Alli is an FDA-approved weight-loss drug available over-the-counter without a prescription. It contains the drug, orlistat, which is also the active ingredient in the prescription drug, Xenical. Alli is half the strength of Xenical and is taken up to three times a day before each fat-containing meal. Because of the way it works, it's safe to take with most medications. However, there are some medications that require caution while using Alli.
Mechanism of Action
Alli produces its effect in the stomach and intestines. It blocks the absorption of about 30 percent of the fat in the food you eat. The undigested fat is then eliminated from your body in the stool. Moreover, most of your orlistat dose is not absorbed by your body. Therefore, only a small amount enters your bloodstream where it would be available to potentially interact with other drugs.
Cyclosporine
When administered together, Alli and cyclosporine potentially interact. Cyclosporine, also sold under the names Sandimmune and Neoral, is an immunosuppressant used by organ transplant patients to prevent the rejection of the transplanted organ. According to the FDA's prescribing information for orlistat, when these drugs are taken together, cyclosporine's absorption may be affected, resulting in decreased blood levels of the drug. To avoid the interaction, Alli and cyclosporine should be taken at least two hours apart, and cyclosporine blood levels should be monitored. If you take cyclosporine, consult your doctor before starting Alli.
Levothyroxine
Levothyroxine, also sold as Synthroid, Levothroid and Levoxyl, may interact with Alli. It is used to treat a thyroid condition called hypothyroidism, which is characterized by low levels of thyroid hormones. Alli may affect your thyroid levels, therefore, you should take Alli and your thyroid medicine four hours apart. Also, have your doctor monitor your thyroid levels. Be sure to consult your doctor before starting Alli if you take a thyroid medicine.
Warfarin
Warfarin, the active ingredient in Coumadin, is a blood thinner used to treat clotting disorders. Alli does not directly interact with warfarin; however it does affect levels of vitamin K, which is the antidote for warfarin. The FDA's prescribing information for orlistat reports that Alli decreases vitamin K in the blood, which may in turn affect the blood-thinning effects of warfarin. Consequently, you should have your coagulation status regularly monitored by your doctor if you are taking warfarin. You should also inform your doctor that you are taking or considering taking Alli.
Vitamins
Alli blocks the absorption the water-soluble A,D,E, and K, potentially causing deficiencies in them. Therefore, while on Alli, you should take a multivitamin daily.
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