the study would not support the claim of Synthroid’s superiority, Boots alleged scores of deficiencies and errors in the study. The university conducted an investigation of how the research was done and found only minor and easily correctable problems. Some members of the investigating panel found Boots’s interactions with the researchers to be “harassment” and characterized the company’s actions as “deceptive and self-serving.” The university concluded that the study was carefully done and complied fully with the terms of the contract.⁸

The results of the study were submitted to the Journal of the American Medical Association in April 1994. The study was sent to five experts for peer review and was accepted for publication in November 1994, with its publication scheduled for the January 25, 1995, issue of the journal. On January 13, 1995, the researchers suddenly withdrew the study from publication, citing as the reason “impending legal action by Boots Pharmaceuticals, Inc. against UCSF and the investigators.” Because of the clause in the contract giving the company veto power over publication, UCSF said it would not defend the researchers if the study was printed without the company’s permission.⁸

Then, in a move striking at the very core of ethical scientific standards, the company’s senior director for medical research took the study results and, without giving credit to the UCSF researchers, published a misleading version in an obscure journal of which he was also an associate editor. The new version was used to support the company’s previous assertion of Synthroid’s superior reliability.

Six years after it was known that there was no difference between Synthroid and generic levothyroxine products, and more than two years after the UCSF research should have been published, the Journal of the American Medical Association published the research just as it would have appeared in January 1995, had it not been for Boots’s interference.

To sum it all up, generic drugs are just as effective and safe as brand-name drugs. Unless you want to waste quite a bit of money, ask your pharmacist to fill your prescription with a generic drug. If the brand-name drug is not yet off patent, your pharmacist will advise you of this. See the table on p. 881 for some examples of generic savings.

Internet Purchase (with Caution) of Drugs and Importing Drugs from Canada

As is well known, the only reason that United States residents have increasingly turned to the Internet or to Canada as a source for drugs is that drug prices are out of control at home. Drug prices in foreign countries are often half of what they are for identical drugs in the United States. Unlike every other industrialized country, the United States refuses to negotiate drug prices or, as is done in Britain, negotiate a guaranteed profit margin for pharmaceuticals. In fact, we are in many respects going in the opposite direction; the recently passed Medicare prescription drug legislation actually prevents the Medicare program from using its massive purchasing power to negotiate lower drug prices.

Among its billions of pages, the Web contains a minigrowth industry in prescription drug sales. That much of this industry has its sights trained on the United States should be no surprise: Americans use prescription drugs heavily and, thanks to the failure of the government to restrict prices or profits (as is done in most developed countries), we pay more for them.

Some consumers have responded to drug company pricing double standards by hopping a bus and heading north to Canada, but for most people in the United States, this will not be feasible. A trip to your computer terminal, however, puts you instantly in touch with dozens of drug-selling operations, all eager for your business. But can you trust them?

The General Accounting Office (GAO), an investigative branch of Congress, recently conducted a study examining the practices of Internet pharmacy sales. The results should give pause to anyone contemplating succumbing to the allure of the less expensive products on offer on the Web.⁹

The GAO identified 13 drugs of particular interest and filed orders with 90 different pharmacies around the world; in the end, 68 drugs were received. The top-selling drugs, including Celebrex, Lipitor, and (of course!) Viagra, were generally widely available, but drugs requiring patient monitoring to protect patient safety (Accutane, Clozaril) and narcotic pain relievers (OxyContin, Percocet) were tougher to find.

All six pharmacies that accepted payments for the drug and then failed to fill the order were located outside of the United States or Canada. Not one of the 21 drugs obtained from outside the United States or Canada included a product label and only six contained warning information. Most improperly shipped drugs came from these countries as well: insulin that was not refrigerated, moisture-sensitive drugs that were not sealed, drugs hidden in compact disc cases, and drugs labeled as “dye and stain remover wax.”

But the United States and Canadian sites were certainly not immune from problems. Sixteen of 18 Canadian drugs did not comply with U.S. regulations in that the packaging or labeling had not been approved by the FDA or the agency had not inspected the manufacturing plant. (These drugs may well have met the requirements of Canadian regulatory authorities, and Canadian labeling is quite similar to that in the United States.) However, all 29 U.S. and all 18 Canadian drugs proved to have the proper amount of the active ingredient, while four of the other foreign drugs did not.

Where the United States proved particularly inadequate was in requiring a prescription. Internet pharmacies are usually divided into three groups: (1) those to whom you have to mail a prescription; (2) those that have you fill out a questionnaire online and that, without ever examining you, dispense the drug; and (3) those that don’t even maintain the pretense of a questionnaire and simply provide the drugs. Most states consider the latter two options to constitute an improper practice of medicine but have generally failed to discipline those physicians lending their names to such schemes. Only five of the 29 United States sites required a prescription, with the remainder requiring the online questionnaire. Three of the non-Canadian foreign sites required a questionnaire, but the remaining 18 simply mailed the drugs. In contrast, every Canadian pharmacy required a prescription from the patient’s own physician, the most reputable option.

The United States government, at least, seems to suspect that illegal activity is rife in this industry. Fourteen of the 68 pharmacies (nine United States, one Canadian, and four from other foreign countries) were under investigation by either the United States FDA or the Drug Enforcement Administration for allegations including selling controlled substances without a prescription, lack of a doctor-patient relationship, selling adulterated or counterfeit drugs, smuggling, and mail fraud.

Given the way the drugs were obtained, it is difficult to make general statements about the reliability of different countries’ Internet sites. The most reliable predictor of Web site quality appears to be whether or not it requires a prescription from your own doctor. Ironically, given the current focus on drug importation, the GAO data suggest that, on this measure at least (and assuming you are willing to accept Canadian regulatory standards as equivalent to those in the United States), if you’re going to hop on a virtual Internet bus, it would be best if it were pointed North.

