Go to
Medically reviewed by
Dr Alexandra Cristina Cowell
Writer & Clinical Content Reviewer
on March 14, 2024.
Meet Alexandra Cristina  
Alexandra Cristina
Was this article useful?
  • The most common side effects of Orlistat include sudden bowel movements, oily and fatty stools and flatulence.
  • Starting a low-fat diet before using Orlistat can help manage common gastrointestinal side effects.
  • Orlistat may impact fat-soluble vitamin absorption, which means it’s essential to take supplements containing vitamins A, D, E and K.
  • Orlistat is generally safe if used correctly, with potential interactions with certain medications. It's not recommended during pregnancy or breastfeeding.

The side effects of Orlistat

When you first look at the patient information leaflet (PIL), it can feel overwhelming to see the list of side effects. But once we walk you through the listed side effects of taking Orlistat then you’ll have a better picture on how they could potentially affect you.

In the UK, all medicines have to go through a strict regulation process to monitor the quality, effectiveness and side effects. This will involve clinical trials, where a number of participants will test the drug to make sure it’s effective and safe to use. At the end of the clinical trial, the reported side effects are put into one of these five categories:

  • Very common – affects more than 1 in 10 people (10%<)
  • Common – affects 1 in 100 or 1 in 10 people (1%-10%)
  • Uncommon – affects less than 1 in 1000 or 1 in 100 people (0.1%-1%)
  • Rare – affects 1 in 10,000, or 1 in 1000 people (0.01% to 0.1%)
  • Very rare – affects less than 1 in 10,000 people (0.01%)
  • Very common side effects

  • Common side effects

  • Other reported side effects

Very common side effects

These side effects have been experienced by more than 1 in 10 people using Orlistat (Alli and Xenical):

  • sudden bowel movements;
  • fatty or oily stools;
  • soft stools; and:
  • flatulence;

The following have been reported in Xenical:

  • headache;
  • abdominal discomfort;
  • discharge;
  • runny stools; and:
  • low blood sugar levels (experienced by some people with type 2 diabetes).

Common side effects

These side effects affect 1 in every 10 people using Alli:

  • stomach pain;
  • stool incontinence;
  • liquid stools;
  • frequent bowel motions; and:
  • anxiety;

The following have been reported by those using Xenical:

  • rectal pain;
  • bloating;
  • soft stools;
  • incontinence;
  • tiredness;
  • tooth/gum disorder; and:
  • irregular menstrual cycle.

Other reported side effects

These side effects have been reported by some people (using Xenical or Alli), but their frequency is unknown. This means it’s likely uncommon or rare to experience them. They include:

  • Allergic reaction - main symptoms include rash, itching, difficulty breathing and feeling unwell.
  • Diverticulitis - inflammation of the large intestine, which can cause pain in the bowel and stomach too.
  • Pancreatitis - inflammation of the pancreas.
  • Skin blistering.
  • Severe stomach pain caused by gallstones.
  • Hepatitis - inflammation of the liver.
  • Oxalate nephropathy - a build-up of calcium, which could lead to kidney stones.
  • Bleeding from the rectum.

You might also notice changes in your blood tests, such as an increase in liver enzymes.

Even though the list of side effects might seem a little long, it's unlikely that you will experience most of them. The most common ones are related to your bowels, but this is completely normal as it indicates Orlistat is effectively working by ‘removing’ the fat from your system.

Are there any other side effects?

Some sources online might claim that Orlistat causes depression or weight gain, but this isn’t currently supported by evidence. You might experience some weight regain after stopping Orlistat, but you can aim to prevent this by maintaining a healthy lifestyle.

What causes the side effects to occur?

Most of the common side effects of Orlistat are caused by the way it works in the body.

For instance, sudden bowel movements, changes in stools and an increase in the frequency of stools are usually seen as a result of Orlistat working. The active ingredient prevents fats from being broken down, which can cause an accumulation of unabsorbed fats in your body. The only way your body can get rid of this fat is by expelling it during a bowel movement, which explains the increased frequency of toilet visits and oily stools. For a similar reason, you might get flatulence, stomach discomfort and bloating. To tackle these side effects, it’s best to go on a low-fat diet. This will be explained in more detail in the sections below.

If you’re diabetic, Orlistat might also affect your blood sugar levels and lower them. Some studies have found Orlistat can improve glycemic control by stimulating the production of GLP-1, which is known to control blood sugar levels.

How soon do Orlistat side effects start?

You might start to experience side effects within a couple of days of taking Orlistat. In most cases, these side effects are temporary and typically resolve on their own without any complications. But this can take anywhere from a week to a month. As your body adjusts to taking Orlistat, you should notice you’re getting fewer side effects over time.

How can I avoid Orlistat side effects?

To prevent some of the more common side effects from occurring you can adopt a low-fat diet (on average 15g of fat per meal) a few days before starting your course. This type of diet involves consuming less butter, oil, biscuits, cakes, chocolate, cured meats, sausages, and more.

The list of food to avoid can seem extensive, which can make starting the low-fat diet confusing and difficult. But there are now plenty of low-fat alternatives available in most supermarkets. It can also be beneficial to prepare your own meals; this way, you can control the amount of fat you use. For example, consider making a tomato-based pasta as an alternative to creamy pasta. Also distributing the amount of fat you eat throughout the day can be easier on your body. So try to avoid ‘saving up’ your fat content at the end of the day for a sweet treat.

