Obesity Pharmacotherapy a. To Start Orlistat: i. Check baseline AST, ALT, liver function tests, creatinine ii. Start orlistat 120 mg TID with meals iii. Skip dose if meal skipped iv. Take daily multivitamin with fat-soluble vitamins and beta-carotene 2 hours before or after orlistat dose. v. Consider over-the-counter formulation if insurance does not cover Xenical vi. OTC dose is 60 mg TID with meals( close to 80 % as effective as prescription strength). vii. Review side effects: Most common are GI: 50 % of all GI side effects( e. g., abdominal pain, steatorrhea, oily anal leakage) lasted for less than 1 week and majority for no more than 4 weeks, small risk of hepatic injury and rare necrosis: jaundice, pruritus, anorexia, dark urine, light- colored stools, Oxalate nephrolithiasis or nephropathy: painful or frequent urination, blood in urine, severe flank, back or groin pain, swelling of legs, Cholelithiasis: nausea, vomiting, RUQ pain. viii. Due to very modest weight reduction and side effects, not utilized very often. b. Discontinue: i. If not tolerated ii. If suspect serious side effect