Of all the three classes of drugs prescribed for weight loss, Meridia diet pills (also sold as Reductil, Reduxade and Ectiva) are probably the most effective of them all.

Marketed as blue-yellow capsules of three different strengths (5, 10, or 15 mg each), Sibutramine (as it is called pharmacologically), packs quite a punch. Numerous research studies have documented an average weight loss of up to 12 kg (slightly over 26 lbs.) over a period of 6 months to 1 year. Therapy usually includes Meridia in conjunction with a healthy lifestyle, exercise and diet.

How does Meridia work?

Meridia diet pills act by increasing the concentration of chemical substances called monoamines (noradrenalin, serotonin and dopamine) in the brain. This allows a multi-pronged action at various centers, stimulating the sympathetic nervous system and the satiety center, along with other unknown affects on metabolism to ultimately decrease appetite and reduce food intake.

When combined with a low-calorie diet and appropriate lifestyle modifications, Meridia diet pills have documented a weight loss anywhere between 2-12 kg over a period of 6 to 12 months. Information from follow-up studies suggests that this weight loss can then be maintained for a substantial amount of time on diet and activity alone.

Sibutramine, the active ingredient in Meridia, does not cause a decrease in the lean body weight (the non-fat content of the body) or blood sugar levels. It decreases the uric acid levels, which is useful since higher uric acid levels in higher weight groups can lead to gout.

Drug therapy for obesity is indicated in individuals in whom obesity cannot be attributed to underlying endocrine and metabolic disorders. Drug therapy is initiated at a BMI of 30 kg/m2 (or 27 kg/m2 in the presence of other risk factors like hypertension, coronary artery disease, diabetes) after a failure of diet and exercise to produce a weight loss of greater than 0.5 kg/1 lb. per week for 4 weeks.

Note: Body Mass Index is calculated as so… BMI=weight(kg)/ [height(m)2]. You can use this online BMI calculator to determine yours!

Treatment Guidelines:

Meridia diet pills are generally prescribed at 10mg per day, starting approximately 2 hours after breakfast. This dosing schedule provides adequate cover for the next 12 to 14 hours when most of the food intake takes place. It also prevents the stimulatory action of the drug to interfere with sleep patterns.

The drug is initially prescribed for a period of 4 weeks during which the individual is monitored for weight loss and side effects. A close watch is kept on blood pressure and heart rate. These tend to go up — especially if the drug is working. A minimal weight loss of 4 lb should be achieved during this duration or therapy should be re-evaluated. In case this target weight loss is not achieved, the therapy should be either discontinued or dosage can be increased to 15mg/day in the absence of side effects.

An increase in heart rate and/or blood pressure during this period may prompt a reduction of the dose to 5mg/day. Thereafter, closer follow-up is recommended to assess the effect of the drug on the cardiovascular system. For any individual, the lowest possible effective dose should be chosen in order to prevent complications.

Using this regime, Meridia diet pills have been found to effectively decrease the girth or waist circumference. In a research study conducted over 12 weeks this drug caused a reduction of 1.8 kg in the group that took this drug, compared to the 0.2 kg weight loss that was seen in the group that was given placebo.

Drug Behavior:

The drug Sibutramine from Meridia diet pills is effectively absorbed from the gut except in the presence of food. Meridia should not be taken either before or after a meal. The drug is broken down into its active ingredients in the liver, which then act via the central nervous system.

Elimination of the drug involves mechanisms in both the liver and the kidney. This is important to note in individuals with dysfunction of either organ or in the elderly where the body’s metabolism generally works at a slower pace.

The efficacy and the safety of the drug has not been studied for any period longer than two years. Therefore longer durations of therapy should be avoided.

Precautions:

Caution is advised when using the drug in individuals with pre-existing kidney or liver diseases, and in the elderly. Risk factors and alternative medications should be given due consideration in people with heart disease, glaucoma, seizure disorder, stoke, gall-stones or past history of drug abuse. Meridia diet pills have shown a tendency to aggravate these problems in clinical trials.

The drug acts through the central nervous system and has the potential to produce drowsiness or alter judgment during due the course of therapy. Proximity to heavy mechanical equipment and driving is not advised for this duration. Significant drug interactions include decreased efficacy of the drug when taken along with antibiotics like erythromycin and anti-fungals like ketoconazole.

