There is a multitude of weight loss medications on the market, which can make selecting a pharmacologic therapy confusing. Two weight loss drugs include Orlistat and Saxenda, which are both shown to be safe and effective in chronic weight management. But which one should you choose? To help you and your provider make this decision, this article will review key similarities and differences between the two medications.

A Brief Overview: Orlistat versus Saxenda

What is Orlistat?

Orlistat is a medication indicated for weight loss. It works by inhibiting the absorption of fats from your diet. To do so, it blocks lipase activity. Lipases are digestive enzymes that function by breaking down fat molecules. In preventing fat digestion, the body excretes this undigested fat through your bowel movements, helping you to lose weight.

Orlistat should be used together with a low-calorie diet and exercise regimen for maximal weight loss results. You can purchase Orlistat both over the counter (OTC) and via a prescription.

What is Saxenda?

Saxenda contains the active ingredient liraglutide, which is considered a glucagon-like peptide-1 (GLP-1) agonist. As a GLP-1 agonist, it mimics naturally occurring GLP-1 found in our body. GLP-1 is a hormone implicated in the regulation of our blood sugar and appetite. Likewise, liraglutide is approved under the brand name Victoza to manage blood sugar levels for individuals with type 2 diabetes mellitus.

Saxenda also elicits effects on the digestive tract, helping to slow down the rate at which food contents move through your body. In doing so, you end up feeling fuller for longer, preventing you from consuming more calories and helping you to lose weight in the process. Thus, liraglutide is approved by the Food and Drug Administration (FDA) for chronic weight management for adults who are either:

  • Obese (a body mass index [BMI] of 30 kg/m2 or more)
  • Overweight (a BMI of 27 kg/m2 or more with at least one weight-associated condition like type 2 diabetes, hypertension, or dyslipidemia)

Like Orlistat, Saxenda should always be used in conjunction with a healthy diet and regular exercise.

How are Orlistat and Saxenda taken?


Orlistat is provided in the form of capsules and is taken by mouth. Typically, Orlistat is administered as a 120 mg dose three times daily with each main meal.

Recall that Orlistat works specifically on dietary fat. Thus, it should only be taken with meals containing fat. It can be taken during the meal or up to one hour after finishing the meal to exert its full effects. If you miss a meal or do not have a meal that contains fat, you should not take Orlistat.


Saxenda is provided as a subcutaneous injection, meaning it is given as an injection under the skin. Typically, it is administered using a pre-filled pen device containing the medication once daily. The recommended starting dose of Saxenda is 0.6 mg daily for one week. From there, the dose of Saxenda can be increased at weekly intervals to minimize the likelihood of gastrointestinal (GI) side effects. The target dose of Saxenda is 3 mg once daily.

Saxenda can be administered at any time of day with or without meals and should be injected into the thigh, abdomen, or upper arm. Patients should rotate injection sites.

How well do Orlistat and Saxenda work for weight loss?

The efficacy of Orlistat and Saxenda in the context of weight loss will differ from individual to individual. Factors such as diet, exercise, lifestyle habits, and underlying health conditions can all influence the efficacy of the medications. Below we outline data from studies conducted on both medications.


Overall, Orlistat is moderately effective in inducing weight loss when used together with physical activity and a low-calorie diet. Typically, people on Orlistat can expect to lose around five to ten percent of their baseline bodyweight throughout six to 12 months.

Digging a bit deeper, pooled data from five different clinical studies indicated that one year of treatment with Orlistat caused a weight loss of 13.4 pounds versus only 5.8 pounds when treated with a placebo. This amounts to an overall three percent difference in lost weight in patients on Orlistat versus placebo.


Saxenda shows slightly more promising results when it comes to evaluating weight loss effects versus Orlistat. Overall, studies show that Saxenda, in conjunction with diet and exercise, can induce greater weight loss versus those on placebo. Additionally, other studies have evaluated liraglutide versus orlistat. In this study, liraglutide caused greater weight loss than orlistat, with liraglutide providing an average loss of 7.7 kg versus only 3.3 kg with orlistat. Additionally, more people lost at least five percent of their body weight with liraglutide (64.7%) compared with Orlistat (27.4%).

What are the side effects of Orlistat and Saxenda?

Though both Orlistat and Saxenda can be used for weight loss, they have different mechanisms of action. Thus, they will vary concerning what sorts of side effects one may experience.


With Orlistat, GI-related effects are common, usually related to its action on fat absorption. Likewise, it can cause effects like fatty or oily stools, discharge from the rectum, gas with discharge, increased frequency of bowel movements, and stomach pain or discomfort.

Orlistat can also cause other types of side effects like headache, nausea, vomiting, diarrhea, rectal pain, and bowel movement urgency.


Because Saxenda also works on the digestive tract, GI effects are common. These can include nausea, vomiting, constipation, diarrhea, and stomach pain. Other effects include headache, fatigue, dizziness, low blood sugar, increased heart rate, and gallbladder issues.

What other differences are there between Orlistat and Saxenda?

There are several other factors to consider when comparing Orlistat and Saxenda, including their warnings, precautions, contraindications, and use in special populations. Let’s review.


