This is a common question about orlistat, and the short answer is that there is no known direct interaction between orlistat and alcohol. However, there are some practical reasons to be careful with alcohol while taking orlistat.
Orlistat and alcohol work in different ways in the body. The NHS information for orlistat does not give a specific restriction on alcohol. However, alcohol can add calories to your diet, and the food and drinks you have alongside it may affect how well you tolerate orlistat.
Key things to know
- There is no known direct interaction between orlistat and alcohol.
- Orlistat works mainly in the digestive system, and only a small amount is absorbed into the bloodstream.
- Alcohol contains around seven calories per gram, so it can add a significant number of calories to your daily intake.
- Orlistat blocks some of the fat from food being absorbed. It does not block the calories from alcohol.
- High fat foods eaten with alcohol may make common orlistat side effects, such as oily stools and urgent bowel movements, more noticeable.
- Some drinks, such as cream based liqueurs and certain cocktails, contain fat as well as alcohol.
- Severe or prolonged diarrhoea can affect how well the combined contraceptive pill works.
- If you have a liver condition or take other medicines, speak to your prescriber about alcohol before drinking.
How Orlistat Works, and Why That Matters for Alcohol
Orlistat is a lipase inhibitor that is usually taken with your main meals. Lipases are enzymes that help your body digest fat. Orlistat blocks some of these enzymes, so part of the fat you eat is not absorbed and instead passes out of the body in your stools.
This is important when thinking about alcohol because orlistat works mainly inside the digestive system. Only a small amount of orlistat is absorbed into the bloodstream.
Alcohol works differently. It is absorbed through the stomach and small intestine and then processed mainly by the liver. Orlistat does not block the absorption of alcohol or prevent your body from processing it.
In simple terms, taking orlistat does not make alcohol disappear from your diet. Alcohol still contributes calories, and orlistat does not reduce those calories.
Orlistat can support weight management when used alongside a reduced calorie, lower fat diet. How well it works varies from person to person, and following your prescribed treatment and dietary advice is important.
If you are pregnant or breastfeeding, speak to your doctor or prescriber before taking orlistat. Orlistat is generally not recommended during pregnancy, and it is not known how much passes into breast milk.
Orlistat can also affect how some medicines and vitamins are absorbed. Tell your doctor, pharmacist or prescriber about any medicines, vitamins or supplements you take so they can check whether orlistat is suitable for you.
Because orlistat can reduce the absorption of some fat soluble vitamins, your healthcare professional may recommend a multivitamin supplement during treatment. Follow the advice given to you about when to take it.
What the NHS Says About Orlistat and Alcohol
The NHS information for orlistat explains that some medicines may not be suitable to take alongside it. These include medicines such as warfarin, amiodarone, some HIV medicines, medicines for depression or anxiety, and levothyroxine.
Alcohol is not listed as a specific interaction with orlistat. The NHS advice focuses on following a healthy, calorie controlled diet and avoiding foods that are high in fat.
This means you do not generally need to avoid alcohol because of a direct interaction with orlistat. However, drinking alcohol can still affect your overall calorie intake and may make it harder to follow the diet recommended while taking orlistat.
If you take other medicines as well as orlistat, check with your pharmacist or prescriber before drinking alcohol, as the other medicine may have its own alcohol restrictions.
Does Orlistat Block the Calories in Alcohol?
No. Orlistat reduces the absorption of some dietary fat. It does not block calories from alcohol, carbohydrates or protein.
Alcohol provides around seven calories per gram, compared with around nine calories per gram for fat and around four calories per gram for carbohydrates and protein. These calories still count towards your overall daily intake.
This is important if you are taking orlistat for weight management. Drinking alcohol can increase your calorie intake, which may make it harder to maintain the calorie deficit needed for weight loss.
Alcohol is also often consumed with foods that are high in fat, such as fried foods, takeaway meals, cheese or creamy dishes. Because orlistat affects the absorption of dietary fat, eating a high fat meal may increase the chance of side effects such as oily stools, oily discharge, wind and an urgent need to open your bowels.
Cream based liqueurs and some cocktails can also contain fat. Orlistat may affect the absorption of this dietary fat, but it does not affect the calories provided by the alcohol itself.
If you develop severe or persistent diarrhoea while taking orlistat, speak to your pharmacist, GP or prescriber. If you use the combined contraceptive pill, severe diarrhoea may affect its effectiveness, so you should follow the relevant contraceptive advice.
If you have liver disease, gallbladder problems or another long term health condition, it is sensible to ask your doctor or prescriber how alcohol fits into your treatment. Your individual circumstances and any other medicines you take may affect the advice you receive.
If you choose to drink alcohol while taking orlistat, keeping within UK alcohol guidelines and being mindful of high fat foods can help you stay closer to the diet recommended during treatment. Always follow the dosage and dietary instructions given by your healthcare professional.
