A long-established, non-hormonal option taken with meals — useful where GLP-1 medicines aren't suitable.
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Orlistat works differently from the GLP-1 medicines: it reduces how much dietary fat your body absorbs, rather than acting on appetite.
It has been in use far longer, costs considerably less, and is often the sensible option where injectable treatments are unsuitable or unaffordable.
A lipase inhibitor taken with meals containing fat. Roughly a third of the fat in that meal passes through undigested.
Including whether a non-hormonal option is the better fit for you.
Taken with meals containing fat. Meals with no fat need no dose.
Tolerance and progress, plus consideration of a multivitamin taken at bedtime, since long-term use reduces absorption of vitamins A, D, E and K.
Orlistat blocks absorption of dietary fat. The side effects are directly proportional to how much fat you eat — which means the medicine effectively enforces a lower-fat diet whether you intend it to or not.
Understanding that in advance is the difference between using it successfully and abandoning it in week one.
Side effects are largely digestive and directly related to dietary fat: oily stools, urgency, flatulence and abdominal discomfort. They are considerably worse on a high-fat diet, which is part of how the medicine works.
Long-term use can reduce absorption of fat-soluble vitamins A, D, E and K.
Not suitable in pregnancy or breastfeeding, or with chronic malabsorption syndrome or cholestasis. Tell the GP if you take ciclosporin, levothyroxine, warfarin or antiepileptics, as absorption can be affected.
Most people who stop orlistat do so within the first fortnight, and almost always because of side effects that could have been reduced by eating less fat. So the early review is about diet rather than dose.
If you have not lost around 5% of your body weight after twelve weeks, orlistat should generally be stopped. That is standard practice and a genuinely useful piece of honesty — continuing a medicine that is not working, at a cost and with side effects, benefits nobody.
No taper is needed and nothing rebounds pharmacologically. Bowel symptoms settle within days.
What matters is what was learned. Many people find the lower-fat eating orlistat enforces is worth keeping — and that habit, rather than the medicine, is what holds the weight afterwards.
It is far cheaper, it is not hormonal, it requires no injection and no strict timing, and it has decades of safety data behind it. It is a legitimate treatment rather than a consolation prize.
It also has a real advantage nobody mentions: it teaches you what you are eating. The side effects are directly proportional to dietary fat, so the feedback is immediate and unambiguous — and for some people that is more useful than a suppressed appetite.
The comparison page sets out the trade-offs properly.
Orlistat 60mg is available over the counter from pharmacies for adults with a BMI of 28 or above. It is a lower dose than the 120mg prescription form and correspondingly less effective — but it costs less and requires no appointment.
If cost is the constraint, ask a pharmacist about that first. We would rather tell you that than take a fee for a prescription you may not need.
If you are not prepared to reduce dietary fat, do not start it — the side effects will be severe and you will stop within a fortnight, having spent the money.
If your work makes sudden urgency genuinely unmanageable, be honest about that at the assessment. It is a practical objection, not a trivial one.
£40 for the consultation, charged whether or not a prescription follows. Reviews are £40 each — and the twelve-week review matters here, because it is where the decision to continue or stop is made.
Orlistat is by a considerable margin the cheapest of the weight management medicines, and it is available as a generic. You pay the pharmacy directly; we dispense nothing and earn nothing from it.
Ring around all the same — prices still differ between pharmacies.
Orlistat 60mg can be bought from a pharmacy without any prescription, for adults with a BMI of 28 or above. It is half the prescription strength and less effective, but it costs less and needs no appointment at all.
If money is the deciding factor, speak to a pharmacist before booking with us. That is a real option and it costs you nothing to ask.
Modestly, and honestly so — typically around 3–5% more weight loss than diet alone. That is considerably less than the GLP-1 medicines.
For some people that is enough, particularly where the goal is improving blood pressure, blood sugar or cholesterol rather than a dramatic change in size.
Oily stools, urgency, wind, and sometimes leakage — and they are directly proportional to how much fat you eat. There is no point being coy about it.
That is the mechanism, not a malfunction. Eat a fatty meal and you will know about it within hours; eat a low-fat one and most people have very few symptoms at all.
For long-term use, yes — a standard multivitamin at bedtime, at least two hours away from a dose. Orlistat reduces absorption of vitamins A, D, E and K.
Yes, and this is the part people miss. Absorption of levothyroxine, ciclosporin, warfarin, antiepileptics and some HIV medicines can be affected.
If you take warfarin your INR needs monitoring, and levothyroxine needs separating in time. Tell the GP everything you take, including supplements.
Not directly — but severe diarrhoea can reduce absorption of the pill. If you have significant diarrhoea, follow the missed-pill rules in your leaflet.
Yes — the 60mg dose is available from pharmacies for adults with a BMI of 28 or above. It is half the prescription strength and less effective, but it is cheaper and needs no appointment.
If cost is your main constraint, ask a pharmacist first.
Reviewed at twelve weeks. If you have not lost around 5% of your body weight by then, it should generally be stopped.
That is the standard rule and a sensible one — there is no case for paying for a medicine with side effects that is not working.
Some regain is common, as with any weight treatment — but the pattern differs from the GLP-1 medicines, because orlistat does not suppress appetite in the first place.
What tends to persist is the lower-fat eating it forced you into. That habit is what holds the result.
It has been in use for over twenty years with a well-understood safety record, which is one of its genuine advantages over much newer treatments.
Rare liver injury has been reported — severe abdominal pain, jaundice or dark urine should be reported promptly. Vitamin monitoring matters with long-term use.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 23, 2026
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