Importing Drugs from Canada

Spiraling drug prices have also driven desperate consumers to look to foreign countries, particularly Canada, to obtain prescription drugs at affordable prices. The FDA and the pharmaceutical industry have complained that such importation is unsafe, due to possible counterfeiting, poor quality manufacturing, and contamination. Counterfeits are a long-standing problem in United States health care, predating the importation debate by decades. The problem is not restricted to imports; domestically manufactured drugs are also all-too-frequently counterfeited or adulterated.

Yet, while the FDA continues to raise concern over counterfeiting, in part by producing misleading reports that exaggerate the problem or focus on the importation dimension of it alone, the agency is in fact part of the problem. A law that was designed to cut down on counterfeiting has, 17 years after it was passed, still not been implemented, thanks to industry-inspired delays at the FDA.

The absurdity of the current situation can be appreciated by analogy. If a car develops a safety problem, the manufacturer has the ability to track down each car from, for example, that model-year to inform the current owner of the problem, no matter how many times the car has been resold. Incredibly, this is not possible for pharmaceuticals.

Historically, the path from a pharmaceutical manufacturer to a consumer was relatively simple: manufacturers sold to wholesalers who sold to hospitals or pharmacists who administered medications or filled prescriptions. Over the years, this path has become circuitous. Secondary wholesalers might obtain the drugs from one of the three major (primary) wholesalers and then sell it to hospitals or pharmacists. Sometimes primary wholesalers obtain drugs from the secondary wholesalers. Occasionally, secondary wholesalers procure the drugs from the manufacturers themselves. These circuitous roots to the patient provide the opportunity for counterfeiters and other fly-by-night operators to insert themselves into the process. In the process, quality assurances may be lost as drugs are not properly stored, for example.

A document could easily circulate with the batch of drugs with each resale, greatly reducing the possibility of counterfeiting or adulteration, because the perpetrator could be more easily identified. Such a document, called a pedigree, was mandated by Congress in the Prescription Drug Marketing Act (PDMA) of 1987. Even the pharmaceutical companies support it, presumably because it would protect their brands from being tarred by counterfeit knock-offs. In 1988, the FDA issued a guidance document that laid out its interpretation of the PDMA. However, the FDA did not even propose a regulation to implement the PDMA until 1994, and a final regulation was not completed until 1999. In fact, the final regulation was very similar to the 1988 guidance. It was only at that point that complaints from the drug wholesaling industry, which claimed that the paperwork would endanger their profitability, began in earnest. Ironically, it is among these very wholesalers that the counterfeiters lurk. Nonetheless, the FDA has “delayed” implementation of the rule five times, most recently through December 2006. Through these accumulating stalling tactics, the FDA has so far succeeded in frustrating the intent of Congress for 17 years.

This important public health issue has thus been in limbo since 1987, with the FDA never implementing its regulations but nonetheless assailing counterfeiters and importers who are aided and abetted by the FDA’s failure to regulate. Meanwhile, the secondary wholesalers practice business as usual—all at the cost of potentially exposing United States patients to counterfeit and adulterated drugs.

This leaves consumers in the lurch. On the one hand, they are besieged by rising drug prices; on the other they have been abandoned by the very agency that is supposed to protect them from counterfeiters. (The increasingly pro-industry FDA apparently is seeking to protect manufacturers’ profits by preventing the importation of less expensive drugs, an ironic stance for an administration that claims affinity to free-market principles.) For now, the best course is to write your congressperson and the FDA demanding that the congressionally mandated pedigree be implemented. If you live close to the Canadian border, a trip north to take advantage of the prices secured by a government that actually protects its residents from the profiteering of the pharmaceutical industry is probably reasonable.

Xenical is the medication which works very outstandingly with a lipase inhibitor named gastrointestinal for the management of obesity that also comprises weight loss and weight maintenance which requires association of reduced-calorie diet. Xenical contains orlistat which execute its work non- scientifically for restraining the fat digesting action of lipase in the gastrointestinal, this drug works not like other weight loss drug which perform their task in the brain or middle nervous system for suppressing appetite and also for speeding up the metabolisms. This ingredient works by jamming around 30 % of dietary fat. This diet pill does not contain any unfamiliar diet along with it is a prescribed drug.

Xenical Orlistat simply goes to the intestine and blocks the functioning of lipase from breaking down the fat that has been munched through with the food. Undigested food is removed by the bowel movements of body. By following this method Xenical presents you the best alternative for losing weight very safely and effectively. Xenical is called as a weight loss drug which does not have any aspire for melting fat or any standard of living varying diet. American Heart Association has recommended the ideal calorie for reduction is 30 % for a healthy heart.

For achieving the desired weight or appearance Generic Xenical perform its job by reducing the content of the body. With the assist of this slimming pill you can now achieve your desired shape as because of fatty foods not only body gains weight but this situation creates numerous of problem related to the health. Diabetes, heart problems, hypertension, atherosclerosis, PE, ED, and many more ailments can be caused due to junk food.

Xenical drug you can now obtained from online also, as from online you can now obtain a great number of benefits as there are no hassle about standing in a queue and time. By online there is golden chance to obtain weight loss pills at discounted price. Discount Xenical from online give you a chance for availing yourself with highly effective outcomes. You can Buy Xenical without any prescription can be a fine option for reducing weight and also for achieving an ideal physique for becoming perfect. With gentle side effects it assures you to have opportunity for losing weight but the use of Generic Xenical requires a little attention for your health history as if you had or have problem related with gallbladder problems, kidney stones or chronic malabsorption syndrome then you will have to consult your doctor for using Xenical.

