Orlistat works by blocking fat absorption, therefore it has a clear risk for specific populations with fat metabolism or absorption disorders. The following two types of patients are strictly prohibited from using it to ensure safety.

1、 Patients with chronic malabsorption syndrome

1.1 Absolute taboos

Patients with chronic malabsorption syndrome (such as chronic diarrhea, pancreatic insufficiency, short bowel syndrome, etc.) are prohibited from taking orlistat. This medicine will further reduce the absorption of fat and fat soluble vitamins, exacerbating malnutrition.

1.2 Risk mechanism

The medication itself reduces dietary fat absorption by about 30%. If the patient already has absorption disorders, the combined effect can lead to severe fat diarrhea, weight loss, and essential fatty acid deficiency.

1.3 Alternative Suggestions

Such patients should prioritize nutritional support treatment for the primary disease under the guidance of a doctor, rather than using weight loss drugs.

2、 Patients with cholestasis

2.1 Absolute taboos

Patients with cholestasis (such as primary biliary cholangitis, biliary obstruction, etc.) are prohibited from taking orlistat. Bile deficiency directly affects fat emulsification and absorption, and this drug is not only ineffective under these conditions, but also exacerbates the deficiency of fat soluble vitamins.

2.2 Risk mechanism

The action of orlistat relies on the normal fat emulsification process in the intestine. During bile stasis, fat cannot be effectively decomposed, and unabsorbed fat and drugs can exacerbate diarrhea, abdominal pain, and liver function burden.

2.3 Precautions

If there is unexplained skin itching, jaundice, or upper right abdominal pain, cholestatic liver disease should be checked before medication to avoid misuse.

3、 The population that must be screened before medication

3.1 Patients with chronic diarrhea or fat diarrhea

If there are frequent bowel movements, oily or foul smelling stool, the cause should be identified first, and poor absorption should be ruled out before considering medication.

3.2 Patients with abnormal liver enzymes or a history of biliary diseases

Before medication, liver function and bilirubin levels should be tested. Those with a history of gallstones or biliary surgery should be evaluated carefully.