Dieters snap up new drug alli despite nasty side effects

LOS ANGELES — Thursday morning, 12 boxes of alli, the first over-the-counter diet drug approved by the Food and Drug Administration (FDA), were placed on the top shelf of a Santa Monica Walgreens' diet section. Four hours later, all but one had been sold.

"I have never in my life experienced anything like this," store manager Roe Love, a pharmacist for 20 years, said as she eyed the empty space next to the last box of 90 capsules — a month's supply — selling for $59.99.

The fact that the product is kept with the rest of the diet drugs under locked glass on the shelf — to prevent theft — did not deter people from requesting it.

The only comparable phenomenon Love could think of was the frenzy over the antibiotic Cipro during the post-Sept. 11 anthrax scare. "You couldn't fill those prescriptions fast enough," she said.

The latest nonprescription diet pill was rolled out last week by manufacturer GlaxoSmithKline. The company's Web site, myalli.com, and literature offer the potential for a greater weight loss than dieting alone (if you do everything right) and a warning of extraordinarily unpleasant and embarrassing side effects (if you don't).

Women customers

Not all merchants have alli (pronounced "ally") in stock yet, but among those that do, the buyers have overwhelmingly been women.

"And they're not fat," Love said of the women she saw buying the drug at her store.

In Los Angeles, where thinness is the Holy Grail and people will do just about anything to get there — including risking some rather unfortunate intestinal distress — buyers did not flinch at possible side effects.

The drug is a lower-dose version of prescription Xenical, which was introduced several years ago. Although Xenical never was a blockbuster, GlaxoSmithKline expects alli to rake in at least $1.5 billion in annual sales, and the company is expected to spend $150 million on marketing the drug in its first year.

It works in the digestive system by blocking the absorption of about 25 percent of fat that is consumed. In a theoretical 3,000-calorie-a-day diet with about 100 grams of fat, the drug would eliminate about 225 calories.

Icky side effects

But it also can result in what the manufacturer describes as diarrhea, uncontrollable bowel movements and gas with an oily discharge. "It's probably a smart idea to wear dark pants, and bring a change of clothes with you to work," the drug's Web site says. The drug maker's literature and Web site say side effects can be minimized with a low-fat, reduced-calorie diet.

"We're skeptical about something like this going over the counter," said Dr. Rohini Ashok, a Kaiser Permanente-Santa Teresa, Calif., physician and a leader of the HMO's new doctor-supervised weight-loss program. "It's not an unsafe drug, but it's not benign. The side effects are pretty gross."

Ashok said many Kaiser Permanente patients who took the prescription version of alli generally didn't refill their first prescription because of the side effects.

"Will it work?"

But the women buying alli were unfazed. At a San Fernando Valley Walgreens that had sold 10 boxes — with one man among the buyers — no one was asking the pharmacist about side effects.

" 'Will it work?' That's the only question they're asking," said the store's pharmacy manager, who spoke on condition of anonymity.

At a prominent display in a Rite Aid in Santa Monica, prospective buyers clutched the big alli starter kit and shared war stories from the diet battleground.

"I've tried so many other things," said Monique Brown, a Santa Monica legal secretary who says she's been through Metabolife, CortiSlim and various other products, some of which made her jittery. She dreams of losing 30 pounds.

At least alli won't make her jittery, she said.

The materials that accompany alli and on the Web site emphasize that people should eat a low-fat, reduced-calorie diet. If dieters can stick to that discipline, they "can lose about 50 percent more weight than dieting alone," according to the drug brochure, which many stores displayed. They can also allay some of the side effects. And the manufacturer notes that awareness of possible side effects acts as a disincentive to overeat fatty foods.

Alli is intended for overweight people 18 and older, according to the manufacturer. However, the controls are unclear.

At some stores, it could be picked up off the shelf and taken to a cashier for purchase.

But at a Walgreens in the San Fernando Valley, the drug was being held behind the pharmacy counter, according to the pharmacy manager.

As sales were rung up, "the register prompts us to check for I.D. for a birth date," said the pharmacy manager, who added that she would not sell it to someone younger than 18.

Earlier this year, Dr. Adrienne Youdim, a weight-loss specialist at Cedars-Sinai Medical Center, said alli has a good safety record and has helped people lose an average of 10 to 16 pounds.

Not everyone, however, welcomes the product or the hype. New York-based nutritionist Oz Garcia, who treats clients on both coasts, said: "There is no real advantage to using alli unless you're doing what you're supposed to do: working out, eating a well-balanced diet, all the things you have to pay attention to."

Garcia noted that a fat-blocking drug does no good for those gulping down cookies and pasta and other carbohydrates.

"A lot of the weight gain that has occurred in the last decade is because people are already eating low-fat, but they're eating high carbs," Garcia said.

Material from the San Jose Mercury News is included in this report.