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Treatment option:
Medically reviewed by Oliinyk Elizabeth Ivanovna, PharmD. Last updated on 24.03.2022
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Symfona is indicated in conjunction with a mildly hypocaloric diet for the treatment of obese patients with a body mass index (BMI) greater or equal to 30 kg/m2, or overweight patients (BMI > 28 kg/m2) with associated risk factors.
Treatment with Symfona should be discontinued after 12 weeks if patients have been unable to lose at least 5 % of the body weight as measured at the start of therapy.
Symfona™ (orlistat 60 mg) is indicated for weight loss in overweight adults, 18 years and older, when used along with a reduced-calorie and low-fat diet.
Diet and exercise are the starting points for any weight loss program. Try these first before adding Symfona (orlistat 60 mg). Check with your doctor before starting any exercise program.
To determine if Symfona (orlistat 60 mg) capsules are right for you, find your height on the chart below. You may consider starting with Symfona (orlistat 60 mg) if your weight is the same or more than the weight shown for your height.
Posology
Adults
The recommended dose of Symfona is one 120 mg capsule taken with water immediately before, during or up to one hour after each main meal. If a meal is missed or contains no fat, the dose of Symfona should be omitted.
The patient should be on a nutritionally balanced, mildly hypocaloric diet that contains approximately 30 % of calories from fat. It is recommended that the diet should be rich in fruit and vegetables. The daily intake of fat, carbohydrate and protein should be distributed over three main meals.
Doses of Symfona above 120 mg three times daily have not been shown to provide additional benefit. The effect of Symfona results in an increase in faecal fat as early as 24 to 48 hours after dosing. Upon discontinuation of therapy, faecal fat content usually returns to pre-treatment levels, within 48 to 72 hours.
Special populations
The effect of Symfona in patients with hepatic and/or renal impairment, children and elderly patients has not been studied.
There is no relevant indication for use of Symfona in children.
The recommended dose of Symfona (orlistat 60 mg) for overweight adults 18 years and older is 1 60-mg capsule with each meal containing fat.
- do not exceed 3 capsules daily
- use with a reduced-calorie, low-fat diet until you reach your weight loss goal.
Most weight loss occurs within the first 6 months. If you stop using Symfona (orlistat 60 mg) , continue with a diet and exercise program. If you start to regain weight after you stop taking Symfona (orlistat 60 mg) , you may need to start taking Symfona (orlistat 60 mg) again along with your diet and exercise program.
Take a multivitamin once a day, at bedtime, when using Symfona (orlistat 60 mg) capsules.
- Hypersensitivity to the active substance or to any of the excipients.
- Chronic malabsorption syndrome.
- Cholestasis.
- Breast-feeding.
Symfona (orlistat 60 mg) is contraindicated in patients who have had an organ transplant or are taking medicine to reduce organ rejection, patients who are taking cyclosporine, and in patients with known problems absorbing food or are allergic to any of the ingredients in an Symfona (orlistat 60 mg) capsule.
In clinical trials, the decrease in bodyweight with Symfona treatment was less in type II diabetic patients than in non-diabetic patients. Antidiabetic medicinal product treatment may have to be closely monitored when taking Symfona.
Co-administration of Symfona with ciclosporin is not recommended.
Patients should be advised to adhere to the dietary recommendations they are given.
The possibility of experiencing gastrointestinal adverse reactions may increase when Symfona is taken with a diet high in fat (e.g. in a 2000 kcal/day diet, > 30 % of calories from fat equates to > 67 g of fat). The daily intake of fat should be distributed over three main meals. If Symfona is taken with a meal very high in fat, the possibility of gastrointestinal adverse reactions may increase.
Cases of rectal bleeding have been reported with Symfona. Prescribers should investigate further in case of severe and/or persistent symptoms.
The use of an additional contraceptive method is recommended to prevent possible failure of oral contraception that could occur in case of severe diarrhoea.
Coagulation parameters should be monitored in patients treated with concomitant oral anticoagulants.
The use of Symfona may be associated with hyperoxaluria and oxalate nephropathy leading sometimes to renal failure. This risk is increased in patients with underlying chronic kidney disease and/or volume depletion.
Rare occurrence of hypothyroidism and/or reduced control of hypothyroidism may occur. The mechanism, although not proven, may involve a decreased absorption of iodine salts and/or levothyroxine.
Antiepileptics patient: Symfona may unbalance anticonvulsivant treatment by decreasing the absorption of antiepileptic drugs, leading to convulsions.
Antiretrovirals for HIV: Symfona may potentially reduce the absorption of antiretroviral medicines for HIV and could negatively affect the efficacy of antiretroviral medications for HIV.