Given its site of action, other drugs acting at the same location may interact with Meridia, producing predictable and unpredictable results and should be avoided unless clear indications exist. Combining Meridia with other centrally acting weight loss drugs, MAO inhibitors (anti-depressants) and alcohol should be avoided.

In this regard one particular interaction is worth specific mention. A group of drugs called SSRI’s, which also work by similar mechanisms, are used as antidepressants and appetite suppressants. There is speculation that combining Meridia with SSRI’s may cause adverse structural alterations in the blood vessels of the heart and the lungs. Though this remains unsubstantiated with no cases reported, using the two classes of drugs is avoided as a rule.

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The side effects of Orlistat diet pills are few and far between, provided you heed the dietary recommendations of this drug. Generally, Orlistat is a pretty safe drug for weight loss.

The most common problem on Orlistat is a “grumbling” gut. The Orlistat diet pill prevents digestion and absorption of fats which then have to traverse the full length of the intestine on “their way out”. Abdominal pain, nausea and diarrhea are the most common side effects of Orlistat diet pills.

A study records 8.8% of patients opted out of therapy for this reason. But most people adapt easily within a week, as the digestive system become accustomed to the additional fat content. Within three months hardly any abdominal pain, nausea or vomiting is present. Keep in mind…

These gastric side effects are increased as the fat content of a meal increases.

Allergic reaction to Orlistat is a rare but important side effect. This needs to be recognized and reported since it can even lead to shock once the person is sensitized to the drug. The initial signs are itching, rash, irritating but transient blebs and swelling of the eyelids or lips. If any of these side effects are experienced on Orlistat, then the drug should be discontinued immediately.

The drug has not be proven safe for use during pregnancy, in nursing mothers, children and elderly. A history of renal or gall bladder stones is another marker of trouble and Orlistat can increase the risk of recurrence.

Orlistat is not recommended in cases where there is already a defect in the digestive and/or absorptive functions of the gut. Since Orlistat further inhibits absorption, it would only exacerbate the condition.

Diabetics and patients on cyclosporine should also be careful when initiating Orlistat treatment because of the documented drug interactions in these two groups. Misuse of Orlistat is a potential problem in people with anorexia nervosa and bulimia and the drug should not be prescribed to them.

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Orlistat diet pills are one of the safest drugs for weight loss. Information on Orlistat indicates that the compound interferes with the absorption of fat in the stomach and the intestine.

This drug binds with and inactivates the enzymes (lipases) that help with digesting fats. With no enzymes to breakdown dietary fats into absorbable components, the gut is prevented from sucking up the fatty content of a meal. The undigested fat is excreted without being able to adversely effect the body weight.

Add a calorie-restricted diet to the Orlistat diet pill and, with no fat coming in from the gut, the body has to access stored flab to meet the daily caloric requirement. As this fat deficit is maintained over the duration of drug administration, the adipose tissue is gradually mobilized until there’s none to spare.

Placebo controlled studies have documented a steady reduction in the body weight and body mass index starting at 2 weeks and continuing for over a year, with the average weight loss ranging from 12.4 lb. to 13.4 lb.

Patients who completed a year’s treatment with Orlistat have been shown to lose at least 5% of their baseline body weight. Orlistat also has a proven record of weight maintenance. 74% of patients treated with Orlistat maintained their weight loss following a year’s therapy.

Orlistat is so special because preventing fat absorption is a very apt action for a diet pill. Reduction of adipose tissue (fat) has inherent added benefits. The total cholesterol, LDL/HDL ratios, diastolic blood pressure and blood sugar levels all drop to healthier levels.

There is often a need to reduce doses of anti-diabetic medications for patients on Orlistat diet pill therapy. Hip and waist circumference slim down by an average of 5 to 7 cms on Orlistat diet pills. An interesting observation is that people on Orlistat have been found to have a smaller chance of developing glucose intolerance and diabetes over the next three years. This is attributed to the reduction in adipose tissue and fat. In turn, this decreases insulin resistance and allows better control of blood sugar levels.

What is perhaps even better is that Orlistat achieves this with the minimum possible hindrance to human physiology. It…

i) acts within the gut

ii) hardly enters the blood circulation

iii) need not be broken-down to be eliminated

iv) is naturally excreted through the feces

v) has few interactions with other drugs or micro-nutrients that cannot be easily compensated for.

Orlistat diet pills do decrease the absorption of fat-soluble vitamins like Vitamin A, D, E and K. However, this can easily be countered by taking a multi-vitamin supplement either two hours before or after administration of an Orlistat diet pill.

