The Independent Pharmacy

Orlistat vs. Saxenda - Which Option Is Best For You

Daniel Hurley
Daniel HurleyMPharm IPPharmacist Independent Prescriber

Reviewed on 11 Oct 2023

The journey towards a healthier weight can be a personal and sometimes challenging adventure. With so many solutions out there promising fast results, it can be hard to know where to start. If you're looking into weight loss medications, two options likely on your radar are Orlistat and Saxenda. But how do you navigate through the choices to find what might work best for you?

Both Orlistat and Saxenda have their benefits and potential challenges. To make sure that you can make an informed choice, it's important that you understand all the factors that could influence your decision.

Here's all you need to know about the differences between Orlistat and Saxenda.

Orlistat vs. Saxenda at a Glance

Features Orlistat Saxenda
Method of Administration Tablet Injection
Function Helps reduce fat absorption Helps control hunger
Early Weight Loss

Around 2-5 lbs in the first month About 5% of body weight in the first
12 weeks
Long-term Weight Loss

Up to 10% of body weight in 6 months Upwards of 15% of body weight in a
year or more
Prescription Requirement Higher dose requires prescription Prescription required
Common Experiences May experience digestive discomfort May experience nausea
Dietary Consideration Beneficial to follow a low-fat diet Advisable to follow a reduced calorie
Cost Consideration Generally more affordable, with a
non-prescription option
Typically higher cost, prescription

Orlistat vs. Saxenda - A Comparison

Understanding the Basics


Orlistat is an oral weight loss capsule taken by mouth. Its active ingredient helps by stopping some of the fat in your food from being absorbed into your body. When these enzymes that break down fat are blocked, about 25% of the fat from your food isn't absorbed by your body and instead is passed out naturally when you go to the bathroom. By gently reducing the absorption of dietary fats, Orlistat can help lower calorie intake, supporting you in your journey to lose excess weight over time, especially when combined with choices like exercise and nutritious eating habits. The undigested fat leaves the body naturally through the stool, which can cause oily spots, loose stools, or more frequent bowel movements.


Saxenda is a weight loss medicine given through a simple needle injection using a ready-to-use injection pen. It works similarly to a natural hormone called GLP-1 that is released from your intestines after eating. GLP-1 triggers signals in the brain that control hunger and the feeling of being full. Saxenda acts like a natural substance in your body that helps control your hunger, making you feel full and eat less. By curbing appetite and promoting faster feelings of satisfaction, Saxenda users tend to consume smaller portion sizes and feel less hungry between meals. Enjoying more mindful portions can lower the calories you take in, nurturing a path towards weight loss over time, especially when harmoniously combined with exercise and a balanced diet.

Results You Can Expect


For many individuals, Orlistat begins to reveal encouraging results within the first month, particularly when embraced alongside positive lifestyle changes like enjoying more physical activity and adopting a mindful, reduced-calorie meal plan. On average, people lose around 2-5 pounds in the first 4 weeks. With continued use over 6 months, Orlistat can help users lose up to 10% of their initial body weight, with many losing at least 5%. The amount of weight loss experienced can vary between individuals based on factors like their starting weight, how strictly they limit caloric intake, their metabolism, and how consistently they take orlistat with meals. Following the recommended low-fat diet can support your weight loss journey, but it's important to find a balanced diet that works for you.


With Saxenda, many individuals start noticing hopeful results within the first 3 months, especially when paired with nurturing lifestyle adjustments like healthier eating choices and increased movement. On average, people lose at least 5% of their weight during the first 12 weeks. With sustained use for a year or more, Saxenda users typically lose upwards of 15% of their initial body weight, though some lose significantly more. Weight loss can vary substantially based on dosage, how strictly users follow the recommended lifestyle changes, their body chemistry, and other medications or health conditions. Higher doses might lead to greater weight loss, yet they also may increase the risk of side effects. It's essential to find a dose that balances efficacy with well-being.

How to Use the Medication


Orlistat is taken by mouth as a 120mg capsule up to 3 times per day. It should be taken during or up to 1 hour after each meal containing fat. The dosage may be reduced if meals have very little fat. For best results, take orlistat consistently with meals and follow dosage recommendations.


Saxenda is injected under the skin once daily at any time of day, with or without meals. You start with a small dose of 0.6mg per day for the first week, then the dose is slowly increased each week by 0.6mg until you reach the regular dose of 3mg per day. Properly storing Saxenda and using sterile injection techniques are important.

How Long to Take the Medication


Orlistat is intended for long-term use alongside diet and exercise. It can be taken indefinitely as long as users remain on a reduced-calorie diet. Discontinuing orlistat may result in some weight gain as it no longer blocks dietary fat absorption. Most guidelines recommend taking Orlistat for at least 6 months for optimal weight loss results.