WARNINGS
Organ transplant alert:
Do not use if you have had an organ transplant. Symfona (orlistat 60 mg) interferes with the medicines used to prevent transplant rejection.
Allergy alert:
Do not use if you are allergic to any of the ingredients in Symfona (orlistat 60 mg) capsules.
Do not use;
- if you are taking cyclosporine
- if you have been diagnosed with problems absorbing food
- if you are not overweight
Ask a doctor before use if you have ever had:
- gallbladder problems
- kidney stones
- pancreatitis
PRECAUTIONS
Ask a doctor or pharmacist before use if you are
- taking warfarin (blood thinning medicine), or taking medicine for diabetes or thyroid disease. Your medication dose may need to be adjusted.
- taking other weight loss products.
When using this product
- take a multivitamin containing vitamins A, D, E, K, and beta-carotene once daily at bedtime is recommended. Orlistat inhibits 25% of dietary fat, and may reduce the absorption of some fat-soluble vitamins. Symfona (orlistat 60 mg) and a multivitamin should not be taken at the same time to gain the most benefit of a multivitamin. However, if they are taken at the same time, at least 70% of the fat-soluble vitamins would be absorbed.
- follow a well-balanced, reduced-calorie, low-fat diet. Try starting this diet before taking Symfona (orlistat 60 mg) capsules.
- Symfona (orlistat 60 mg) capsules work by preventing the absorption of some of the fat you eat. The fat passes out of your body so you may have bowel changes. You may get:
- gas with oily spotting
- loose stools
- more frequent stools that may be hard to control
Eating a low-fat diet lowers the chance of having these bowel changes.
For every 5 pounds you lose from diet alone, Symfona (orlistat 60 mg) can help you lose 2-3 pounds more. In studies, most people lost 5-10 pounds over 6 months.
Stop use and ask a doctor if severe or continuous abdominal pain occurs. This may be a sign of a serious medical condition.
If pregnant or breast-feeding, do not use.
Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center right away.
Do not use if an individual has been diagnosed with problems absorbing food or is allergic to any of the ingredients in an Symfona (orlistat 60 mg) capsule.
Do not use if not overweight.
Symfona has no influence on the ability to drive and use machines.
Adverse reactions to Symfona are largely gastrointestinal in nature. The incidence of adverse events decreased with prolonged use of Symfona.
Adverse events are listed below by system organ class and frequency. Frequencies are defined as: very common (>1/10), common (>1/100 to <1/10), uncommon (>1/1,000 to <1/100), rare (>1/10,000 to <1/1,000) and very rare (<1/10,000) including isolated reports.
Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.
The following table of undesirable effects (first year of treatment) is based on adverse events that occurred at a frequency of > 2 % and with an incidence > 1 % above placebo in clinical trials of 1 and 2 years duration:
| System organ class | Adverse reaction/events |
| Nervous system disorders | |
| Very common: | Headache |
| Respiratory, thoracic and mediastinal disorders | |
| Very common: | Upper respiratory infection |
| Common: | Lower respiratory infection |
| Gastrointestinal disorders | |
| Very common: | Abdominal pain/discomfort Oily spotting from the rectum Flatus with discharge Faecal urgency Fatty/oily stool Flatulence Liquid stools Oily evacuation Increased defecation |
| Common: | Rectal pain/discomfort Soft stools Faecal incontinence Abdominal distension* Tooth disorder Gingival disorder |
| Renal and urinary disorders | |
| Common: | Urinary tract infection |
| Metabolism and nutrition disorders | |
| Very common: | Hypoglycemia* |
| Infections and infestations | |
| Very common: | Influenza |
| General disorders and administration site conditions | |
| Common: | Fatigue |
| Reproductive system and breast disorders | |
| Common: | Menstrual irregularity |
| Psychiatric disorders | |
| Common: | Anxiety |
* only unique treatment adverse events that occurred at a frequency of > 2 % and with an incidence > 1 % above placebo in obese type 2 diabetic patients.
In a 4 year clinical trial, the general pattern of adverse event distribution was similar to that reported for the 1 and 2 year studies with the total incidence of gastrointestinal related adverse events occurring in year 1 decreasing year on year over the four year period.
The following table of undesirable effects is based on post-marketing spontaneous reports, and therefore the frequency remains unknown:
| System organ class | Adverse reaction |
| Investigations | Increase in liver transaminases and in alkaline phosphatase. Decreased prothrombin, increased INR and unbalanced anticoagulant treatment resulting in variations of haemostatic parameters have been reported in patients treated with anticoagulants in association with Symfona |
| Gastrointestinal disorders | Rectal bleeding Diverticulitis Pancreatitis |
| Skin and subcutaneous tissue disorders | Bullous eruptions |
| Immune system disorders | Hypersensitivity (e.g. pruritus, rash, urticaria, angioedema, bronchospasm and anaphylaxis) |
| Hepatobiliary disorders | Cholelithiasis Hepatitis that may be serious. Some fatal cases or cases requiring liver transplantation have been reported. |
| Renal and urinary disorders | Oxalate nephropathy that may lead to renal failure |
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the MHRA Yellow Card Scheme, Website - www.mhra.gov.uk/yellowcard.