Do you want to lose weight then no problem you can do this with highly effective weight loss pills like Generic Xenical. By the consumption of generic Xenical with a combination of diet and daily exercise brings best outcome for reducing weight. Orlistat is unsurprisingly contained by the generic xenical which performs its work as a self-motivated ingredient which works effectively for supporting the weight loss among the huge number of persons across the world. Being a most amicable and inimitable medication Xenical offers best consequences by blocking the absorption of fat.

Some food items comprise fat in large quantity and fewer amounts of protein and carbohydrate, in this situation Generic Xenical that inhibits the endorsement of fats. There are no tablets in the market which have better results like Xenical as users are satisfy with its outcomes which they gain for reducing their weight. Generic Xenical indicates its effectiveness within a month of using this tablet. This medicine is prescribed drug for reducing weight which is a frustrating task that is why this situation requires more support and also self confidence.

By blocking one third part of fat from digestion and also absorption which you have consumed it avoid gaining weight. As it contains orlistate, this element blocks the action of lipase which is an enzyme that is responsible for breaking down your dietary fats so that the absorption can be done easily and also effectively. It becomes mandatory that Generic Xenical must be taken with diet which is low calorie referred by physician along with exercise. This weight loss program will assist you very proficiently if you go for educing weight with this well planned weight loss program.

Generic Xenical is approved by Food and Drug Association as a prescribed drug for getting better results by reducing weight which blocks dietary fat of your body. For having sound health it is necessary for the persons to take this Generic Xenical under the direction of your medical healthcare as he is the best person for telling you proper dosage of this drug. It is great option to buy Xenical for getting an ideal physique. This drug requires low calorie diet in this condition you must be aware with the nutrition which is necessary for the functioning of body.

You can Buy Xenical for achieving your target but you should know about its side effects also such as loss of bowel control, oily stools, diarrhea, rectal pain, fatigue and liver inflammation which are gentle in nature.?

What is the difference between Xenical and Alli?

Although both medications contain the same active ingredient, the differing dose means that they are prescribed in different ways. Xenical must be prescribed on prescription by a doctor, whereas Alli can be prescribed over the counter by a pharmacist. The criteria for both treatments are similar, however a doctor has more discretion in deciding how long to continue treatment for, whereas a pharmacist has much stricter prescribing guidelines. Strict guidelines on OTC provision of Alli means that the drug cannot be issued to patients with BMI < 28. Xenical on private prescription on the other hand can be provided up to BMI 25.

The maximum treatment times of these medications can also differ. Xenical Orlistat 120mg can be used for up to 2 years, pharmacists must not exceed 6 months of treatment with Alli Orlistat 60mg.

How should these medicines be taken?

One capsule of Orlistat should be taken with each of your three main meals. If you skip a meal or eat one which contains no fats at all, you can skip your dose of Orlistat too. One 84 capsule pack of Orlistat should last about 4 weeks.

One recommendation for taking Orlistat based medicines is to start with the lower dose drug and increase to the higher after one month. Do not increase the dose from 60mg to 120mg if side effects can not be tolerated. Start by taking Alli moving onto Xenical later on once you have learnt how to manage Orlistat’s side effects.

Which will help me lose weight fastest?

With only half the dose, treatment with Alli is slower compared with weight loss treatment using Xenical. It is recommended that obese patients or patients with weight related illnesses choose Xenical to lose weight faster. This is especially important if the patient has high cholesterol, high blood pressure or diet controlled diabetes. * Patients treated for diabetes with insulin should let the physician know, so that any special dosing advice can be given to avoid contraindications between medications.
Alli and Xenical alone will both bring gradual weight loss results. Alli will help a patient increase their weight loss potential by 30%, whereas Xenical will make a difference of up to 50%. Using medications alone without making any lifestyle changes is not recommended and weight loss potential can be increased by following a diet and an exercise programme.
The choice of whether a patient should use Xenical or Alli will depend on a patient’s medical history and whether their weight loss programme needs to be followed by a doctor or can be supported by a pharmacist instead.

Orlistat : Xenical

Trade/Brand names?
Orlistats trade/brand name includes Xenical

Why is Orlistats/Xenical prescribed?
Orlistat is used with a low-calorie diet to help you lose weight and to maintain your weight after weight loss. Orlistat is used in patients with a certain weight who may also have high blood pressure, diabetes, high cholesterol, or heart disease.

Orlistat is in a class of drugs called lipase inhibitors. It works in your intestines, where it blocks some of the fat you eat from being absorbed and disgested. This undigested fat is then removed in your bowel movements (BM).

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

How should Orlistats/Xenical be used?
Orlistat comes as a capsule to take by mouth. It is usually taken three times a day with each main meal that contains fat. Each time you take orlistat, your meal should contain no more than about 30% of calories from fat. Take orlistat during or up to 1 hour after a meal. If a meal is missed or does not have fat, you may skip your dose. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take orlistat exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

What special precautions should I follow before taking Orlistats/Xenical?

Before taking orlistat,

tell your doctor and pharmacist if you are allergic to orlistat or any other drugs.
tell your doctor and pharmacist what prescription and nonprescription drugs you are taking, especially anticoagulants (”blood thinners”) such as warfarin (Coumadin); medications for diabetes, such as glipizide (Glucotrol), glyburide (DiaBeta, Dynase, Micronase), metformin (Glucophage), and insulin; other medications for weight loss; pravastatin (Pravachol); vitamins such as beta-carotene and vitamins A, E, and K; and herbal products. If you are taking cyclosporine (Neoral, Sandimmune), take it 2 hours before or 2 hours after orlistat.
tell your doctor if you have or have ever had anorexia nervosa or bulimia, gallstones, thyroid disease, diabetes, kidney problems, or if you consistently have problems absorbing food (malabsorption syndrome).
tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding.
What special dietary instructions should I follow?
Follow the diet program your doctor has given you. You should evenly divide your daily intake of fat, carbohydrates, and protein over three main meals. If orlistat is taken with a meal very high in fat (30% total daily calories from fat), you may experience more side effects from the medication.

