Orlistat

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The European Medicines Agency has completed a review of orlistat-containing medicines, following concerns about the possible risk of severe liver injury with these medicines. The Agency’s Committee for Medicinal Products for Human Use (CHMP) has concluded that the benefits of orlistat continue to outweigh its risks, and recommended that the marketing authorisations be maintained with minor amendments to the product information to ensure the same information on very rare liver-related side effects is provided for all orlistat-containing medicines.

What is orlistat?

Orlistat is an anti-obesity medicine, which does not affect appetite. Orlistat blocks the action of gastrointestinal lipases (enzymes that digest fat). When these enzymes are blocked, they cannot digest some fats in the diet, and this allows about a quarter of the fat eaten in the meal to be passed out in the stools undigested. The body does not absorb this fat and this helps the patient reduce their weight.

Two orlistat-containing medicines hold a European Union (EU)-wide marketing authorisation. Xenical was authorised in 1998 and is available as capsules (120 mg) which can only be obtained with a prescription. Alli was authorised in 2007 and is available as capsules (60 mg) and chewable tablets (27 mg) which can be obtained without a prescription (‘over-the-counter’).

A number of generic orlistat-containing medicines have also been authorised via national procedures in Belgium, Bulgaria, Denmark, Estonia, Latvia, Lithuania, Norway, Portugal, Slovakia, the Netherlands and the United Kingdom.

Why was orlistat reviewed?

Since 2001, it has been recognised that some patients taking orlistat could experience very rare liver-related side effects. This risk has been closely monitored by the CHMP and measures to manage the known risks were put in place. The product information for orlistat-containing medicines lists hepatitis, cholelithiasis (gall stones) and a change in liver enzyme levels as potential liver-related side effects.

Xenical and Alli are together estimated to have been used by over 53 million people worldwide, with over 20 million in the EU. Since authorisation, there have been some reports of severe liver problems in users of these medicines. Recent safety monitoring showed that from August 2009 to January 2011, four cases of severe liver injury were reported in patients using Xenical where the role of orlistat could not be excluded, including one fatal case of liver failure and one case leading to liver transplantation. Overall, from 1997 to January 2011, 21 cases of severe liver toxicity were reported where Xenical was considered a possible cause, although other factors that could have caused the liver injury were present. There were 9 reports of liver failure in people using Alli since it was marketed in May 2007 until January 2011, although in some cases there were other possible explanations and in some cases there was insufficient information to assess the cause.

Therefore, the CHMP considered it necessary to assess whether the evidence gathered over time on the risk of severe liver problems had altered the benefit-risk balance of orlistat-containing medicines. Consequently, the European Commission asked the CHMP to issue an opinion on orlistat and on whether the marketing authorisation for orlistat-containing medicines should be maintained, varied, suspended or withdrawn across the EU.

Which data has the CHMP reviewed?

The CHMP reviewed the available data on the risk of liver injury and other side effects with orlistat, including post-marketing surveillance, data from the studies supporting the marketing authorisations and population-based studies in the published literature. The Committee also reviewed information requested from the companies that market orlistat-containing medicines, including the estimated number of people using these medicines and an analysis of the observed number of reports of severe liver problems compared with the expected background rate of liver problems in these people.

What are the conclusions of the CHMP?

The CHMP considered that there was no strong evidence that orlistat increased the risk of severe liver injury, and there was no known mechanism by which orlistat was expected to cause liver disorders. The Committee concluded that the number of reported severe liver reactions in orlistat users was low and below the background rate expected in these people, given the large number of users. A pattern was not seen in the type of liver problems reported, and in most cases there were other factors which were likely to increase the risk of liver injury such as existing health problems or the use of other medicines. The CHMP also noted that published population-based studies suggest that obesity may be associated with a higher risk of liver disease. The Committee considered that while there may be very rare cases of serious liver injury for which orlistat cannot be excluded as a possible cause, the cases do not provide good evidence of a causal link.

Based on the evaluation of the currently available data and the scientific discussion within the Committee, the CHMP concluded that the benefits of orlistat continue to outweigh its risks, and therefore recommended that the marketing authorisations be maintained for orlistat-containing medicines. It noted that the product information for Xenical already listed ‘hepatitis that may be serious’ as a side effect of unknown frequency, and recommended that the product information for all orlistat-containing medicines should be harmonised to include this information. The product information for Alli, which currently lists ‘hepatitis’, will be updated accordingly. The Committee also agreed on minor amendments to the package leaflet for all orlistat-containing medicines to ensure they give the same information, including a description of the symptoms of hepatitis to alert patients to these symptoms.

The amended information to doctors and patients are detailed under the 'All documents' tab.

What are the recommendations for patients and prescribers?
  • Patients and prescribers are reminded that the benefits of orlistat-containing medicines continue to outweigh the risks. These medicines should continue to be used as before.
  • Patients and prescribers should be aware that certain liver-related problems, including very rare serious reactions such as hepatitis, have been reported and are listed in the product information for orlistat-containing medicines as possible side effects. There remains no clear evidence that orlistat causes these reactions.
  • Patients should note that symptoms of hepatitis can include yellowing skin and eyes, itching, dark coloured urine, stomach pain and liver tenderness (indicated by pain under the front of the rib cage), sometimes with a loss of appetite. Patients should stop taking orlistat and inform their doctor if they experience any of these symptoms.
  • Patients who have any questions should speak to their doctor or pharmacist at a routine appointment.