The calorie content of alcoholic drinks can vary considerably, so it is easy to underestimate how much they contribute to your daily intake.
| Drink | Typical calories | Approximate units |
|---|---|---|
| Pint of standard lager (4 to 5% ABV) | Around 180 to 222 | 2.3 to 2.6 |
| Medium glass of wine, 175ml | Around 130 to 158 | 2.3 |
| Large glass of wine, 250ml | Around 190 to 228 | 3.3 |
| Single 25ml spirit with a sugar-free mixer | Around 60 to 65 | 1 |
| Single 25ml spirit with a regular mixer | Around 110 to 130 | 1 |
| Cream liqueur, 50ml | Around 150 to 175 | 1 to 1.5 |
Figures vary depending on the strength and serving size. Always check the ABV on the label, as this gives you the most reliable indication of the alcohol content.
Over time, these calories can add up. NHS figures indicate that five pints of 5.2% lager a week provide roughly 57,720 calories over a year, while four bottles of 12% wine a month provide around 32,400 calories a year. Taking orlistat does not reduce these calories.
If you are taking orlistat as part of a weight management plan, your overall calorie intake matters. Alcohol can be an easy source of extra calories, so it is worth including it when thinking about your diet. This is a practical consideration rather than a direct interaction between alcohol and orlistat.
What the Research Shows About Orlistat and Blood Alcohol
There is limited research looking directly at orlistat and alcohol. One small study looked at whether orlistat could affect how quickly alcohol was absorbed after a fatty meal.
Researchers gave ten healthy male volunteers a fatty drink made with cream, with or without a 120mg dose of orlistat. Thirty minutes later, they were given an alcoholic drink. The researchers then measured stomach emptying, blood alcohol and blood glucose levels.
The study found that the stomach emptied slightly faster when orlistat was taken. Blood alcohol levels were also slightly higher at 15 minutes with orlistat than without it. However, there was no difference in the total amount of alcohol exposure over the four hour measurement period.
One possible explanation is that dietary fat can slow stomach emptying. Orlistat reduces the digestion and absorption of some fat, which may have slightly reduced this effect in the study. As a result, alcohol may have reached the bloodstream a little sooner.
In practical terms, this small study suggests that alcohol could potentially be absorbed slightly faster after a fatty meal when orlistat is taken. It does not show that orlistat makes you more intoxicated overall. The study involved only ten healthy men, so the findings should be treated as limited evidence rather than a general warning about drinking while taking orlistat.
The Real Problem Is Usually the Food, Not the Drink
For many people, the bigger concern when drinking alcohol while taking orlistat is the food eaten alongside the drinks.
A night out can often involve foods that are high in fat, such as chips, fried starters, pizza, curry, cheese, kebabs, burgers and takeaways. Eating a high fat meal while taking orlistat can increase the chance of side effects such as oily or fatty stools, an urgent or more frequent need to open your bowels, wind with oily spotting, stomach discomfort and diarrhoea.
This does not mean alcohol itself causes these side effects. In many cases, the amount of fat in the meal is the more important factor.
There is also an important point about when to take orlistat. It is normally taken with meals that contain fat. If you skip a meal or the meal contains no fat, a dose may not be needed. However, always follow the instructions on your medicine label or those given by your prescriber rather than changing your dose based on general information.
If you are unsure whether you should take a dose when you are drinking, speak to your pharmacist or prescriber.
Which drinks actually contain fat?
Most do not, but some do, and orlistat will act on the ones that do.
| Drink type | Fat content | Relevance on orlistat |
|---|---|---|
| Beer, lager, cider | None | No fat for orlistat to act on |
| Wine, prosecco, champagne | None | No fat for orlistat to act on |
| Neat spirits and standard mixers | None | No fat for orlistat to act on |
| Cream liqueurs, for example Irish cream | Contains cream, so genuinely fatty | Can contribute to fat-related side effects |
| Creamy cocktails, piña colada, espresso martini variants with cream | Variable, often significant | Can contribute to fat-related side effects |
| Milk-based or coconut-based drinks | Variable | Worth accounting for in your daily fat total |
If you want a fuller picture of managing fat across your meals, our orlistat diet guide on what to eat covers how to spread fat intake across the day rather than concentrating it in one sitting.
Alcohol, Diarrhoea and the Contraceptive Pill
This is a practical point that is easy to overlook when talking about orlistat and alcohol.
Alcohol can sometimes cause loose stools, while orlistat can cause diarrhoea, particularly after eating a high fat meal. Having both on the same evening may therefore make diarrhoea more likely.
NHS guidance advises that if you take orlistat with the combined contraceptive pill and develop severe diarrhoea, or diarrhoea that lasts for more than 24 hours, your contraceptive protection may be reduced. In this situation, use additional contraception, such as condoms, a diaphragm or a cap, and follow the advice provided with your contraceptive.
This is not a direct interaction between alcohol and orlistat. It is simply something to be aware of if diarrhoea occurs while you are taking orlistat.
Orlistat, Alcohol and Your Liver
Because alcohol is processed by the liver, it is understandable to wonder whether drinking while taking orlistat could place extra strain on the liver.
