Can orlistat (Xenical) induce hallucinations?/nA 44-year-old man with diabetes, cervicobrachialgia

Fråga: Can orlistat (Xenical) induce hallucinations?

A 44-year-old man with diabetes, cervicobrachialgia and hypertension. A couple of years ago he had a possible cerebral transient ischemic attack. He has no known alcohol or substance abuse, nor any psychiatric illness. Due to overweight (140 kg) he has been treated with orlistat 120 mg x2-3 for 14 days. During this treatment he has experienced auditory hallucinations. Other medication is not known.

Sammanfattning: The absorption of orlistat is negligible and there are no descriptions of orlistat causing hallucinations. However the hallucinations began when orlistat was introduced. It is therefore not ruled out that orlistat can induce hallucinations and it is recommended that orlistat treatment be stopped to see if hallucination is reversed and possibly later do a rechallenge.

Svar: Orlistat is a newly registered drug, used for treatment of obesity. It is recommended for people with a Body Mass Index (BMI) equal to or higher than 30 kg/m2 and for overweight patients (BMI <28) with risk factors for cardiovascular diseases such as high blood pressure (1). Orlistat specifically inhibits lipases and it acts in the gastrointestinal lumen where it prevents the lipase-catalysed breakdown of triglycerides and thereby reduces the dietary ingested fat by about one third (2). Normal dose is 120 mg x3. The absorption of orlistat is negligible (3).

A search in Medline, Drugline and SWEDIS (Swedish Drug Information System) and pharmacological handbooks gave no descriptions of orlistat causing hallucinations. Roche, the manufacturer, has no reports of this adverse effect.

We recommend this case be reported to SADRAC (Swedish Adverse Drug Reaction Advisory Committee).