Orlistat

Zusammenfassung

Orlistat (Tetrahydrolipstatin) ist der erste im Darm (peripher) nachgewiesen wirksame, pharmakologisch effektive Fettresorptionshemmer. Orlistat hemmt die intestinale Triglyzeridlipase und senkt so die gastrointestinale Fettspaltung dosisabhängig um bis zu etwa 35 Prozent. Diätetisch wird bei Gabe von Orlistat für die Fettzufuhr etwa 30 Prozent der Gesamtkalorien angestrebt, insgesamt aber jedenfalls weniger als 70 g/Tag. Wird diese Fettmenge überschritten, kann es zu Fettstühlen, Stuhlinkontinenz und fehlender Wirkung kommen. Bei der damit verbundenen Malabsorption ist auch mit Störungen der Vitamin- und Elektrolytresorption zu rechnen. Die Wirksamkeit einer Orlistat-Therapie ist im Sinne des Gewichtsverlusts moderat und vergleichbar mit Sibutramin, hat aber auch erzieherischen Wert, da es die unbedingte Notwendigkeit fettarmer Ernährung “prägen” hilft. Besonders eine bisher selten geübte Langzeitgabe könnte zur Gewichtsstabilisierung beitragen (“weight maintenance”). Die metabolischen Effekte sind zum Teil gewichtsunabhängig (Insulinresistenz und LDL-C-Senkung). Durch seine exzellente Therapiesicherheit wurde Orlistat kürzlich innerhalb eines neuen Therapieprogrammes als OTC-Produkt zugelassen (2).

Summary

Orlistat (Tetrahydrolipstatin) is the first in the intestine (peripherally) active, pharmacologically efficacious fat resorption inhibitor. Orlistat inhibits the intestinal triglyceridlipase, and it is dose dependently reducing gastrointestinal fat digestion up to about 35 %. The diet with orlistat should contain about 30 % fat with a total daily fat intake of lower than 70 g. With an increased fat intake fat stools, stool incontinence and loss of action can occur. Due to the concomitant malabsorption disturbances in vitamin and electrolyte resorption have to be expected.The efficacy and safety of orlistat regimens is with respect to weight moderate and comparable to sibutramine, but it is also of educational value by teaching the absolute necessity of low fat food. Especially a presently not so common long term use could contribute to improved weight maintenance. The metabolic effects are in part weight independent (insulin resistance, LDL-C). Due to its excellent safety profile a therapeutic programm using orlistat has recently been registered as an OTC product (2).

Schlüsselwörter

Adipositas - Orlistat - Gewichtsreduktion - metabolische Effekte

Keywords

Obesity - orlistat - weight reduction - metabolic effects

• Literatur

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