The European Commission issued a decision for orlistat Article 31 on 24 April 2012.

Name Language First published Last updated
Questions and answers on the review of orlistat-containing medicines BG = bălgarski 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines ES = español 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines CS = čeština 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines DA = dansk 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines DE = Deutsch 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines ET = eesti keel 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines EL = elliniká 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines EN = English 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines FR = français 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines IT = italiano 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines LV = latviešu valoda 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines LT = lietuvių kalba 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines HU = magyar 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines MT = Malti 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines NL = Nederlands 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines PL = polski 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines PT = português 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines RO = română 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines SK = slovenčina 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines SL = slovenščina 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines FI = suomi 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines SV = svenska 16/02/2012 21/12/2012

Key facts

Approved nameOrlistat
International non-proprietary name (INN) or common name

orlistat

Associated names-
Class-
Reference numberEMEA/H/A-31/1318
TypeArticle 31 referrals

This type of referral is triggered when the interest of the Community is involved, following concerns relating to the quality, safety or efficacy of a medicine or a class of medicines.

StatusEuropean Commission final decision
Opinion date16/02/2012

All documents

Name Language First published Last updated
Questions and answers on the review of orlistat-containing medicines BG = bălgarski 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines ES = español 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines CS = čeština 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines DA = dansk 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines DE = Deutsch 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines ET = eesti keel 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines EL = elliniká 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines EN = English 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines FR = français 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines IT = italiano 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines LV = latviešu valoda 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines LT = lietuvių kalba 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines HU = magyar 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines MT = Malti 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines NL = Nederlands 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines PL = polski 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines PT = português 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines RO = română 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines SK = slovenčina 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines SL = slovenščina 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines FI = suomi 16/02/2012 21/12/2012
Questions and answers on the review of orlistat-containing medicines SV = svenska 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex I BG = bălgarski 21/12/2012  
Orlistat - Article 31 referral - Annex I ES = español 21/12/2012  
Orlistat - Article 31 referral - Annex I CS = čeština 21/12/2012  
Orlistat - Article 31 referral - Annex I DA = dansk 21/12/2012  
Orlistat - Article 31 referral - Annex I DE = Deutsch 21/12/2012  
Orlistat - Article 31 referral - Annex I ET = eesti keel 21/12/2012  
Orlistat - Article 31 referral - Annex I EL = elliniká 21/12/2012  
Orlistat - Article 31 referral - Annex I EN = English 21/12/2012  
Orlistat - Article 31 referral - Annex I FR = français 21/12/2012  
Orlistat - Article 31 referral - Annex I IT = italiano 21/12/2012  
Orlistat - Article 31 referral - Annex I LV = latviešu valoda 21/12/2012  
Orlistat - Article 31 referral - Annex I LT = lietuvių kalba 21/12/2012  
Orlistat - Article 31 referral - Annex I HU = magyar 21/12/2012  
Orlistat - Article 31 referral - Annex I MT = Malti 21/12/2012  
Orlistat - Article 31 referral - Annex I NL = Nederlands 21/12/2012  
Orlistat - Article 31 referral - Annex I PL = polski 21/12/2012  
Orlistat - Article 31 referral - Annex I PT = português 21/12/2012  
Orlistat - Article 31 referral - Annex I RO = română 21/12/2012  
Orlistat - Article 31 referral - Annex I SK = slovenčina 21/12/2012  
Orlistat - Article 31 referral - Annex I SL = slovenščina 21/12/2012  
Orlistat - Article 31 referral - Annex I FI = suomi 21/12/2012  
Orlistat - Article 31 referral - Annex I SV = svenska 21/12/2012  
Orlistat - Article 31 referral - Assessment report for orlistat-containing medicinal products (English only) 21/12/2012  
Orlistat - Article 31 referral - Annex II (English only) 21/12/2012  
Orlistat - Article 31 referral - Annex III BG = bălgarski 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III ES = español 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III CS = čeština 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III DA = dansk 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III DE = Deutsch 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III ET = eesti keel 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III EL = elliniká 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III EN = English 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III FR = français 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III IT = italiano 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III LV = latviešu valoda 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III LT = lietuvių kalba 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III HU = magyar 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III MT = Malti 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III NL = Nederlands 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III PL = polski 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III PT = português 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III RO = română 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III SK = slovenčina 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III SL = slovenščina 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III FI = suomi 16/02/2012 21/12/2012
Orlistat - Article 31 referral - Annex III SV = svenska 16/02/2012 21/12/2012

Document description

  • Questions and answers (Q&A) - easy-to-understand summary of key issues and Committee conclusions
  • Summary of Opinion - contains the CHMP opinion of the referred medicine(s)
  • List of the medicines affected by the referral (Annex I)
  • Scientific conclusions of the Committee (Annex II)

The following two documents are sometimes available:

  • Changes to the summary of product characteristics, labeling or package leaflet (also known as Annex III) - available when changes have been recommended by the Committee
  • Conditions of the marketing authorisation (also known as Annex IV) - available when the Committee recommends measures to be taken for the marketing authorisation(s) such as safety measures or extra studies

Current status:
European Commission final decision

More information on orlistat