What about drug interactions? An important drug that needs to be mentioned is Warfarin, a blood thinner used to prevent blood clots. Orlistat can potentiate the action of Warfarin and can lead to bleeding problems in people on this drug. Therefore diabetics and people on blood thinners should take Orlistat diet pills only under strict medical supervision.

Orlistat diet pills are an excellent choice in a BMI greater than 30 kg/m2 or in a BMI of 27 kg/m2 when associated with other risk factors like diabetes, hypertension, atherosclerosis.

Note: Body Mass Index is calculated as so… BMI=weight(kg)/ [height(m)2]. You can use this online BMI calculator to determine yours!

The recommended therapy for Orlistat diet pills is 120 mg three times a day, taken during or up to 1 hour after a nutritionally balanced, reduced-calorie meal.

Treatment can be continued for a maximum period of 2 years, and should be accompanied with a multi-vitamin — taken either two hours before or after the administration of the drug.

Orlistat is not recommended for use in pregnant or nursing mothers, in children and the elderly.

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Phendimetrazine side effects are related to its stimulatory action on a variety of organ systems. The most common side effects of this drug are restlessness, anxiety, sweating, dizziness, agitation, sleeplessness, tremor, blurring of vision and psychosis.

The effects on the heart include palpitations, increased heart rate and high blood pressure. Other effects are nausea, altered bowel habits, dryness of mouth, frequent urination and changes in libido.

Phendimetrazine borrows its side effects from amphetamines, a group to which it is chemically related. Phendimetrazine also has the same abuse potential as the amphetamines. A past history of drug abuse or a profile susceptible to dependence is therefore a relative contraindication to this drug.

Phendimetrazine produces psychological dependence and can cause severe social dysfunction. Long-term therapy with Phendimetrazine produces severe skin changes, sleeplessness, irritability, hyperactivity and personality changes. At the extreme end of this spectrum, Phendimetrazine has been known to produce a psychotic condition not different from schizophrenia.

Phendimetrazine can aggravate hypertension and caution should be exercised when the patient on Phendimetrazine has even mild hypertension. Guanethidine, an antihypertensive drug may become ineffective when given along with Phendimetrazine. Phendimetrazine may impair certain judgment skills and so the patient should be cautioned about working with heavy machinery and driving.

Indiscriminate use can lead to overdosage of the drug. Acute overdose manifests itself as restlessness, confusion, hallucinations, aggressiveness and panic states. Fatigue and depression usually follow. Abnormal heartbeat rhythms and even heart failure can result due to overdosage. Toxicity due to the drug results in convulsions, coma and eventually death.

There are no specific antidotes for poisoning with Phendimetrazine and hence timely symptomatic, supportive therapy is required. Sedatives such as barbiturates are required to calm the patient. Hypertension is common and prompt antihypertensive therapy may be required.

In view of this skewed benefit/risk ratio, it is recommended that dosage be limited to the smallest possible effective amount of drug to minimize the possibility of overdose.

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Phendimetrazine, a white bitter diet pill, is used for weight loss in exogenous obesity. It belongs to a class of drugs that are believed to help control weight by decreasing appetite (also known as anorectics). Phendimetrazine diet pills are typically prescribed at a dose of 1 to 2 35mg tablets up to three times a day, taken an hour before meals.

How does Phendimetrazine work?

Phendimetrazine diet pills fall under a group of drugs that are very similar in their action to amphetamines.

Information on Phendimetrazine’s mechanism of action as it is related to weight loss is limited and unclear. The decreased appetite seen with Phendimetrazine diet pills is equally attributed to their excitatory action on the brain and to as yet unknown effects on metabolism. The end result, in either case, is decreased appetite and increased satiety. Thus, food intake is reduced and the restricted calorie consumption is speculated to result in weight loss.

Therapy with Phendimetrazine diet pills is justified when diet and exercise alone have failed to produce a weight loss of more than 0.5 kg/1 lb. week after a four week diet trial in an individual with a BMI of 30 kg/m2 (or 27 kg/m2 in the presence of other risk factors like diabetes, hypertension and hyperlipidemia).

Note: Body Mass Index is calculated as so… BMI=weight(kg)/ [height(m)2]. You can use this online BMI calculator to determine yours!

