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Orlistat marketed as a prescription under the trade name Xenical and as an over-the-counter drug as Alli also known as tetrahydrolipstatin, is a drug designed to treat obesity. Its primary function is preventing the absorption of fats from the human diet, thereby reducing caloric intake. 'It is intended for use in conjunction with a physician-supervised reduced-calorie diet'.

Orlistat is the saturated derivative of lipstatin, 'a potent natural inhibitor of pancreatic lipases isolated from the bacterium Streptomyces toxytricini'.  So it is based on bacteria.

Orlistat works by inhibiting gastric and pancreatic lipases, the enzymes that break down triglycerides in the intestine. When lipase activity is blocked, triglycerides from the diet are not hydrolyzed into absorbable free fatty acids, and are excreted undigested instead. The primary route of elimination is through the faeces.

Orlistat is 'notorious for its gastrointestinal side effects' , which can include steatorrhea (oily, loose stools). A 2006 animal study linked orlistat with aberrant crypt foci (ACF), lesions found in the colon which are believed to be one of the earliest precursors of colon cancer. One of the other principle problems with the drug is mineral and vitamin deficiency. Absorption of fat-soluble vitamins and other fat-soluble nutrients is inhibited by the use of orlistat. Thus vitamins A, D, E, K, and beta-carotene cannot be absorbed from ordinary food.

“Orlistat is contraindicated in:

• Malabsorption

• Hypersensitivity to orlistat

• Reduced gallbladder function (e.g. after cholecystectomy)

• Pregnancy and breastfeeding

• Use caution with: obstructed bile duct, impaired liver function, and pancreatic disease

On June 4, 2009, the U.S. Food and Drug Administration released its quarterly list of drugs that are under investigation for potential safety issues or new safety information. Orlistat was included in the list as having a "Potential Signal of Serious Risk" of liver toxicity, meaning that a potential risk of liver toxicity was identified based on reports to the FDA Adverse Event Reporting System between October and December 2008. On August 24, the FDA reported that it would investigate 30 cases of liver damage reported between 1999 and October 2008 in patients taking orlistat, including six cases of liver failure.

Thus as we can see the causes of the hallucinations from this drug could be many.

On Jun, 16, 2015: 10,757 people reported to have side effects when taking Xenical. Among them, 34 people (0.32%) have Hallucination.

On Jun, 6, 2015: 10,757 people reported to have side effects when taking Xenical. Among them, 64 people (0.59%) have Death.

On Jun, 12, 2015: 15,869 people reported to have side effects when taking Alli. Among them, 8 people (0.05%) have Death.