Additive gastrointestinal effects with concomitant use of olestra and orlistat.
OBJECTIVE
To report a case of significant additive gastrointestinal effects with concomitant use of orlistat and an olestra-containing snack food.


METHODS
A 16-year-old African American girl with type 2 diabetes, hypercholesterolemia, and hypertension was participating in a pilot study that tested the safety and efficacy of orlistat. After 2 weeks of orlistat treatment, the patient presented to the clinic with complaints of soft, fatty/oily stools, flatus with discharge, abdominal pain, increased flatus, and fecal incontinence. On further questioning, it was determined that she was also consuming approximately 5 ounces of olestra-containing potato chips on a daily basis. The patient eliminated olestra from her diet and returned to the clinic with substantially diminished gastrointestinal adverse effects, despite continuing to take orlistat.


CONCLUSIONS
This is the first published case describing additive gastrointestinal effects after concurrent use of orlistat and olestra. Education about the potential for serious additive gastrointestinal adverse effects is important to prevent premature and unnecessary discontinuation of orlistat therapy. Awareness of this potential interaction could be especially important for patients with underlying disease states in which severe gastrointestinal symptoms could result in significant complications.


CONCLUSIONS
This case illustrates that significant gastrointestinal distress may result after olestra consumption during orlistat therapy. All patients receiving orlistat for the management of obesity should be properly educated about this potential drug-food interaction.
Heck
Amy M
AM
Purdue University School of Pharmacy and Pharmacal Sciences, Indianapolis, IN 46202-2879, USA. amheck@iupui.edu
Calis
Karim Anton
KA
McDuffie
Jennifer R
JR
Carobene
Suzanne E
SE
Yanovski
Jack A
JA
D000293:Adolescent; D019440:Anti-Obesity Agents / Q000008:administration & dosage / Q000009:adverse effects; D002986:Clinical Trials as Topic; D004064:Digestive System / Q000187:drug effects; D004347:Drug Interactions; D019358:Fat Substitutes / Q000008:administration & dosage / Q000009:adverse effects; D005227:Fatty Acids / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced*; D006801:Humans; D007783:Lactones / Q000008:administration & dosage* / Q000009:adverse effects*; D000077403:Orlistat; D010865:Pilot Projects; D013395:Sucrose / Q000008:administration & dosage* / Q000009:adverse effects* / Q000031:analogs & derivatives*
D019440:Anti-Obesity Agents; D019358:Fat Substitutes; D005227:Fatty Acids; D007783:Lactones; D013395:Sucrose; C013692:sucrose polyester; D000077403:Orlistat