Camacho TR, Lago AA, Parada TMG, González PM

Language: Spanish
References: 12
Page: 333-342
PDF size: 732.45 Kb.

ABSTRACT

Background: Some patients stop treatment with orlistat because of the hassle of gastrointestinal effects, but is now known that adding a fiber can reduce such problems significantly.
Objectives: To determine whether the gastrointestinal side effects induced by orlistat may be prevented or mitigated by the concurrent use of Psyllium plantago and determine the frequency of gastrointestinal effects inherent in the use of orlistat and management related or not of psyllium for 12 months.
Design: Comparative study of 4-arm parallel, factorial design 2 to 2, experimental, along, prospective, open-label Phase IV. 120 Patients of both sexes between 18 and 60 years with BMI› 27 kg/m², randomized treatment with orlistat, with or without psyllium for 12 months. The dosage of orlistat was 60 or 120 mg every 8 hours and who received 6 g psyllium was dissolved in water every 8 h. We quantified each month gastrointetinales side effects inherent in the use of orlistat (number of stools, loose stools, liquid or steatorrhea, flatulence, oily spotting, fecal urgency and incontinence).
Results: We found that administration of psyllium significantly reduced the mean fecal urgency (without Psyllium [10.6], with Psyllium [3.8]), regardless of the dose of orlistat. The administration of Psyllium also significantly reduced the average spot oil and liquid feces, predominantly with the dose of 120 mg oil stain (without Psyllium [49.7], with Psyllium [16.5]) and loose stools (without Psyllium [33.5], with Psyllium [4.5])
Conclusions: The results suggest that concomitant administration of Psyllium plantago protects patients from gastrointestinal side effects, fecal urgency, oily stains and loose stools. The protective effect of Psyllium appears to be prevalent for the dose of 120 mg in cases of fecal stains and loose stools.

REFERENCES

1. Cavaliere H, Floriano I y Medeiros-Neto G. Los efectos secundarios gastrointestinales de orlistat podrían prevenirse con la prescripción concomitante de fibras naturales. Int J Obesity 2001;25:1095-1099.

2. James WPT, Avenell A, Broom J, Whitehead J. A one year trial to assess the value of orlistat in the management of obesity. Int J Obes Relat Metab Disord 1997; 21(Suppl 3): 524-S30.

3. Sjöström L, Rissanem A, Andersen T, Boldrin M, Golay A, Koppeschaar HPF, Krempf M. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. Lancet 1998; 352: 167-173.

4. Drent ML, Larsson I, William-Olsson T, Quaade F, Czubayko F, von Bergmann K, Strobel W, Sjöström L, van der Veen EA. Orlistat, a lipase inhibitor, in the treatment of human obesity: a multiple dose study. Int J Obes Relat Metab Disord 1995; 19: 221- 226.

5. Davidson MH, Hauptman JB, Digirolamo M, Focyt JP, Halsted CH, Heber D, Heimburger DC, Lucas CP, Robbins DC, Chung J, Heymsfield SB. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat. JAMA 1999; 281: 235-241.

6. Bray GA, Greenway FL. Current and potential drugs for treatment of obesity. Endocr Rev 1999; 20:805-875.

7. Hauptman J, Lucas C, Boldrin MN, Collins H, Segall KR. Orlistat in the long-term treatment of obesity in primary care settings. Arch Farm Med 2000; 9: 160-167.

8. Everson GT, Daggy BP, McKimley C, Story JA. Effects of psyllium hydrophillic mucilloid on LDL-cholesterol and bile acid synthesis in hypercholesterolemic men. J Lipid Res 1992; 33: 1183-1192.

9. Levin EG, Miller VT, Muesing RA, Stoy DB, Balm tK, LaRosa JC. Comparison of psyllium hydrophillic mucilloid and cellulose as adjuncts to a prudent diet in the treatment of mild to moderate hypercholesterolemia. Arch Intern Med 1990; 150: 1822-1827.

10. Bell LP, Hectorme K, Reynolds H, Balm TK, Hunninghake DB. Cholesterol-lowering effects of psyllium hydrophilic mucilloid. JAMA 1989; 261: 3419-3423.

11. Vahouny GV, Krutchevsky M (eds). Dietary fiber: basic and clinical aspects. Plenum Press: New York; 1986. pp 181-209.

12. Kesaniemi YA, Tarpila S, Miettinem L. Low vs. high dietary fiber and serum, biliary and fecal lipids in middle-aged men. Am J Clin Nutr 1990; 51: 1007-1012.