orlistat and breastfeeding (2018)
See also https://breastfeeding-and-medication.co.uk/fact-sheet/semaglutide-and-breastfeeding
Orlistat Brand name: Xenical®, Alli®
Orlistat is a lipase inhibitor and reduces the absorption of dietary fat. It is used in conjunction with a hypocalorific diet with a low-fat level. Orlistat may reduce the absorption of fat-soluble vitamins. There is no information on its use in lactation although it is reported to be minimally absorbed after oral doses (Martindale 2017). In the absence of safety data, lifestyle advice and support may be preferable.
Hale (2017 online access) comments that ‘With high protein binding, moderately high molecular weight, and poor oral absorption, it is unlikely that orlistat would enter breastmilk in clinically relevant amounts, or affect a breastfeeding infant’. In the presence of fats orlistat can produce explosive diarrhoea. As breastmilk is high in fat there may be a concern that the baby may produce similar bowel motions, although these have not been reported in any publication.
The BNF states that “No information is available and it should be avoided”.
Practical Suggestions
When I worked with patients trying to lose weight, I found that in the period where they had to prove they were determined to lose weight, they lost more than once orlistat was prescribed. In fact, I rarely needed to prescribe it. Biggest hint I found useful, is to use a smaller plate and as with smoking cessation distract yourself when you are hungry by cleaning teeth, washing the kitchen floor or drinking a whole tumbler of water. Also have an event or photo which you want lose weight for on the fridge / biscuit tin!
The commercial slimming companies like Slimming World® and Weight Watchers® have programmes for breastfeeding mums.
Tips for a low fat, high fibre diet
https://patient.info/health/obesity-overweight/features/orlistat-healthy-eating-guide
- Change from butter or regular spreads to a low-fat spread such as Flora Light®, Bertolli Light® or supermarket versions.
- Choose lean cuts of meat and trim visible fat. Avoid skin on chicken and crackling on pork.
- Avoid added fat/oil when cooking, (or use a spray oil) – grill, poach, bake or microwave instead.
- Choose low-fat dairy foods such as semi-skimmed or skimmed milk, low-calorie yoghurts, reduced-fat cheeses and low-fat spreads.
- Choose lower-fat cook-in sauces with less than 5 g fat per 100 g sauce.
Fibre, fruit and vegetables
Fibre is needed in the diet to help maintain a healthy digestive system, fill you up and it can also help to reduce raised cholesterol levels.
Look carefully at portion sizes
Hale (2024) “Orlistat, is used in the management of obesity. It is a reversible inhibitor of gastric and pancreatic lipases, thus it inhibits absorption of dietary fats by 30%.[1] No studies have been performed on the transmission of orlistat to the breast milk. With high protein binding, moderately high molecular weight, and poor oral absorption, it is unlikely that orlistat would enter breast milk in clinically relevant amounts, or affect a breastfeeding infant. However, due to orlistat’s effect on the absorption of fat soluble vitamins and other fats, nutritional status of a breastfeeding mother should be closely monitored.”
References
- Jones W Breastfeeding and Medication 2018
- Hale TW Medication and Mother’s Milk 2018