Saxenda is meant for long-term weight management. The recommended duration is at least 12 months to promote substantial weight loss that users can then maintain. After stopping Saxenda, some weight gain is common since the appetite-suppressing effects fade. Discuss discontinuation with your doctor to transition off safely after achieving weight loss targets.

Who Shouldn't Use the Medication


People with:

  • Conditions where your body has trouble absorbing nutrients
  • Medical procedures like organ transplants or gallbladder removal
  • Liver conditions like cholestasis

You should also avoid Orlistat if you're pregnant or breastfeeding.


People with:

  • A rare type of thyroid cancer (medullary thyroid carcinoma)
  • A rare genetic disorder affecting glands that produce hormones (Multiple Endocrine Neoplasia syndrome type 2)
  • Severe kidney or liver disease

Don't take Saxenda if you're pregnant or breastfeeding. The medication also isn't safe for those who have a history of pancreas issues or severe gut problems.

Do You Need a Prescription to Get the Treatment?


Getting orlistat does not always require a prescription. There is an over-the-counter version sold under the brand names Alli that you can purchase at pharmacies and retailers without a prescription. The over-the-counter orlistat capsules are a lower 60mg dose. For higher doses of 120mg per capsule, you will need a doctor's prescription. The prescription strength is more potent since you take 2 capsules up to 3 times per day with high-fat meals. Both prescription and OTC orlistat function the same way to block fat absorption.


Saxenda is a prescription-only injection medication. It is not available over the counter. To start using Saxenda, you will need to book an appointment with a doctor or weight loss clinic. They will review your medical history and BMI to determine if Saxenda is appropriate for your situation. The doctor will also explain how to properly use the pen injector. You will get training on injecting your dosage and storing Saxenda properly. The medication can only be obtained with a valid prescription and doctor supervision due to potential side effects.

Side Effects


Orlistat can cause several digestive side effects as it prevents your body from absorbing dietary fat. Some of the commonly reported adverse effects are:

  • Abdominal cramping
  • Gas
  • Leaking oily stool
  • Having to go to the bathroom more urgently or frequently

These digestive changes might be more noticeable with high-fat meals but often lessen over time as your body adjusts. More severe risks of orlistat involve:

  • Potential liver injury
  • Kidney stones
  • Gallstones
  • Intense stomach pain

Since Orlistat blocks fat digestion, it can also affect your body's ability to take in certain vitamins (A, D, E and K) that need fat to be absorbed. This may require taking supplements to prevent vitamin deficiencies.


The most common side effects when using Saxenda are stomach and digestion problems like:

  • Nausea
  • Diarrhoea
  • Constipation
  • Vomiting
  • Indigestion
  • Loss of appetite

Saxenda use can also lead to:

  • Headaches
  • Dizziness
  • Fatigue
  • Low blood sugar

Saxenda works by mimicking the appetite hormone GLP-1, so regulating digestion too much can cause problems. More serious risks include inflammation of the pancreas, gallbladder disease, kidney problems, and suicidal thoughts. The likelihood of side effects depends on the dosage - starting low and increasing gradually can help minimise risk.

Lifestyle Considerations


Orlistat works by preventing the absorption of dietary fats. To get the best results, you need to follow a reduced-calorie, low-fat meal plan while taking orlistat. Foods high in fat can worsen side effects like gas, abdominal cramping, and loose stools. Follow your doctor's recommended diet, limiting fat intake to less than 15g per meal. Taking a daily multivitamin can help ensure you get adequate nutrition while taking Orlistat. Inform your doctor of any other medications, as orlistat may interfere with prescription drugs' effectiveness.


Using Saxenda requires adopting lifestyle changes to get the most weight loss benefits. You will need to follow a low-calorie meal plan, exercise more, and drink plenty of fluids to avoid side effects like dehydration, constipation and low blood sugar. Avoid drinking alcohol while taking Saxenda, as it can intensify side effects. Check with your pharmacist about any medication interactions, as Saxenda impacts digestion. Use caution engaging in high-impact exercise or operating heavy machinery until you know how Saxenda affects you.

Safety Tips


To use Orlistat safely:

  • Take it exactly as prescribed with meals and stick to recommended dosages.
  • Consider lowering fat intake even more than directed to manage digestive side effects.
  • See your doctor regularly while taking orlistat, especially if experiencing severe abdominal pain, rectal bleeding, or other concerning symptoms.
  • Orlistat may make it harder to absorb certain medications, so take other drugs at least 2 hours before or after taking orlistat.
  • Report any worrisome side effects. Stop taking Orlistat and contact your doctor if you develop liver problems.


