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pRare cases of increase in transaminases and in alkaline phosphatase and hepatitis that may be serious have been reportedThere have been reports of hepatic failure observed with the use of XENICAL in postmarketing surveillancewith some of these cases resulting in liver transplant or deathsee WARNINGS AND PRECAUTIONSRare cases of hypersensitivity have been reported with the use of XENICALSigns and symptoms have included pruritusrashurticariaangioedemabronchospasm and anaphylaxisVery rare cases of bullous eruption have been reportedRare cases of leukocytoclastic vasculitis have been reportedClinical signs include palpablepurpuramaculopapular lesionsor bullous eruptionAcute oxalate nephropathy after treatment with XENICAL has been reported in patients with or at risk for renal diseasesee WARNINGS AND PRECAUTIONSPancreatitis has been reported with the use of XENICAL in postmarketing surveillanceNo causal relationship or physiopathological mechanism between pancreatitis and obesity therapy has been definitively establishedLower gastrointestinal bleeding has been reported in patients treated with XENICALMost reports are nonserioussevere or persistent cases should be investigated further./ppLoss of virological control has been reported in HIV-infected patients taking orlistat concomitantly with antiretroviral drugs such as atazanavirritonavirtenofovir disoproxil fumarateemtricitabineand with the combinations lopinavir/ritonavir and emtricitabine/efavirenz/tenofovir disoproxil fumarateThe exact mechanism for this is unclearbut may include a drug-drug interaction that inhibits systemic absorption of the antiretroviral drugHIV RNA levels should be frequently monitored in patients who take XENICAL while being treated for HIV infectionIf there is a confirmed increase in HIV viral loadXENICAL should be discontinued./ppPatients should be strongly encouraged to take a multivitamin supplement that contains fat-soluble vitamins to ensure adequate nutrition because XENICAL has been shown to reduce the absorption of some fat-soluble vitamins and beta-carotenesee DOSAGE AND ADMINISTRATIONand ADVERSE REACTIONSIn additionthe levels of vitamin D and beta-carotene may be low in obese patients compared with non-obese subjectsThe supplement should be taken once a day at least 2 hours before or after the administration of XENICALsuch as at bedtime./ppOrganic causes of obesitye.ghypothyroidismshould be excluded before prescribing XENICAL./ppNo pharmacokinetic study was conducted for specific populations such as geriatricdifferent racesand patients with renal and hepatic impairment./p

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