Bile Binding Resin

Aka: Bile Binding Resin, Bile Acid-Binding Resin, Cholestyramine, Colestipol, Colesevelam, Welchol

II. Effects

  1. LDL Cholesterol decreased (15-30%)
  2. HDL Cholesterol increased (3-5%)
  3. Triglycerides increased

III. Efficacy

  1. Lowers cardiovascular mortality by 30%
  2. Reduces Myocardial Infarction risk
    1. Eggertsen (1984) JAMA 251(3):349-50 [PubMed]

IV. Adverse effects

  1. Gastrointestinal
    1. Effects
      1. Constipation
      2. Flatulence
      3. Dyspepsia
    2. Reduce Adverse GI side effects
      1. Use moderate doses: 8-10 g per day
      2. Increase Dietary Fiber or supplement with Psyllium
      3. Colesevelam may have less GI intolerance
  2. Interferes with fat soluble Vitamin Absorption
    1. Take Vitamin 2 hours before or 4 hours after Resin
    2. Colesevelam does not affect Vitamin Absorption

V. Contraindications

  1. Absolute
    1. Serum Triglycerides >500 mg/dl
    2. Bowel Obstruction
    3. Complete biliary obstruction
  2. Relative
    1. Triglycerides >200 mg/dl

VI. Preparations

  1. Cholestyramine (Questran)
    1. Dose: 4g (9g packet) bid ($54) MAX: 24 g/day
  2. Colestipol (Colestid)
    1. Dose: 5g bid ($47) MAX: 30 g/day
  3. Colesevelam (Welchol)
    1. Most expensive agent of the class
    2. May be preferred agent of class
      1. Lower adverse effect profile (see above)
      2. May be taken concurrently with Statin
      3. Lowers A1C by 0.5%
        1. Zieve (2007) Clin Ther 29(1):74-83 [PubMed]
    3. Dosing
      1. One Dose: Six 325 mg tablets daily with food, liquid
      2. Two Doses: Three 325 mg tablets bid with food, liquid

VII. Drug Interactions

  1. Take at least 2 hours apart from Warfarin, Digoxin and Amiodarone
  2. Take with water or orange juice before meals

VIII. References

  1. (2000) Med Lett Drugs Ther 42:102-4 [PubMed]

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Related Studies

Cost: Medications

cholestyramine (on 1/19/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
CHOLESTYRAMINE LIGHT PACKET Generic $0.98 each
CHOLESTYRAMINE LIGHT POWDER Generic $0.24 per gram
CHOLESTYRAMINE PACKET Generic $1.06 each
CHOLESTYRAMINE POWDER Generic $0.14 per gram
colestipol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
COLESTIPOL HCL 1 GM TABLET Generic $0.79 each
COLESTIPOL HCL GRANULES PACKET Generic $2.79 each
colesevelam (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
COLESEVELAM 625 MG TABLET Generic $0.38 each
COLESEVELAM HCL 3.75 G PACKET Generic $4.33 each
welchol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
WELCHOL 625 MG TABLET Generic $0.38 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.