Xenical Vs. Saxenda: Drug Comparison

Xenical^® (orlistat) is a prescription medication used for weight management by inhibiting the enzyme lipase, which reduces the absorption of dietary fats in the intestines, thereby helping with weight loss. Its FDA-approved indication is for obesity management, including weight loss and weight maintenance, in conjunction with a reduced-calorie diet. Xenical is available in capsule form and is typically taken three times daily with meals containing fat. Common side effects include gastrointestinal issues such as oily stools, flatulence, and frequent bowel movements, especially after consuming high-fat meals. Xenical can affect the absorption of fat-soluble vitamins, and patients are advised to take a multivitamin supplement to avoid deficiencies.

Saxenda^® (liraglutide) is an injectable medication used for chronic weight management in adults with obesity or overweight with at least one weight-related condition, such as hypertension, type 2 diabetes, or high cholesterol. It works by mimicking the hormone glucagon-like peptide-1 (GLP-1), which helps regulate appetite and food intake, leading to reduced caloric consumption and weight loss. Administered once daily, Saxenda is used in conjunction with a reduced-calorie diet and increased physical activity. Common side effects include nausea, diarrhea, and constipation, and it should be used with caution in patients with a history of pancreatitis​.

Reversible inhibitor of gastrointestinal lipases

Glucagon-like peptide-1 (GLP-1) receptor agonist

Xenical (orlistat) is indicated:

• For obesity management including weight loss and weight maintenance when used in conjunction with a reduced-calorie diet

• To reduce the risk for weight regain after prior weight loss

Saxenda (liraglutide) is indicated:

• As an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in:

  • Adult patients with an initial body mass index (BMI) of:

    • 30 kg/m² or greater (obese), or

    • 27 kg/m² or greater (overweight) in the presence of at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia)

  • Pediatric patients aged 12 years and older with:

    • Body weight above 60 kg and

An initial BMI corresponding to 30 kg/m² for adults (obese) by international cut-offs

• Typically taken three times daily

• Comes in 120 mg capsules

• Typically taken as an injection once daily

• Comes in single-patient-use pens that deliver 0.6 mg, 1.2 mg, 1.8 mg, 2.4 mg, or 3 mg per injection

Most common treatment emergent adverse reactions (≥5% and at least twice that of placebo) include:

• Oily spotting

• Flatus with discharge

• Fecal urgency

• Fatty/Oily stool

• Oily evacuation

• Increased defecation

• Fecal incontinence

Most common adverse reactions, reported in greater than or equal to 5% are:

• Nausea

• Diarrhea

• Constipation

• Vomiting

• Injection site reactions

• Headache

• Low blood sugar

• Indigestion

• Fatigue

• Dizziness

• Abdominal pain

• Increased lipase

• Upper abdominal pain

• Fever

• Inflammation of the digestive system

• Pregnancy

• Chronic malabsorption syndrome

• Cholestasis

• Known hypersensitivity to Xenical or to any component of this product

• Drug interactions: Cyclosporine, fat-soluble vitamin supplements and analogues, levothyroxine, warfarin, amiodarone, antiepileptic drugs, antiretroviral drugs

• Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2

• Hypersensitivity to liraglutide or any excipients in Saxenda

• Pregnancy

• Drug interactions: Saxenda delays gastric emptying. May impact absorption of concomitantly administered oral medications

• Xenical has drug interactions and can decrease vitamin absorption

• Take a multivitamin supplement that contains fat-soluble vitamins to ensure adequate nutrition

• Rare cases of severe liver injury with hepatocellular necrosis or acute hepatic failure have been reported

• Patients may develop oxalate nephrolithiasis and oxalate nephropathy following treatment with Xenical

• Substantial weight loss can increase the risk of cholelithiasis

• Exclude organic causes of obesity (e.g., hypothyroidism) before prescribing Xenical

• Gastrointestinal events may increase when Xenical is taken with a diet high in fat (>30% total daily calories from fat)

• Breastfeeding: Caution should be exercised when administered to a nursing woman

• Thyroid C-cell tumors

• Acute pancreatitis

• Acute gallbladder disease

• Low blood sugar: Can occur in adults when Saxenda is used with an insulin secretagogue (e.g., a sulfonylurea) or insulin

• Heart rate increase

• Renal impairment

• Hypersensitivity reactions

• Suicidal behavior and ideation

WARNING: RISK OF THYROID C-CELL TUMORS

Liraglutide causes thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. It is unknown whether Saxenda causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the human relevance of liraglutide-induced rodent thyroid C-cell tumors has not been determined.

Saxenda is contraindicated in patients with a personal or family history of MTC or in patients with multiple endocrine neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk of MTC and the symptoms of thyroid tumors.

*This information is from the label for brand name Xenical^®. See the Full Prescribing Information for more complete information. Orlistat, the active ingredient in Xenical, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient orlistat.

*This information is from the label for brand name Saxenda^®. See the Full Prescribing Information for more complete information. Liraglutide, the active ingredient in Saxenda, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient liraglutide.