Orlistat is contraindicated, meaning it should not be used, in individuals that are pregnant, have cholestasis (a disorder affecting the bile), or have chronic malabsorption syndrome.

Additionally, the following warnings and precautions should be taken:

  • Concomitant administration with other drugs and vitamins. Because Orlistat affects fat absorption, it can also impact the absorption of fat-soluble vitamins and medications.
  • Liver injury. Orlistat has been associated with severe liver injury in rare cases, manifesting as symptoms like skin and eye yellowing, stomach pain, itching, and dark urine.
  • Kidney stones. Hydration is essential to preventing kidney stones. Symptoms of kidney stones include stomach or back pain, blood in the urine, or painful urination.


Saxenda is contraindicated in people with a personal or family history of Multiple Endocrine Neoplasia syndrome type 2 or medullary thyroid carcinoma. It should also not be used in pregnancy.

Additionally, the following warnings and precautions should be considered:

  • Low blood sugar. Recall that liraglutide is also approved for the treatment of diabetes due to its blood sugar-lowering effects. Thus, it has the potential to cause low blood sugar levels, which can be dangerous if severe enough.
  • Pancreatitis. Symptoms of pancreatitis include serious stomach pain radiating to the back, which necessitates medical attention.
  • Increased heart rate. Saxenda should be used with caution in those with a history of arrhythmias or heart disease.
  • Kidney impairment. Saxenda has been associated with potential renal dysfunction accompanied by symptoms of nausea, vomiting, dehydration, and diarrhea.
  • Gallbladder issues. There is a risk of gallbladder problems with Saxenda.
  • Suicidal behavior. Monitor yourself for signs of depression or suicidal thoughts and contact a healthcare provider immediately if you experience this.

Comparison summary

Let’s summarize the similarities and differences between Orlistat and Saxenda using the table below:

Mechanism of actionInhibits gastric and pancreatic lipases, preventing the breakdown and absorption of fatsMimics the hormone GLP-1, lowering blood sugar and delaying gastric emptying
IndicationWeight loss and maintenance together with a low-calorie dietChronic weight management adjunct to diet and exercise in obese (BMI of 30 kg/m2 or more) or overweight (BMI of 27 kg/m2 or more) individuals with one weight-associated condition
Dosage and administrationCapsule taken orally three times daily during or after meals that have fatOnce daily subcutaneous injection
EfficacyModest effects on weightMore effective in weight loss versus Orlistat
Side effectsGI: Fatty or oily stools, discharge from the rectum, gas with discharge, increased frequency of bowel movements, stomach pain or discomfort

Other: Headache, nausea, vomiting, diarrhea, rectal pain, bowel movement urgency

GI: Nausea, vomiting, constipation, diarrhea, stomach pain

Other: Headache, fatigue, dizziness, low blood sugar, increased heart rate, gallbladder issues

ContraindicationsPregnancy, cholestasis, chronic malabsorption syndromePregnancy, personal or family history of Multiple Endocrine Neoplasia syndrome type 2 or medullary thyroid carcinoma
Warnings and precautionsConcomitant administration with other drugs and vitamins, liver injury, kidney stonesLow blood sugar, pancreatitis, gallbladder issues, kidney injury, pancreatitis, suicidal thoughts

Which medication should I choose?

While both Orlistat and Saxenda are effective in weight loss, Saxenda tends to be more effective in chronic weight management. However, the two medications have other differences in their mechanism, side effects, contraindications, warnings, and precautions. Thus, you may be better suited for one medication over the other.

Selecting a medication for your weight loss journey will require careful consideration and discussion with your healthcare provider. They will be able to pick a medication that is both safe and effective for you specifically.

Cost Comparison: Saxenda vs. Orlistat

When considering weight loss medications like Saxenda and Orlistat (marketed as Xenical), the cost is a significant factor for many patients. Here’s a breakdown of the costs associated with each medication:

  • Xenical (Orlistat 120mg/80 capsules):
    • In the US, the cost is approximately $791.
    • Through, the cost is significantly lower at $199, or you can opt for a bulk purchase of 252 capsules for $570.
  • Saxenda 5 pens:
    • The price in the US exceeds $1000 for 5 pens.
    • offers a more affordable price of $515 for 5 pens, with an option to buy 15 Saxenda pens for $1500. stands out as a cost-effective solution for purchasing these medications. The platform offers express shipping across the US within 3-5 business days. Importantly, cold-chain medications like Saxenda are shipped in temperature-controlled packaging to ensure the medication’s integrity upon delivery. Patients have the convenience of searching over 2,000 medications via the website’s search function, with bulk savings available on select medications, making it an attractive option for those looking to manage their weight loss journey more affordably.

Key Takeaways

  • Orlistat and Saxenda are both FDA-approved for weight loss but work through different mechanisms.
  • Orlistat blocks fat absorption, while Saxenda mimics a hormone that regulates appetite.
  • Side effects vary: Orlistat mainly affects the GI tract, Saxenda can also impact blood sugar and heart rate.
  • Both require a healthy diet and exercise for best results, but Saxenda may lead to greater weight loss.
  • Choice between Orlistat and Saxenda depends on individual health profiles and preferences.