To use Saxenda safely, make sure that you

  • Follow dosing guidelines carefully and incrementally increase the dosage.
  • Only use the pen injector as trained by your healthcare provider to avoid infection or injury.
  • Monitor blood sugar levels closely and have snacks on hand in case you develop low blood sugar.
  • Stay well hydrated while using Saxenda.
  • Seek medical attention for symptoms like pancreas issues such as severe stomach pain.
  • Discontinue Saxenda if you become pregnant.
  • Never share your Saxenda pen with anyone else.
  • Immediately seek help if you get any thoughts of self-harm or suicide.

Stopping the Medication


If you want to stop taking Orlistat, talk to your doctor about safely discontinuing it. It's recommended to continue following a low-fat, reduced-calorie diet and exercising even after discontinuing orlistat to maintain weight loss. It's natural to experience some weight fluctuation after stopping Orlistat, as dietary fat will be absorbed again, but remember, your journey towards health is a process, and your healthcare provider is there to support you. Work with your doctor on a transition plan to prevent regaining too much weight. It's important to consult with your healthcare provider before making any decisions to stop taking Orlistat.


If you decide to stop using Saxenda, it's important to work closely with your doctor to safely decrease the dosage over several weeks. This helps avoid sudden return of appetite and weight gain. You will likely need to continue your lifestyle changes of a low-calorie diet and regular exercise to prevent regaining weight. Saxenda doses are meant to be tapered under medical supervision. Monitor for returning hunger cues or gastrointestinal issues when discontinuing Saxenda. Discuss long-term weight maintenance plans with your doctor for life after Saxenda treatment.

What Research Says


Clinical studies on orlistat show it can be moderately effective for weight loss when combined with lifestyle changes. In one study, 20% of people taking orlistat lost more than 10% of their initial weight compared to 8% of those taking a placebo after 12 months. Research found orlistat users lost around 2.5kg (5.5 lbs) more than non-users after 1 year. Orlistat's effectiveness seems directly tied to adherence to a low-fat diet. There is minimal evidence of serious long-term side effects with proper usage. However, some studies suggest orlistat may lead to severe liver damage in rare cases.


Research trials demonstrate that Saxenda can produce significant weight loss, especially for obese patients. In one 56-week study, Saxenda users lost an average of 6 kg more than those taking a placebo (a treatment with no active drug). About 62% of patients taking Saxenda lost at least 5% of body weight. However, studies note common side effects like nausea, vomiting, diarrhoea, and constipation. There is also some evidence of increased risk for severe pancreas inflammation and gallbladder issues. However, Saxenda shows promise for sustained weight loss for obese patients when combined with lifestyle changes.

Orlistat vs. Saxenda: Choosing the Right Option

Orlistat may be a better choice for people who want a little help sticking to a low-fat diet to lose a small or moderate amount of weight. It also works well if you prefer taking a weight loss capsule instead of getting injections. Since there is an over-the-counter version, Orlistat may appeal if you want a non-prescription option.

Saxenda may be preferable for those who need to lose a large amount of weight or have struggled to see results with just diet and exercise. It is a good option if you are considered obese with a high BMI. Because Saxenda uses injections, it works well if you are comfortable with shots and can closely monitor for potential side effects.

Talk to your doctor to review your health history and weight goals to determine if Orlistat or Saxenda is the better fit for your needs. Making lifestyle changes like improving your nutrition and increasing physical activity continues to be important, along with these medications, for long-term success.


Is Saxenda more effective than Orlistat?

Overall, studies show Saxenda generally produces greater weight loss than Orlistat. In clinical trials, people taking Saxenda lost over 6% more of their body weight on average compared to those taking Orlistat after 6 months. However, Saxenda is injected daily while Orlistat is an oral capsule, and Saxenda has more potential side effects. So, effectiveness also depends on the user's preferences and how well they tolerate each medication.

What is better than Saxenda for weight loss?

Some alternatives to Saxenda include phentermine, Mysimba, Wegovy, and bariatric surgery options like gastric bypass. These other treatments often lead to more dramatic or faster weight reduction, but not necessarily with fewer side effects. Discuss all your weight loss options with your healthcare provider.

What is the best alternative to Saxenda?

Some top alternatives to Saxenda for weight management include Contrave, phentermine, liraglutide, and Wegovy. These other prescription medications and injections can also help suppress appetite, leading to reduced calorie intake and weight loss for obese patients. Discuss the pros and cons of each option with your doctor.

Does Saxenda speed up weight loss?

Yes, Saxenda can speed up weight loss by helping control your hunger. By mimicking the hormone GLP-1, Saxenda promotes feelings of fullness and satisfaction. This results in eating smaller portions and less frequent meals. Cutting daily calorie intake speeds up weight loss results when combined with lifestyle changes.


Weight Loss: Diet, Exercise, or Orlistat? (

Saxenda (liraglutide [rDNA origin] injection) | CenterWatch

Evaluation of efficacy and safety of orlistat in obese patients - PMC (

Liraglutide for weight management: a critical review of the evidence - PMC (

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