Orlistat blocks your body’s uptake of some fat-soluble vitamins and beta carotene. Therefore, when you use orlistat you should take a daily multivitamin supplement that contains vitamins A, E, K, and beta-carotene. Take the vitamin once a day, 2 hours before or 2 hours after taking orlistat, or take the vitamin at bedtime.

To help you get started on reducing the fat in your diet to about 30%, read the labels on all the foods you buy. While you are taking orlistat, you should avoid foods that have more than 30% fat. When eating meat, poultry (chicken) or fish, eat only 2 or 3 ounces (about the size of a deck of cards). Choose lean cuts of meat and remove the skin from poultry. Fill up your meal plate with more grains, fruits, and vegetables. Replace whole-milk products with nonfat or 1% milk and reduced- or low-fat dairy items. Cook with less fat. Use vegetable oil spray when cooking. Salad dressings; many baked items; and prepackaged, processed, and fast foods are usually high in fat. Use the low- or non-fat versions of these foods and/or cut back on serving sizes. When dining out, ask how foods are prepared and request that they be prepared with little or no added fat.

What should I do if I forget a dose?
Take the missed dose as soon as you remember it unless it is more than 1 hour since you ate a main meal. If it is longer than 1 hour since you ate a main meal, skip the missed dose and continue on your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can Orlistats/Xenical cause?
The most common side effect of orlistat is changes in bowel movement (BM) habits. This generally occurs during the first weeks of treatment; however, it may continue throughout your use of orlistat. Tell your doctor if any of these symptoms are severe or do not go away:

oily, spotting BMs
gas with discharge
urgent need to have a BM
oily or fatty stools
an oily discharge
increased number of BMs
inability to control BMs
orange or brown color of a BM
stomach pain
irregular menstrual periods
If you experience any of the following symptoms, call your doctor immediately:

itching
redness of skin
skin rash or hives
swelling
chest pain
difficulty breathing
fever

What storage conditions are needed for this medicine?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

What other information should I know?
Keep all appointments with your doctor. Read the patient information before starting treatment with orlistat and each time you refill the medication.

You should also follow a program of regular physical activity, such as walking. However, before you start any new activity or exercise program, talk with your doctor or health care professional.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

Orlistat is a drug that can help you to lose weight if you are obese or overweight. It works by interfering with the way that fat is digested and absorbed into the body. Doctors have guidelines as to when orlistat can be prescribed. You can also buy orlistat from pharmacies – but certain conditions apply, detailed below. If you take orlistat, as it may possibly interfere with the absorbtion of some vitamins, you should take a multivitamin supplement at bedtime. Tell your doctor or pharmacist if you take any other drugs as orlistat can interfere with the absorbtion of some drugs.

How can I lose weight?
To lose weight, the best chance of long term success is to eat a healthy diet and, if you are able, to exercise regularly. See separate leaflet called ‘Weight Reduction – How to Lose Weight’ for more details. There is only a limited role for medicines to help with weight loss.

Orlistat is a medicine that is sometimes advised. However, it is no ‘wonder-drug’, it only partially helps, and you still need to eat less to lose weight..

How does orlistat work?
Orlistat works by blocking chemicals (enzymes) in your gut which digest fat. Nearly a third of the fat that you eat is blocked by orlistat. The undigested fat is not absorbed into your body, and is passed out with your faeces (stools). The normal dose is one capsule, three times a day with each meal. However, you do not need to take one if there is no fat in the meal or if you miss a meal..

How effective is orlistat?
Studies have shown that, on average, orlistat, plus a weight-reducing diet and exercise, causes more weight loss than a weight-reducing diet and exercise alone. Some people lose 10% or more of their body weight within six months with the help of orlistat. In others, it is less effective.

One reason why orlistat may not work is that you may think that you can relax your weight-reducing diet, and the orlistat will ‘do it all’. This is not true. You still have to eat less. Remember, orlistat prevents only some of the fat that you eat from being absorbed (just under a third). But, if you do not keep to a healthy weight-reducing diet, and eat more fat (chocolates, cakes, etc), the extra fat that you eat will easily cancel out the effect of the orlistat..

Guidelines for using orlistat
.When orlistat is prescribed
Doctors are expected to follow guidelines when prescribing orlistat. These include: .

•Your BMI (Body Mass Index – see below)
◦must be 30 or above, or
◦must be 28 or above, and you have a medical condition that would benefit from losing weight (such as diabetes or high blood pressure).
•You must lose at least 5% of your weight by three months from starting orlistat, and at least 10% of your weight by six months. If not, the orlistat should not be continued to be prescribed.
•You must be between the ages of 18 and 75 years.
If you continue to lose weight after six months, your doctor may advise that you continue to take orlistat. This may be for up to 1-2 years, or longer if you have a great deal of weight to lose..

Buying orlistat from pharmacies
In the spring of 2009, low-dose orlistat became available to buy from pharmacies. Pharmacists cannot just sell it to anyone. They are expected to follow guidelines which include:.

•Your BMI (Body Mass Index) must be 28 or above.
•Your BMI should be checked on each occasion that you request orlistat.
•You must be between the ages of 18 and 75 years.
Good practice would also mean a pharmacist advising you on an appropriate diet. That is, orlistat must be used in conjunction with a low-calorie and low-fat diet..