In controlled studies where Phendimetrazine diet pills were compared to a placebo, the difference in weight loss was not more than a fraction of a pound a week. Added to this low efficacy, these diet pills seem to stop working after a couple of weeks. The body gets used to their stimulatory effects and develops a tolerance. At this point, a further increase in the dose will only aggravate the adverse effects of the drug. Many other factors also seem to be related to the Phendimetrazine produced weight loss, such as the physician-investigator relationship, the population treated and the diet prescribed.

Considering all this, Phendimetrazine is not the most effective of diet pills. The indications to use this drug are very limited. It is recommended only as a short term solution (3 weeks at most) and in cases where obesity is purely related to excessive caloric intake. The safety of the drug has not been documented in pregnant women and children under 12 years. People with mild hypertension and diabetes need strict supervision of their medical practitioner should they choose to take these diet pills.

Phendimetrazine diet pills do have effects on other organ systems. Their stimulating action can cause excitation, hyperactivity and irritability. It also causes an increase in the blood pressure. Once the therapy is started the drug should not be stopped suddenly — a sudden cessation of its stimulatory effect could lead to fatigue and depression. Also occupational and recreational activities involving mechanical machinery should be avoided for the duration of the therapy.

People with symptomatic heart or blood vessel disease, hypertension, thyroid disorders, anxiety disorders, past history of drug abuse or known allergy to this class of drugs are not suitable for Phendimetrazine diet pills. Overdose of this drug is also a serious complication that requires treatment with sedatives and intravenous drugs to control hypertension.

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Phentermine (Fastin, Adipex) side effects parallel those of its drug class, the amphetamines.

Stimulation of the sympathetic nervous system results in an increased heart rate and blood pressure. Other nervous system side effects are increasing sleeplessness, plus increased restlessness and excitement as the dose is increased.

Other Phentermine side effects include dryness of the mouth, disruption of normal gut motility, bladder dysfunction and changes in libido. The dosage of this drug should be tapered off before stopping therapy. An abrupt withdrawal of the drug can precipitate depression and fatigue — as the body becomes dependent on its stimulatory effects.

It also produces psychological dependence on the drug. Individuals who have been known to abuse drugs should not be given Phentermine. Chronic abuse of Phentermine produces easily recognizable symptoms like irritability, sleeplessness, over-activity and personality changes. In instances when the drug dose has been increased many times, severe disruption of normal thought processes have occurred — not unlike that seen in schizophrenia.

What about Phentermine overdose?

Due to over-stimulation of the nervous system, overdosage results in symptoms such as mental confusion, hallucinations and panic states. Other symptoms are exaggeration of the side effects on the heart and the brain. Fatal overdose results in convulsions. The danger of an overdose can be easily prevented by watching out for the known side effects and by being supervised by a physician.

Phentermine toxicity is treated by symptomatic therapy. Phentermine capsules that have not yet been absorbed from the gut can be removed by inducing vomiting and a stomach wash. A hospital admission with supportive therapy including sedation and antihypertensive drugs may be needed to control the hyperactivity of the nervous system and rise in blood pressure.

Given this wide spectrum of Phentermine side-effects, the indication to initiate and continue drug therapy needs to be strictly evaluated in each case. This is not aspirin we’re talking about here.

Any individual taking Phentermine should have enough awareness to recognize indicators of adverse effects and drug complications. A close monitoring for the known side-effects is also warranted.

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Phentermine diet pills belong to the category of centrally acting drugs known as amphetamines (it is not an amphetamine, it is only similar in chemical structure). Phentermine is sometimes sold under various different names – Fastin, Adipex, etc.

How does Phentermine work?

Phentermine diet pills stimulate the sympathetic nervous system and produce a feeling of satiety (fullness). It is speculated that this action, along with as yet undetermined effects on the metabolism are responsible for the loss of appetite seen with this class of drugs. Phentermine can be appropriate for individuals whose eating habits or behavior alone is responsible for excessive weight gain.

Research into the effectiveness of Phentermine diet pills shows an average weight loss of 2-8 kg more than placebo for the same duration of treatment.

Obesity predisposes one to higher risks of heart attacks, strokes, gallstones, certain cancers, and a low body image. Generally, a body mass index of 30 kg/m2 (or slightly less in the presence of other disorders like hypertension, diabetes, hyperlipidemia) is considered a significant risk factor of these complications.

Note: Body Mass Index is calculated as so… BMI=weight(kg)/ [height(m)2]. You can use this online BMI calculator to determine yours!