Some people on Symfona™ (orlistat 60 mg) will experience GI side effects, which is expected since Symfona (orlistat 60 mg) works by inhibiting about 25% of dietary fat. Symfona (orlistat 60 mg) is half the strength of prescription Xenical® (orlistat 120 mg), and, as a result, has fewer GI events overall than Xenical®. In clinical trials, subjects on 120 mg withdrew due to GI adverse events at a rate of 5.4%-and at 60 mg it was only 3.2%.
The main treatment effect occurs when an individual eats a meal with too much fat while taking Symfona (orlistat 60 mg). Treatment effects may include:
- Loose or more frequent stools that may be hard to control
- An urgent need to go to the bathroom
- Gas with oily spotting
- While excess fat that is excreted is not harmful, patients could be distressed by the experience. Treatment effects can be lessened if an individual sticks with reduced-calorie, low-fat meals that average 15 grams of fat per meal (or 30% fat or less). Diets may vary from 1,200 calories to 1,800 calories per day, so 15 grams is an average. Individuals need to be aware of hidden fat in food, so that they can lower the chance of having treatment effects.
Not all individuals will experience treatment effects, but those that do can reduce the likelihood of these effects by taking Symfona (orlistat 60 mg) as directed and sticking with a reduced-calorie, low-fat diet. The Symfona (orlistat 60 mg) starter pack includes portable reference guides and online support at mySymfona (orlistat 60 mg).com to help patients follow the program accurately. Some patients may experience treatment effects as they begin therapy until they learn to adjust their diet.
Single doses of 800 mg Symfona and multiple doses of up to 400 mg three times daily for 15 days have been studied in normal weight and obese subjects without significant adverse findings. In addition, doses of 240 mg tid have been administered to obese patients for 6 months. The majority of Symfona overdose cases received during post- marketing reported either no adverse events or adverse events that are similar to those reported with recommended dose.
Should a significant overdose of Symfona occur, it is recommended that the patient be observed for 24 hours. Based on human and animal studies, any systemic effects attributable to the lipase-inhibiting properties of Symfona should be rapidly reversible.
No information provided.
Pharmaco-therapeutic group: Peripherally acting antiobesity agent, ATC code A08AB01.
Symfona is a potent, specific and long-acting inhibitor of gastrointestinal lipases. It exerts its therapeutic activity in the lumen of the stomach and small intestine by forming a covalent bond with the active serine site of the gastric and pancreatic lipases. The inactivated enzyme is thus unavailable to hydrolyse dietary fat, in the form of triglycerides, into absorbable free fatty acids and monoglycerides.
In the 2-year studies and the 4-year study, a hypocaloric diet was used in association with treatment in both the Symfona and the placebo treated groups.
Pooled data from five 2 year studies with Symfona and a hypocaloric diet showed that 37 % of Symfona patients and 19 % of placebo patients demonstrated a loss of at least 5 % of their baseline body weight after 12 weeks of treatment. Of these, 49 % of Symfona treated patients and 40 % of placebo treated patients went on to lose > 10 % of their baseline body weight at one year. Conversely, of patients failing to demonstrate a loss of 5 % of their baseline body weight after 12 weeks of treatment, only 5 % of Symfona
treated patients and 2 % of placebo treated patients went on to lose > 10 % of their baseline body weight at one year. Overall, after one year of treatment, the percentage of patients taking 120 mg Symfona who lost 10 % or more of their body weight was 20 % with Symfona 120 mg compared to 8 % of patients taking placebo. The mean difference in weight loss with the drug compared to placebo was 3.2 kg.
Data from the 4-year XENDOS clinical trial showed that 60 % of Symfona patients and 35 % of placebo patients demonstrated a loss of at least 5 % of their baseline body weight after 12 weeks of treatment. Of these, 62 % of Symfona treated patients and 52 % of placebo treated patients went on to lose > 10 % of their baseline body weight at one year. Conversely, of patients failing to demonstrate a loss of 5 % of their baseline body weight after 12 weeks of treatment, only 5 % of Symfona treated patients and 4 % of placebo treated patients went on to lose > 10 % of their baseline body weight at one year. After 1 year of treatment, 41 % of the Symfona treated patients versus 21 % of placebo treated patients lost > 10 % of body weight with a mean difference of 4.4 kg between the two groups. After 4 years of treatment 21 % of the Symfona treated patients compared to 10 % of the placebo treated patients had lost > 10 % of body weight, with a mean difference of 2.7 kg.
