PP+401+-+3

= Patient starting on Xenical =

//Peter regularly comes into your pharmacy to purchase various items. He is 35 years of age and his recent dispensing history is as follows://



Problem
possibly: - diabetes and weight management (may have read that some diabetes medications can cause weight gain)

What to do
Peter is likely to have good renal function at his age despite possible diabetes. Therefore no dose reduction is necessary. If taking with meals, unlikely to experience gastrointestinal side effects. Maximum daily dose of metformin is 3g daily (currently at 1.5g daily). May be using metformin to aid weight management, without diabetes (or avoiding weight gain with sulphonamides).

If Peter were to ask about Xenical, the interaction might proceed as follows:

"Xenical reduces the amount of fat you take up from your food. It works in the gut.
 * How it works**

One capsule is taken three times a day with your main meals. If you skip a meal, or are having a meal that doesn't contain fat, such as a regular fruit salad, don't take the tablet, as it's obviously not going to do anything.
 * How to take it**

Xenical reduces the fat you absorb by 30%. Because of the way it works, it can reduce your absorption of fat-soluble vitamins, so taking a multivitamin daily is a good idea, just make sure to space this at least 2 hours apart from a dose of xenical. //might not be necessary, as a reduction of 30% fat won't give a massive reduction in vitamin intake//

When trying to lose weight, 5-10% of your body weight is a good (long-term) goal. Losing this amount reduces risk of heart attack and stroke, diabetes, etc etc by a large percentage. On average, people using Xenical can lose 5-10% when it is combined with a reduced-calorie diet and exercise. It can also have some beneficial effects on cholesterol and blood glucose levels, and weight loss may mean you don't need more diabetes medications in the future.
 * Expectations**

As in every situation of attempting weight loss, it's all about energy in, energy out. Xenical reduces the energy in, but the quality of the meals you eat is also important. I'm sure you would have heard these types of guidelines before. In general it's good to have lots of vegetables and fruit in your diet and some wholemeal carbohydrate foods. Lean meat and dairy are also important. Try to keep the processed foods that are high in sugar and fat to a minimum. To have the best chance at weight loss and also improving your health, you need to increase the energy out as well, so fitting in some physical activity wherever you can is very beneficial.

Don't weigh yourself too often. Weight fluctuates a lot everyday due to meals, perspiration and fluid intake. Hop on the scales once a week and record the result. It's a really good feeling to see that the effort you're putting in is paying off. Healthy weight loss is considered to be about 1kg a week. Doing it slowly and steadily means you're more likely to keep it off.

In some trials, metformin has been shown to be equally good at assisting with weight loss as Xenical. Just like with Xenical, significant weight loss can only be achieved if you make those adjustments to your diet and exercise as well.
 * When did you start metformin?**

Any drug that assists with weight-loss only does so while you're taking it, so it's a matter of figuring out a plan that includes the food, exercise and the medication at the start to get you rolling.

Xenical will result in fatty diarrhoea if your food is high in fat. As a rule, keep the fat content of the meal to less than 30%. Some people will also get a bit of abdominal discomfort. If it bothers you, you can talk to your doctor or stop taking xenical and there are other options that are available.
 * Do you have any problems with diarrhoea usually?**