Orlistat

How it works

It blocks lipase, the enzyme that breaks down fat in the gut, so roughly a quarter to a third of the fat in a meal passes through undigested. It is not absorbed into the body and it does not act on appetite or on the brain. That is also why its side effects are all in the gut.

What to expect

About 2% to 3% of body weight on average, on top of diet. In XENDOS, the largest and longest trial, people on orlistat had lost 5.8 kg at four years against 3.0 kg on placebo, so the medicine itself accounted for about 2.8 kg. For a 90 kg adult that is under 3 kg. Set that expectation before starting rather than at month three. It is a genuine effect and it is much smaller than the injections.

The 2025 revised Indian statement on obesity in Asian Indians recommends it for people with obesity and without diabetes, where stage 2 means a BMI above 23 together with a raised waist or a waist-to-height ratio above 0.5 and a health problem caused by the weight. That recommendation sits differently from the European guidance, which now puts semaglutide and tirzepatide first line. Both positions are defensible and the difference is mostly about cost and access.

How to take it

• 120 mg with each main meal that contains fat, up to three times a day, during the meal or within an hour of it.
• If a meal has no fat, or you skip the meal, skip the capsule.
• Take a multivitamin containing vitamins A, D, E and K at bedtime, at least two hours away from any capsule, because it reduces absorption of those vitamins.
• A 60 mg strength also exists and is weaker.

Side effects

Oily spotting, wind with discharge, urgent or oily stools, and more frequent motions. These are not rare and they are the reason most people stop. They are worst with fatty meals, which is the medicine working as designed and also a useful nudge. Cutting the fat in the meal reduces them.

Medicines it interferes with

• Levothyroxine. Keep at least 4 hours between the two. Thyroid blood tests may need rechecking after starting.
• Ciclosporin. Avoid the combination, or keep 3 hours apart under supervision.
• Warfarin. INR may change, so it needs checking more often.
• Some antiepileptic medicines and some HIV medicines. Tell your doctor everything you take.

Who should not take it

• Chronic malabsorption syndrome.
• Cholestasis, or obstruction of the bile flow.
• Pregnancy and breastfeeding.

What it costs

Roughly ₹450 to ₹1,350 a month depending on the brand and the dose. It is available from many Indian manufacturers and it is by a wide margin the cheapest medicine on this site.

Where it genuinely fits

For someone who cannot afford anything else, or who wants to try a medicine before committing to an injection, it is a reasonable starting point and it is honest to say so. For someone who can sustain an injection for a year or more, the size of the difference in effect is large enough that orlistat is usually the wrong first choice. The treatment options planner lays that out against your own budget.

Sources: XENDOS (Diabetes Care 2004), the revised definition and management of obesity in Asian Indians (Diabetes and Metabolic Syndrome, 2025), and the Indian prescribing information. Prices are indicative Indian maximum retail prices in September 2026, they change often, and they are not a quotation. No medicine is sold or supplied through this website. Reviewed on 11 September 2026 by Dr. Khizer Hussain Junaidy, Diabetologist & Bariatric Physician, Telangana State Medical Council registration no. 04937.