More patients on Symfona or placebo lost baseline body weight of at least 5 % at 12 weeks or 10 % at one year in the XENDOS study than in the five 2-year studies. The reason for this difference is that the five 2-year studies included a 4-week diet and placebo lead-in period during which patients lost on average 2.6 kg prior to commencing treatment.
Data from the 4-year clinical trial also suggested that weight loss achieved with Symfona delayed the development of type 2 diabetes during the study (cumulative diabetes cases incidences: 3.4 % in the Symfona group compared to 5.4 % in the placebo-treated group). The great majority of diabetes cases came from the subgroup of patients with impaired glucose tolerance at baseline, which represented 21 % of the randomised patients. It is not known whether these findings translate into long-term clinical benefits.
In obese type 2 diabetic patients insufficiently controlled by antidiabetic agents, data from four one year clinical trials showed that the percentage of responders (> 10 % of body weight loss) was 11.3 % with Symfona as compared to 4.5 % with placebo. In Symfona-treated patients, the mean difference from placebo in weight loss was 1.83 kg to 3.06 kg and the mean difference from placebo in HbA1c reduction was 0.18 % to 0.55 %. It has not been demonstrated that the effect on HbA1c is independent from weight reduction.
In a multi-centre (US, Canada), parallel-group, double-blind, placebo-controlled study, 539 obese adolescent patients were randomised to receive either 120 mg Symfona (n=357) or placebo (n=182) three times daily as an adjunct to a hypocaloric diet and exercise for 52 weeks. Both populations received multivitamin supplements. The primary endpoint was the change in body mass index (BMI) from baseline to the end of the study.
The results were significantly superior in the Symfona group (difference in BMI of 0.86 kg/m2 in favour of Symfona). 9.5 % of the Symfona treated patients versus 3.3 % of the placebo treated patients lost > 10 % of body weight after 1 year with a mean difference of 2.6 kg between the two groups. The difference was driven by the outcome in the group of patients with > 5 % weight loss after 12 weeks of treatment with Symfona representing 19 % of the initial population. The side effects were generally similar to those observed in adults. However, there was an unexplained increase in the incidence of bone fractures (6 % versus 2.8 % in the Symfona and placebo groups, respectively).
Absorption
Studies in normal weight and obese volunteers have shown that the extent of absorption of Symfona was minimal. Plasma concentrations of intact Symfona were non- measurable (< 5 ng/ml) eight hours following oral administration of Symfona.
In general, at therapeutic doses, detection of intact Symfona in plasma was sporadic and concentrations were extremely low (< 10 ng/ml or 0.02 μmol), with no evidence of accumulation, which is consistent with minimal absorption.
Distribution
The volume of distribution cannot be determined because the drug is minimally absorbed and has no defined systemic pharmacokinetics. In vitro Symfona is > 99 % bound to plasma proteins (lipoproteins and albumin were the major binding proteins). Symfona minimally partitions into erythrocytes.
Metabolism
Based on animal data, it is likely that the metabolism of Symfona occurs mainly within the gastrointestinal wall. Based on a study in obese patients, of the minimal fraction of the dose that was absorbed systemically, two major metabolites, M1 (4-member lactone ring hydrolysed) and M3 (M1 with N-formyl leucine moiety cleaved), accounted for approximately 42 % of the total plasma concentration.
M1 and M3 have an open beta-lactone ring and extremely weak lipase inhibitory activity (1000 and 2500 fold less than Symfona respectively). In view of this low inhibitory activity and the low plasma levels at therapeutic doses (average of 26 ng/ml and 108 ng/ml respectively), these metabolites are considered to be pharmacologically inconsequential.
Elimination
Studies in normal weight and obese subjects have shown that faecal excretion of the unabsorbed drug was the major route of elimination. Approximately 97 % of the administered dose was excreted in faeces and 83 % of that as unchanged Symfona.
The cumulative renal excretion of total Symfona-related materials was < 2 % of the given dose. The time to reach complete excretion (faecal plus urinary) was 3 to 5 days. The disposition of Symfona appeared to be similar between normal weight and obese volunteers. Symfona, M1 and M3 are all subject to biliary excretion.
Non-clinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity, carcinogenic potential, and toxicity to reproduction.
In animal reproductive studies, no teratogenic effect was observed. In the absence of a teratogenic effect in animals, no malformative effect is expected in man. To date, active substances responsible for malformations in man have been found teratogenic in animals when well-conducted studies were performed in two species.
Not applicable.
No special requirements.
However, we will provide data for each active ingredient