Are there any side-effects with orlistat?
The main side-effects are caused by the fat which is passed out with your faeces. You may get fatty smelly stools, urgency to get to the toilet, oily spotting on your underclothes, and excess wind. These side-effects are less likely if you eat a low-fat diet. They tend to settle with time, possibly because if they occur they remind you that you should be eating a low-fat diet! Other side-effects are rare. (Read the packet leaflet for a full list of possible side-effects.).

Who should not take orlistat?
The following people should definitely not take it:.

•Pregnant or breastfeeding women.
•People under the age of 18.
•People with a malabsorption syndrome (where food is not absorbed properly).
•People with cholestasis (a condition where bile does not flow properly from the liver to the duodenum).
Orlistat can also interfere with the absorbtion of various drugs and vitamins and affect the way that they work. Most notably: ciclosporin, acarbose, amiodarone, warfarin. Possibly also the contraceptive pill. Therefore, if you take orlistat:.

•Take a multivitamin supplement at bedtime – a time when they will not be taking orlistat – to help ensure adequate vitamin intake.
•If you take the contraceptive pill and have severe diarrhoea you should use other methods of contraception in addition to the pill – for example, condoms.
•Tell your doctor or pharmacist about other drugs that you take before starting on orlistat.
Always read the packet leaflet for a full list of cautions and of people who should not take orlistat..

What is my body mass index (BMI)?
BMI, mentioned above, is a good estimate of how much of your body is made up of fat. It relates your weight to your height.

You can work out your BMI by dividing your weight (in kilograms) by the square of your height (in metres). So, for example, if you weigh 70 kg and are 1.75 metres tall, your BMI is 70 / 1.75 x 1.75, which is 22.9. Alternatively, your practice nurse can measure and weigh you, and tell you your BMI..

Keeping to a reduced weight
A number of people who lose weight with the help of orlistat put the weight back on once the orlistat is stopped. Try to anticipate this.

Once you have lost some weight, you are more likely to keep your weight down if you stick to a healthy diet, exercise regularly (if you are able), and weigh yourself once a week..

Further help
See your practice nurse for further help and advice about a healthy diet and exercise. There are also more detailed leaflets in this series called ‘Weight Reduction – How to Lose Weight’, ‘Healthy Eating’, and ‘Obesity and Overweight’.

Orlistat Review
The FDA approved Orlistat for prescription use in 1999 under the brand name Generic Xenical. Orlistat is used to treat obese patients who have a body mass index of over 30 and is combined with a low calorie diet and an exercise program to reduce weight. Xenical is also used to prevent weight gain after a patient has lost weight. The lower dose formula of Orlistat was approved by the FDA in 2007 and is now sold over-the-counter under the name Alli.

Orlistat weight loss
Orlistat supposedly blocks the absorption and the digestion of fat in food. Lipase is an enzyme that is found in the intestine and separates the fat in the food, so it can be absorbed in the system. Orlistat blocks about 25% of the fat in a meal by blocking lipase. The fat that’s not absorbed is not digested and passes through the system and is excreted in a bowel movement. Studies claim that when Orlistat is taken as directed, the average weight lost over a six to twelve month period may be 12 to 13 pounds. Vitamins bind to fat and they can be eliminated along with fat while using Orlistat, so a fat-soluble multi-vitamin should be part of the weight loss program and should be taken two hours before or a few hours after taking Orlistat.

Orlistat ingredients
•Orlistat
•Microcrystalline Cellulose
•Sodium Starch Glycolate
•Sodium Lauryl Sulfate
•Povidone
•Talc
Orlistat cost
The recommended dose is one 120 mg capsule three times a day. A Bottle of 84 capsules is $65 to $78.

Orlistat side effects
The most common side effects are: diarrhea, urgent bowel movements, flatulence, fatty stool, skin rash, sleep problems, muscle pain, tooth problems and urinary tract infections.

Does Orlistat work?
Orlistat may prevent some of the fat in food from being digested, but in order for the drug to make an impact a low fat diet must be part of the program, along with an exercise routine. Orlistat claims it can block about 25 to 30 percent of the fat that enters the body, but if the food is high in fat there may not be much weight loss. Reviewers who use Orlistat did say they experienced some weight loss, but the side effects preventing them from continuing the program. Vitamins are also lost in this weight loss system so it is important to be under the care of a physician when using Orlistat. There are several issues that could develop, especially if there are thyroid problems or if diabetes is an issue.

Hoodia Balance is an all natural supplement that has been proven to reduce weight, boost the immune system and increase stamina. Hoodia has been used for decades as an appetite suppressant and a stamina builder. Hoodia Balance contains P57 a chemical compound that interacts with the hypothalamus, which is the part of the brain that controls appetite, body temperature and blood sugar. P57 tell the brain that the blood sugar level is normal, so body is not hungry. Fewer calories are eaten and the body automatically starts to burn fat calories that are stored in cells throughout the body. Hoodia Balance along with a balanced diet rich in fruits and vegetables, eight glasses of water a day and an exercise program that includes aerobic and resistant training will build muscle mass, increase the energy level and burn stored fat calories, so your ideal weight becomes a reality.

Orlistat, also known as tetrahydrolipstatin (THL), is a drug used to treat obesity in conjunction with a low-calorie, low-fat diet. The anti-obesity drug is used as a medical aid to lose weight (weight loss) and to maintain that weight afterwards (weight maintenance). It is classified within the drug class called lipase inhibitors, where lipase is produced primarily in the pancreas. Orlistat is a crystalline power that is whitish in color. Chemically, it is the saturated derivative of lipstatin, which is isolated from Streptomyces toxytricini. The empirical chemical formula for orlistat is C29H53NO5.