Typically, medical intervention in obesity starts with diet therapy for four weeks, along with an appropriate exercise regime. If this fails to achieve an average weight loss of 0.5kg/week (approximately 1 pound/week) then drug therapy may be recommended. However, underlying hormonal or metabolic diseases should be ruled out prior to initiation of drug therapy.

Phentermine Treatment Guidelines:

The weight loss produced on Phentermine diet pills is greatest during the first few weeks of therapy. The beneficial effect then wears off gradually. Phentermine is therefore best for short term weight management. The drug has to be taken with a restricted calorie diet to produce maximum benefit.

Caution is advised when Phentermine diet pills are taken along with other drugs that act on the brain and the heart. If co-administered with other weight loss drugs such as Fenfluramine, it has been found that they increase the resistance to blood flow in the lung and even cause defects in the heart valves.

Phentermine should never be given along with MAO inhibitors (a class of antidepressant drugs) for fear of acute elevations in blood pressure. If the patient is already on MAO inhibitors, then Phentermine should be started at least two weeks after treatment with the MAO inhibitor has terminated.

The safety of Phentermine diet pills in pregnant and breastfeeding mothers has not been studied enough. It is recommended that the drug not be used in these groups. It has also not been tested sufficiently in younger age-groups, and should not be prescribed to children less than 16 years old.

The drug is also not recommended if pre-existing anxiety states, severe hypertension, advanced coronary heart disease, dysfunction of the heart valves, drug abuse, glaucoma or hypersensitivity to this drug class are known or suspected.

Alcohol consumption may also produce an adverse drug reaction.

At the end of the four week treatment period, the therapy needs to be reevaluated in every case. At the end of this time, a weight reduction of at least 2 kg should have been achieved. This is a predictor that the drug is going to work in a particular individual. If this minimal weight loss is not achieved, a different class of drug may need to be used.

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The side effects of Tenuate are produced by two mechanisms. One set of side effects is related to the stimulation of the sympathetic nervous system and may include…

i) restlessness

ii) sleeplessness

iii) tremors

iv) headaches

v) dizziness

And…

vi) blurring of vision.

This may result in elevated blood pressure and an increase in heart rate. Dryness of the mouth, nausea, diarrhea and constipation, stomach pain, increased urination and changes in sexual drive can also be attributed to the same set of side-effects of the drug.

The other main reason for side-effects on Tenuate diet pill therapy is due to a hypersensitivity exhibited by some patients. This allergic reaction can manifest itself as itching, rash, blebs or swelling of the lips and eyelids. This warrants an immediate termination of the drug therapy — continued treatment can lead to anaphylactic shock and respiratory arrest.

Abuse of amphetamines and related drugs, like Tenuate, may be associated with intense psychological dependence and severe social dysfunction. Signs suggestive of abuse include skin changes, irritability, hyperactivity, aggressiveness and personality changes. Prolonged use of Tenuate diet pills at doses much higher than therapeutic recommendations have led to psychosis not unlike that seen in Schizophrenia.

Acute overdosage of the drug will result in symptoms like: unusual restlessness, confusion, belligerence, hallucinations, and panic states. Fatigue and depression usually follow the central stimulation. It may also result in…

i) very low blood pressure or very high blood pressure

ii) nausea

iii) vomiting

iv) diarrhea

v) abdominal cramps.

Poisoning may result in convulsions, coma, and eventually, death.

The management of a Tenuate overdose is largely symptomatic. It includes hospitalization with intravenous sedation. If hypertension is noted, the use of a powerful anti-hypertensive may be administered under cardiovascular monitoring. There is no specific antidote or modality available to remove the drug from the system.

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Tenuate diet pills belong to a class of weight loss drugs called appetite suppressants. Tenuate diet pills are marketed as either immediate or sustained release tablets. The capsule form of Tenuate resists rapid dissolution in the gut and continues to release the drug for a sustained period of time.

How does Tenuate work?

The action of Tenuate diet pills is very similar to that of amphetamines, and acts on the brain to stimulate the sympathetic nervous system. It is believed that the appetite suppression seen with these drugs is a combination of this central action and other unknown effects of the drug on metabolism. Tenuate is also known as an anorexiant (which simply means it causes a “lack of appetite”).

Tenuate may be prescibed if a patient has failed to make progress on a diet and exercise program, and the cause of obesity has been determined to be exogenous (related to eating behavior) with no underlying hormonal or metabolic abnormality.