The European Medicines Agency has reviewed reports of severe liver injury in people taking orlistat. Its review concluded that the benefits of orlistat continued to outweigh its risks and that there was no strong evidence that orlistat increases the risk of severe liver injury. Liver related effects, including hepatitis, gallstones and changes in liver enzyme levels, are listed as possible side effects in the product information, although these are very rare.
At the time of the review, Xenical and Alli had been used by an estimated 53 million people worldwide.
Orlistat is therefore not generally considered a medicine that commonly causes liver damage. However, drinking large amounts of alcohol can itself harm the liver. If you have an existing liver condition, speak to your prescriber about whether alcohol is suitable for you. The NHS also advises that orlistat may not be suitable for people with cholestasis, a condition that affects the flow of bile from the liver.
Seek medical advice promptly if you develop yellowing of the skin or eyes, persistent nausea or vomiting, unusual tiredness, dark urine, pale stools or itching. These symptoms can have several causes, but they should be checked rather than ignored.
Alcohol and Fat Soluble Vitamins
Orlistat can reduce the absorption of fat soluble vitamins A, D, E and K. This is why a multivitamin containing these vitamins is often recommended during treatment. It is usually taken at a different time from orlistat, often at bedtime.
Heavy alcohol consumption can also affect the absorption and storage of some nutrients. These are separate effects, but they are another reason to follow the vitamin advice given by your healthcare professional while taking orlistat.
If you normally take your multivitamin at bedtime but miss it because your routine changes, take it when you remember rather than taking two doses together. Follow the instructions on your specific product or from your healthcare professional.
You can also read our guide to vitamins to take with orlistat for more information about suitable timing.
Does the Answer Change for Alli or Orlos 60mg?
The basic advice is the same. Alli and Orlos contain orlistat at a lower strength of 60mg, while prescription orlistat and Xenical contain 120mg.
Because they contain the same active ingredient and work in the same way, there is no known direct interaction between alcohol and these products. However, orlistat can still cause digestive side effects, particularly after meals that are high in fat.
Alcohol calories are also still absorbed by the body. Taking a lower dose of orlistat does not change this.
The same principle applies to Xenical, which contains orlistat 120mg. Whether you are taking Xenical, generic orlistat, Alli or Orlos, alcohol itself is not blocked by orlistat.
How Alcohol Affects Your Overall Weight Loss Results
Even when there is no direct interaction, alcohol can still affect your weight management goals.
The most obvious issue is calories. Alcohol can add a significant amount to your daily intake, particularly when drinks are combined with high calorie foods.
Alcohol may also make it harder to stick to your usual food choices. Some people find that they are more likely to choose high fat or high calorie foods when drinking. Alcohol can also affect sleep, and poor sleep may influence appetite and food choices the following day.
NICE guidance recommends reviewing the response to orlistat after around 12 weeks. Treatment is generally not continued beyond three months if a person has not lost at least 5% of their starting body weight. Your prescriber will assess your progress and decide whether continuing treatment is appropriate.
This does not mean that you cannot drink alcohol while taking orlistat. It simply means that alcohol should be included when considering your overall calorie intake and weight management plan.
How Orlistat Compares With Other Weight Loss Treatments on Alcohol
If you are considering different weight management treatments, it is useful to know that they do not all interact with alcohol in the same way.
Orlistat does not have a known direct interaction with alcohol. The main practical concerns are the extra calories from alcohol and the possibility of digestive side effects, particularly after high fat meals.
GLP 1 based treatments work differently. They can affect appetite and slow stomach emptying, and some people may notice changes in how they tolerate alcohol while taking them. Your experience can vary depending on the medicine, your dose and your individual circumstances.
Our weight loss treatment options section explains what is available in the UK, how eligibility can differ between treatments and what each option involves. Suitability always depends on an individual clinical assessment, and your prescriber will decide which treatment, if any, is appropriate for you. Results vary between individuals.
Practical Tips for a Night Out on Orlistat
If you are planning a night out while taking orlistat, a little preparation can make things easier. These simple tips may help you manage your diet and reduce the chance of digestive problems.
- Choose a lower fat meal rather than fried or creamy foods, which can increase the chance of orlistat related digestive side effects.
- Only take an orlistat dose with a meal that contains fat, and follow the instructions on your medicine label.
- Alternate alcoholic drinks with water to help you stay hydrated and keep track of how much you are drinking.
- Be mindful of drinks such as cream liqueurs and creamy cocktails, which can contain fat as well as alcohol.
- If you are prone to bowel side effects, make sure you know where the toilet facilities are, particularly if you have eaten more fat than usual.
- If you take the combined contraceptive pill and develop severe diarrhoea, use additional barrier contraception and follow the advice provided with your contraceptive.
- Keep taking your multivitamin as advised. If you miss your usual time, adjust the timing rather than taking an extra dose.
- Include alcohol in your overall calorie intake. Orlistat does not block the calories from alcohol.