The drug orlistat was approved by the U.S. Food and Drug Administration (FDA) in 1999 for use within the United States. It was recommended for obese people with a body mass index (BMI) of more than 30 kilograms per square meters. It was also recommended when peoples’ BMI was between 27 and 30 kilograms per square meters and other heath considerations such as high blood pressure, elevated blood cholesterol, or diabetes were detrimental to their lives. Medical studies, which paralleled previous conclusions, performed before orlistat was approved by the FDA found that when taken for six months, adults lost 12.4 to 13.4 pounds on average. Orlistat is marketed under the prescription name Xenical® and the over-the-counter name alli®.

Purpose
Orlistat prevents the digestion and absorption of dietary fats into the bloodstream so that, instead, they pass through bowel movements within the feces. Consequently, they reduce the amount of calories that go into the human body. It is often used within a physician-supervised diet plan for obese people and as a maintenance plan for formerly obese people after they have lost weight. It is also used for people desiring to lose weight when they have such illnesses as diabetes, high cholesterol, heart disease, or high blood pressure.

KEY TERMSAnorexia nervosa—An eating disorder involving low body weight, distorted image of one’s body, and fear of gaining weight.
Bulimia—An eating disorder that involves cycles of overeating and undereating.
Cardiovascular disease—Diseases that have to do with the heart and blood vessels (veins and arteries).
Gastrointestinal—Relating to the stomach and intestines.
Hypertension—Disease of the arteries that usually indicate high blood pressure.
Immunosuppressant—Suppression of the immune system.
Lipase—An enzyme produced from the pancreas that breaks down fats.
Inside the human body, orlistat diminishes the production of pancreatic lipase, which is an enzyme that decomposes triglycerides within the intestines. When pancreatic lipase is not present, triglycerides which are ingested within foods, are stopped from being hydrolyzed into free fatty acids. They are, instead, excreted through bowel movements within feces without being digested. Orlistat, itself, is only slightly absorbed into the body. Most of it is taken into the gastrointestinal tract and eventually removed through the feces.

Orlistat was introduced into the marketplace primarily because of the increasing number of overweight or obese people in the United States and other countries around the world. According to the National Institutes of Health (NIH), as of 2007, about 65% of all U.S. adults are overweight or obese. NIH scientists have shown that being overweight or obese can lead to increased risk of developing health issues such as high blood pressure, heart disease, arterial disease, and type-2 diabetes. According to the World Health Organization (WHO), over one billion adults are overweight in the world, and at least 300 million of them are considered obese.

Description
Orlistat is usually prescribed by medical professionals in a dosage of 120 milligrams three times per day, specifically after or during main meals. According to The Obesity Society, taking more than three dosages in one day has been shown ineffective at eliminating additional weight and, thus, is not recommended by medical doctors. Orlistat is available in a capsule that is taken orally (by mouth) during or up to one hour after the eating of main meals. It should be taken with a full glass of water.

According to the Mayo Clinic, these primary meals should contain no more than about 30% of fat by total calories. When used within these guidelines, about 30% of dietary fat is stopped from being absorbed into the body and, instead, is expelled through the feces.

The effectiveness of orlistat and, thus, the amount of weight loss achieved varies among humans. Orlistat, as of 2006, has been the most studied weight-loss medication on the international market. It has been used since 1999 in the United States and since 1998 in 145 other countries. Over 125 million people have used orlistat and more than 100 clinical studies with over 30,000 subjects have been performed. In all, it has been proved safe and efficient when used as prescribed.

A landmark one-year study, which concluded in 2007, was conducted by Xenical Pharmacology. The study shows that the drug reduces body mass by 5% or more in about one-third to one-half of the subjects and decreases body mass by at least 10% in about one-sixth to one-fourth of patients. The effectiveness and safety of orlistat have only been proven in four years or less of use.

Precautions
Some side effects caused by the use of ortistat include gastrointestinal problems. Most problems reported happen within the first year of use, with the severity and number of problems diminishing over time. Because dietary fat is expelled with the feces, the stool may become oily, fatty, or loose. The color may change to an orange color. In addition, increased gas (flatulence) with noticeable discharge is frequently reported. Bowel movements are also more frequent and sometimes urgently sensed. It may become difficult to control bowel movements. Upon stopping the use of ortistat, feces return to normal fatty levels and color between 24 and 72 hours.

To minimize side effects, foods with a high fat content should be avoided. Physicians recommend a low-fat, reduced-calorie diet when taking ortistat. In addition, a well balanced diet should consist of even proportions of carbohydrates, fat, and protein that are distributed throughout one day over three large meals. If a main meal is missed or contains no fat, the pill can be eliminated, too. It is recommended that whole-milk products be replaced with nonfat milk or 1% milk and low-fat or reduced-fat dairy items. Baked items and prepackaged, processed, and fast foods should be avoided because they are usually high in fat content. In general, people taking orlistat should actively read food labels before buying and eating in order to avoid foods high in fat.

Because orlistat can impair the absorption of vitamins (especially A, D, E. and beta-carotene, which are classified as fat-soluble vitamins) and other nutrients into the body, a multivitamin should be taken daily, at least two hours before or several hours after taking ortistat, or at bedtime.

Interactions
Problems with interactions may arise if orlistat is taken along with anticoagulants (blood thinners) such as warfarin (Coumadin®). A physician should monitor patients who are taking both drugs. Orlistat can also cause problems with diabetic medicines such as glipizide (Glucotrol®), glyburide (DiaBeta®, Dynase®, Micronase®), metformin (Glucophage®, Diabex®, Fortamet®), and insulin. Diabetics should consult with their doctor because the amount of oral diabetic medicine may need to be changed when weight loss has occurred.