Additionally, if you suffer from heavy flatulence taking an over-the-counter medicine, such as Simethicone, can help. It’s an antiflatulent that works by connecting the smaller gas into a big one for easier passing.

In some cases, taking psyllium might help with reducing the occurrence of fatty and oily stools. Psyllium is a natural fibre that’s used as a bulk-forming laxative. It works by trapping excess water and combining it with stool to help regulate bowel movement and stool consistency. This can help make stools less fatty, runny or oily. However, the response to psyllium can differ depending on the individual.

Furthermore, taking multivitamins while on Orlistat is recommended. This will make sure you don’t become nutrient-deficient and should also help with fatigue. It’s best to take it near your bedtime so that the absorption isn’t affected by Orlistat.

Are there any foods I should avoid?

High-fat foods are the only food you need to avoid when taking Orlistat. It can be helpful to be prepared and think of some food swaps you can make before you start your course of treatment. Such as:

  • boiled or poached eggs instead of fried eggs
  • lean meat, tofu and lentils instead of sausages, pork belly or salami
  • white fish like cod instead of canned fish
  • semi-skimmed milk instead of full-fat milk.

By making simple swaps like this, you can still enjoy foods you’d normally eat while taking Orlistat.

Will Orlistat affect my vitamin levels?

Yes, Orlistat can hinder fat absorption, which can also affect the absorption of fat-soluble vitamins, like vitamins A, D, E and K. These vitamins are typically absorbed with dietary fats and stored in the liver and fatty tissue. As a result, it’s recommended to take supplements containing vitamins A, D, E and K, to ensure you have a sufficient amount of nutrients.

Will Orlistat affect my contraception?

Your contraceptive shouldn't be affected when taking Orlistat. However, if you get severe diarrhoea, and you use an oral contraceptive, this might render it less effective. In this case, use an additional form of contraception and check the patient leaflet provided with your contraceptive for more information.

Are there any side effects when stopping Orlistat?

No, you shouldn’t get side effects after stopping Orlistat. But it can take around three to five days for Orlistat to be completely removed from the body. You might need to continue taking multivitamins for a while and you should discuss this with your prescribing clinician.

It’s important to note that after stopping treatment, some people might go on to regain the weight they’ve lost. To prevent this from happening, you should aim to implement healthier lifestyle choices, such as maintaining a low-fat diet, reducing your calorie intake and regular exercise.

Does Orlistat interfere with other medicines?

Orlistat can affect the effectiveness of other medicines, including Warfarin. Warfarin is an anticoagulant (blood thinner) that’s commonly used to prevent blood clots. It works by inhibiting the action of vitamin K. Since Orlistat can interfere with the absorption of fat-soluble vitamins, like vitamin K, it might decrease the effectiveness of warfarin. It’s recommended not to use warfarin with Orlistat or any other blood thinner. You should also avoid taking Ciclosporin while you’re on Orlistat.

It’s also not recommended to use the following drugs with Orlistat:

  • Iodine salts
  • Levothyroxine
  • Amiodarone
  • Medicines to treat HIV
  • Antidepressants or medicine for psychiatric disorders
This isn’t an exhaustive list, so if you are taking any other medicine, let your clinician know and they’ll check if it’s safe for you to use with Orlistat. 
 

If you are taking any other medicine, let your clinician know and they’ll check if it’s safe for you to use with Orlistat.

Can I take Orlistat when I'm breastfeeding or pregnant?

Don’t take Orlistat if you are pregnant. While no harmful effects have been found in animal studies, it’s recommended to avoid any weight loss treatment when you’re pregnant as it can increase your risk of miscarriage. Additionally, Orlistat does affect the way some vitamins are absorbed, which are essential for you and your baby’s development. Likewise, it’s not recommended to take Orlistat whilst you’re breastfeeding as it’s unknown whether it enters into breast milk.

Is Orlistat safe?

Yes, Orlistat is safe if used in the correct way mentioned in the PIL and advised by your clinician. While it does come with some side effects, the majority of users are unlikely to develop anything serious. 

Remember to only take Orlistat as your clinician advises. If you’re still concerned about taking Orlistat, just log into your account and send our clinicians a message.

Reference Popover #ref1
Reference Popover #ref2
Reference Popover #ref3
Reference Popover #ref4
Reference Popover #ref5
Reference Popover #ref6
Reference Popover #ref7
Reference Popover #ref8
Reference Popover #ref9
Reference Popover #ref10

How we source info.

When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.

This page was medically reviewed by Dr Alexandra Cristina Cowell, Writer & Clinical Content Reviewer on March 14, 2024. Next review due on March 14, 2026.

What did you like about it?

What didn't you like about it?

Suggest a treatment

If there’s a particular treatment or condition you’re looking for, tell us and we’ll look into it for you.

We may email you about the problem, but you can opt out of these communications any time you like.

Ask or suggest something.

Submit your question here, or tell us if you’ve found an issue on our site.

We may email you about your query, but you can opt out of these communications any time you like.
4.8

Our average rating based on 3551 reviews.

Tell us about a problem

I accept the terms of use.
We may email you about the problem, but you can opt out of these communications any time you like.

We’ll get back to you very soon. We aim to respond to all queries in one working day.

You’re signed up to our newsletter. Keep an eye on your inbox for our latest update.

news-letter

Sign up to our newsletter for all the latest on and more.

By clicking 'Subscribe now' you're agreeing to our Privacy Policy.