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a multivitamin supplement is recommended, taken at bedtime or at least 2 hours before or after an orlistat dose Orlistat should be skipped if a meal is fat-free or a meal is missed Important interactions with orlistat include: Ciclosporin : avoid concomitant use (reduced ciclosporin absorption) Warfarin and other anticoagulants : monitor INR closely, as orlistat may affect vitamin K absorption Levothyroxine : separate doses by at least 4 hours and monitor thyroid function Antiepileptics (e.g., valproate, lamotrigine) and some antiretrovirals : reduced absorption possible