Orlistat can also reduce the effectiveness of cyclosporine while being taken as an immunosuppressant drug to reduce the body’s risk of organ rejection after transplants. Make sure that cyclosporine is taken at least two hours before or after the taking of orlistat. The drug can also increase the absorption of pravastatin (Pravachol®, Selektine®), which is used to improve cholesterol levels and to prevent cardiovascular diseases.

The drug ortistat can also cause problems if other medicines for weight loss are taken along with the drug. According to the NIH, always consult with a medical physician before taking orlistat and to inform your doctor of any currently used medicines or allergic reactions (such as with animals, foods, dyes, or preservatives) before starting ortistat. Pregnant and nursing women should not take orlistat. Anyone with problems with an eating disorder, gallbladder, malabsorption syndrome (difficulty absorbing food), or kidney stones should not take orlistat.

Complications
The use of orlistat has been shown to increase the risk of breast cancer and colon cancer. However, such medical claims are preliminary in nature and further scientific research is necessary. Orlistat has also been shown to increase the risk for problems with the gallbladder and kidneys, along with complications in pregnancies and breastfeeding. It may cause complications if patients have problems with anorexia nervosa or bulimia, and thyroid disease.

Parental concerns
According to the Mayo Clinic, orlistat has only been tested on adults. Information is not currently available on how children are affected by orlistat. In addition, studies performed on pregnant animals do not show evidence of harm to fetuses. However, according to the Mayo Clinic, orlistat is not recommended for pregnant women. Also, due to lack of medical studies, it is not recommended for women who are nursing newborn babies. Proper dosage amounts for children have not been determined. When considering the use of orlistat for children, a medical professional should be consulted as to the amount given for each individual child.

On February 7, 2007, the FDA approved Alli® as an over-the-counter drug. Alli® is a lower dose version (60 milligrams) of the prescription drug Xenical®. Made by GlaxoSmithKline PLC, it is the first weight loss drug to be approved for over-the-counter (OTC) use. Partially due to controversy with its release, when buying Alli® the package also includes Welcome and Companion Guides, a Calorie and Fat Counter, Quick Fact Cards, a Guide to Healthy Eating, a Daily Journal, and free access to an online action program. The company recommends Alli® only to people over the age of 18 years. Consumer advocacy organizations, such as Public Citizen, opposed the easy availability of Alli® as being potentially dangerous to the health of consumers.

Resourcestop
BOOKS
Bray, George A., and Claude Bouchard, eds. Handbook of Obesity: Etiology and Pathophysiology.New York: Marcel Dekker, 2004.

Hofbauer, Karl G., Ulrich Keller, and Olivier Boss. Phar-macotherapy of Obesity: Options and Alternatives. Boca Raton, FL: CRC Press, 2004.

Kelly, Evelyn B.Obesity. Westport, CT: Greenwood Press, 2006.

OTHER
Effect of orlistat dose on fecal fat excretion. The Obesity Society. [Cited April 4, 2007].

FDA OKs First Nonprescription Diet Pill. Randolph E.Schmid, Associated Press, as found in USA Today. February 8, 2007 [Cited April 3, 2007].

Obesity and Overweight. Global Strategy on Diet, Physical Activity and Health, World Heath Organization. [Cited April 4, 2007].

Orlistat. U.S. National Library of Medicine, National Institutes of Health. January 1, 2002 [Cited April 3, 2007].

Orlistat (Oral Route). The Mayo Clinic June 28, 2002[Cited April 3, 2007].

Overweight and Obesity: Home. Department of Health and Human Services, U.S. Centers for Disease Control and Prevention.March 1, 2007 [Cited April 3, 2007].

Xenical (orlistat) Capsules. Hoffmann-La Roche Inc.(Roche). January 1, 2002 [Cited April 3, 2007].

ORGANIZATIONS
American Obesity Association (AOA). Home page of AOA. May 2, 2005 [accessed April 4, 2007]

What is Xenical?

Xenical (orlistat) is a prescription medication used in the management of obesity including weight loss and weight maintenance when used with a reduced-calorie diet.

Unlike other commonly prescribed weight-loss medications, Xenical is not an appetite suppressant and does not have a direct effect on the brain. Instead, it works in your digestive system to block about one-third of the fat in the food you eat from being digested. The First Med clinic offers online Xenical to buy today.

How does Xenical work?

Xenical works by blocking some of the fat that you eat from being absorbed by your body.

Enzymes in your digestive system, called lipases, help digest (or break down) fat. Xenical inhibits pancreatic lipase, an enzyme that breaks down triglycerides in the intestine. Without this enzyme, triglycerides from the diet cannot be absorbed and are excreted undigested. Xenical helps block about one-third of the fat in the foods you eat from being absorbed by your body. By consuming fewer calories, your body will automatically tap into its fat stores and use them for the energy it needs.

How well does Xenical work?

In clinical studies, almost two-thirds of people treated with Xenical plus diet successfully lost at least 5% of their body weight after 2 years. In comparison, only half of the people treated with diet alone managed to lose 5% of their weight.

