The primary side effects of the drug are gastrointestinal-related, and include steatorrhea (oily, loose stools with excessive flatus due to unabsorbed fats reaching the large intestine), fecal incontinence and frequent or urgent bowel movements. To minimize these effects, foods with high fat content should be avoided; the manufacturer advises consumers to follow a low-fat, reduced-calorie diet. Oily stools and flatulence can be controlled by reducing the dietary fat content to somewhere in the region of 15 grams per meal. The manual for Alli makes it clear that<unk>  treatment involves aversion therapy, encouraging the user to associate eating fat with unpleasant treatment effects. Side effects are most severe when beginning therapy and may decrease in frequency with time; It has also been suggested that the decrease in side effects over time may be associated with long-term compliance with a low-fat diet. On 26 May 2010, the U.S. Food and Drug Administration (FDA) approved a revised label for Xenical to include new safety information about cases of severe liver injury that have been reported rarely with the use of this medication. An analysis of over 900<unk>  users in Ontario showed that their rate of acute kidney injury was more than triple that of non-users. The putative mechanism for this effect is postulated to be excessive oxalate absorption from the gut and its subsequent deposition in the kidney, with excessive oxalate absorption being a known consequence of fat malabsorption. An April 2013 study published in the British Medical Journal looked at 94,695 patients receiving<unk>  in the UK between 1999 and 2011. This study showed no evidence of an increased risk of liver injury during treatment. They concluded: Long-term Despite a higher incidence of breast cancer amongst those taking<unk>  in early, pooled clinical trial data—the analysis of which delayed FDA review of<unk> —a two-year study published in 1999 found similar rates between<unk>  and placebo (0.54% versus 0.51%), and evidence that tumors predated treatment in 3 of the 4 participants who had them. There is evidence from an in vitro study to suggest that the introduction of specific varied preparations containing<unk> , namely the concurrent administration of<unk>  and the monoclonal antibody trastuzumab, can induce cell death in breast cancer cells and block their growth. Fecal fat excretion promotes colon carcinogenesis. In 2006 the results of 30-day study were published indicating that<unk>  at a dosage of 200 mg/kg chow administered to rats consuming a high-fat chow and receiving two 25 mg/kg doses of the potent carcinogen 1,2-dimethylhydrazine produced significantly higher numbers of aberrant crypt foci (ACF) colon lesions than did the carcinogen plus high-fat chow without<unk> . ACF lesions are believed to be one of the earliest precursors of colon cancer. Precautions Absorption of fat-soluble vitamins and other fat-soluble nutrients is inhibited by the use of<unk> . A multivitamin tablet containing vitamins A, D, E, K, and beta-carotene should be taken once a day, at bedtime, when using<unk> . Interactions<unk>  may reduce plasma levels of ciclosporin (also known as "cyclosporin" or "cyclosporine", trade names Sandimmune, Gengraf, Neoral, etc.), an immunosuppressive drug frequently used to prevent transplant rejection; the two drugs should therefore not be administered concomitantly.<unk>  can also impair absorption of the antiarrhythmic amiodarone. The MHRA has recently suggested that<unk>  could theoretically reduce the absorption of antiretroviral HIV medications.
Orlistat
Ketotifen
Atorvastatin
Tolbutamide
Clofibrate
Cobicistat
Udenafil
Migalastat