Tenuate Treatment Guidelines:

Tenuate diet pills are available as two formulations. Immediate release preparations come as 25 mg tablets, 3 of which are taken once daily in the morning. Controlled release preparation comes as a 75 mg tablet, which is taken once a day. The drug should be taken 1 or 2 hours prior to a meal. Late evening dosing should be avoided for fear of causing insomnia. The lowest possible dosage of drug should be used since this class of drugs has a very narrow safety margin.

Therapy with Tenuate diet pills should be re-evaluated at the end of a 4 week period. If the patient has lost less than 2 kg/4.5 lbs., then Tenuate may not be ideal – either the dose should be increased or a different drug should be used.

This drug should not be prescribed beyond a 3 month period for two reasons. One, the body develops a tolerance to its appetite suppressing effect and fails to respond to it — even to increasing doses. The other reason is the absence of clear documentation regarding the effectiveness and safety of Tenuate beyond a 12 weeks period.

Contraindications:

The Tenuate diet pills are not to be used in people…

i) with known allergic reactions to this class of drugs (the sympathomimetics).

ii) suffering from advanced arteriosclerosis, heart disease, moderate to severe hypertension, thyroid abnormalities & glaucoma

iii) who have a history of dependence or drug abuse (Tenuate diet pills have a potential for abuse).

iv) who are taking drugs that act on the brain or the heart and blood vessels. Such combinations may can alter the magnitude of each individual drug’s response and can also aggravate the underlying disease.

v) under 12 years of age.

Special precaution for taking Tenuate…

i) As Tenuate diet pills can elevate the blood pressure, caution is has to be exercised in prescribing for patients with even mild hypertension. It may also interfere with the action of other anti-hypertensive medications, like Guanethidine.

ii) In patients with diabetes, the insulin requirements and the concomitant dietary regimen may be altered in association with the use of the drug.

iii) The least possible amount needs to be prescribed or dispensed at one time in order to minimize the possibility of overdosage

SPECIAL WARNING:

These diet pills are not be taken by women who are, or may become, pregnant unless, in the opinion of the physician, the potential benefits outweigh the possible hazards.

As indicated already, the body develops tolerance to the weight loss effects of Tenuate diet pills within a few weeks. The recommended dosage should never be exceeded in an attempt to increase the effect once this happens; rather the drug needs to be stopped. Increasing the dose at this point will only broaden the spectrum of its side effects. Abrupt cessation following high-dosage administration results in extreme fatigue and mental depression. A gradual “tapering off” of the dosage is recommended. Patients also note changes in their sleep pattern

Patients on this drug are to be cautioned against involving themselves in potentially hazardous activities such as operating machinery or driving a motor vehicle.

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Side effects of the Xenical diet pills are associated mostly with its site of action – the gut. Oily spotting, flatus with discharge, fecal urgency, fatty/oily stool, oily evacuation, increased defecation & fecal incontinence are a few gastrointestinal side effects generally associated with this drug.

These and other commonly observed adverse reactions were generally mild. Over a period of a week most people get used to Xenical and the side effects largely disappear (to read visitor comments on Alli, the low dose, over the counter version of Xenical, click here!).  

One way of avoiding Xenical’s side effects is to limit the amount of fat in a meal. The gut disturbances are directly related to the fat content of a meal. Restricting fat content to 30% of total calories will decrease the side effects.

Other side effects of Xenical include a deficiency of fat-soluble vitamins like Vitamin A, D, E and K. Solution? A multi-vitamin taken two hours before Xenical can ensure that you do not become deficient.

Rare cases of hypersensitivity have been reported with the use of Xenical. Signs and symptoms of such include itching, rash, skin blebs, swelling of the lips and eyelids. In such cases, the drug needs to be stopped since repeated exposure in an allergic individual can cause shock and respiratory obstruction.

Xenical should not be taken by pregnant women and nursing mothers, as the drug may be excreted in their milk. It is not prescribed for children below the age of 12. The behavior of the drug in individuals above 65 years of age is also not clear and the drug is generally avoided in the elderly.

The drug should not be taken by people who have obesity as a result of a disease, such as hypothyroidism. Another consequence of decreased fat content (especially triglycerides), is an increased tendency to form gall-stones. Xenical is not a choice for persons with a past history of gall-stones or renal stones.

As with any weight loss agent, the potential exists for misuse of Xenical in people with eating disorders like anorexia nervosa or bulimia.

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