Weight loss with Xenical and a healthy diet also improves a number of weight-related health risks. Studies show that weight loss with Xenical can:

•Decrease total and LDL cholesterol (level of low-density lipoprotein-also known as bad cholesterol)
•Improve ratio of bad to good cholesterol (LDL/HDL cholesterol)
•Reduce blood pressure
•Reduce levels of insulin (hormone that allows glucose or sugar to enter the body’s cells), high levels of which are associated with coronary heart disease
•Reduce the risk or delay the progression to type 2 diabetes in patients

How much weight should I expect to lose?
The amount of weight you lose depends on how well you stick to a reduced-calorie diet with no more than 30% of calories from fat and an appropriate physical activity level, as well as on your compliance with the prescribed medication regimen. Help your weight loss with treatments from the First Med weight loss clinic.

What is the correct dosage?

The recommended dose is one 120-mg capsule by mouth with liquid at each main meal that contains fat. Take this drug, generally three times daily during (or up to one hour after) each main meal that contains fat. Your daily intake of fat, protein and carbohydrate should be evenly spread over three main meals. If a meal is occasionally missed or contains no fat, skip that dose of the medication. Because this drug can interfere with absorption of fat-soluble vitamins (e.g., A, D, E, K), a daily multivitamin supplement containing these nutrients is recommended. Take the multivitamin at least 2 hours before or 2 hours after this drug (e.g., at bedtime). The effects of this drug may begin as soon as 1-2 days after treatment begins; noticeable weight loss will take longer. Buy Xenical online from First Med, your weight loss clinic.

How soon after starting Xenical should I expect to notice weight loss?

Typically, people begin losing weight within 2 weeks of starting Xenical, and may continue to lose weight for 6 to 12 months, at which point weight loss usually begins to level off – even if you’re still taking Xenical. This doesn’t mean that Xenical is not working. People who continue to take Xenical are better able to maintain their weight loss.

What are the side effects of Xenical?
All drugs have side effects, and Xenical is no exception. Generic Xenical could be less severe than what someone would experience with many other weight loss drugs. Possible side-effects include:

•Fatty / oily stool
•oily spotting
•intestinal gas with discharge
•bowel movement urgency
•poor bowel control
•headaches may occur

If these effects persist or worsen, notify us or your doctor promptly. Intestinal side effects (e.g., oily stool) may increase in intensity if you exceed your daily dietary fat allowance. If you notice other effects not listed above, contact your doctor or pharmacist. Order Xenical online today from First Med Weight Loss Clinic.

Is there any reason why I shouldn’t take Xenical?

Do not take Xenical without first talking to your doctor if you have

•A chronic malabsorption syndrome, or gallbladder problems
•diabetes
•anorexia or bulimia
•take any other weight-loss medicine
•take cyclosporine (Sandimmune, Neoral)
•have a history of kidney stones
You may not be able to take Xenical, or you may require a dosage adjustment or special monitoring during your treatment if you have any of the conditions listed above.

Xenical is in the FDA pregnancy category B. This means that it is not expected to harm an unborn baby. Do not take Xenical without first talking to your doctor if you are pregnant.

It is not known whether Xenical passes into breast milk. Do not take Xenical without first talking to your doctor if you are breast-feeding a baby.

Discuss with your doctor all medications you are currently taking (including over-the-counter medicines and herbal products you can get without a prescription) to determine if Xenical can be taken along with these medications. If you are taking cyclosporine, let your doctor know before taking Xenical; cyclosporine and Xenical should be taken at least 2 hours apart. If your cyclosporine levels are being measured, more-frequent measurements may be necessary while you’re taking Xenical.

Where can I buy Xenical?

Xenical can be prescribed by our doctor following an online consultation. Simply complete our online registration form which will then be reviewed by a Firstmed doctor. Once you have been cleared for treatment you can then log into our secure treatments area, from there you can buy Xenical online.

Is Xenical (Orlistat) a Scam?

No complaints are found on consumer complaints websites, and no complaints are found in various web forums except for side effects (please see below).

Pros:

-Based on consumer feedback in various online forums, most people seem to have high success rate with Xenical.

-You get 5% discounts on all return orders (i.e. 2nd order and thereafter).

Cons:

Although almost all consumer feedback indicates Generic Xenical to be quite effective in helping to lose weight, many people have experienced side effects as listed below.

Side Effects of Xenical (Orlistat):

Many consumers have reported the following side effects: oily stains in underpants, oily stool, diarrhea, gas, and more frequent bowel movements.  Please consult your personal physician before using this product.

Customer Feedback / Comments:

“I took Xenical for about 2 months. It’s basically a fat blocker to absorb the fat intake in your food. I lost 7 pounds, but you also have to watch your diet. Just because you take Xenical doesn’t mean you should drive through McDonald’s. You will get major diarrhea if you eat too much fat.” — Actual Consumer Comments from Yahoo Answers

“I have been taking the weight loss drug Xenical for 2 weeks now and have…lost 2-3 kilos”– Actual Consumer Comments from Yahoo Answers

“I have used it and loved it. Many will tell you horror stories about the side effects but if you are eating healthy and watching your fat intake, they are bearable.” — Actual Consumer Comments from Yahoo Answers

“By taking 1 Xenical per day I am only losing about 2-3 pounds every 2 weeks, but like the fabled tortoise and the hare, I guess slow and steady wins the race.” — Actual Consumer Feedback from Topix[dot]com

“my mom was and sometimes still is taking orlistat and when she started she hardly ate fat. it seems orlistat broke down her body fat and she went from being 160 lbs to 130.” — Actual Consumer Feedback from Topix[dot]com

“Hello, My name is Karen and my DH, Paul, got a prescription for 120mg xenical almost a month ago.  He quickly lost 19 pounds (in less than 7 days) but gained 5 back the next week.  He has remained stable since then.” — Actual Consumer Feedback from CaloriesPerHour[dot]com

“i have had no side effects apart from a bit of wind but thats it and i have lost 3lbs” — Actual Consumer Comments from Minimins[dot]com