II. Effects
- LDL Cholesterol decreased (15-30%)
- HDL Cholesterol increased (3-5%)
- Triglycerides increased
III. Efficacy
- Lowers cardiovascular mortality by 30%
- Reduces Myocardial Infarction risk
IV. Adverse effects
- Gastrointestinal
- Effects
- Reduce Adverse GI side effects
- Use moderate doses: 8-10 g per day
- Increase Dietary Fiber or supplement with Psyllium
- Colesevelam may have less GI intolerance
- Interferes with fat soluble Vitamin Absorption
V. Contraindications
- Absolute
- Serum Triglycerides >500 mg/dl
- Bowel Obstruction
- Complete biliary obstruction
- Relative
- Triglycerides >200 mg/dl
VI. Preparations
- Cholestyramine (Questran)
- Dose: 4g (9g packet) bid ($54) MAX: 24 g/day
- Colestipol (Colestid)
- Dose: 5g bid ($47) MAX: 30 g/day
- Colesevelam (Welchol)
- Most expensive agent of the class
- May be preferred agent of class
- Lower adverse effect profile (see above)
- May be taken concurrently with Statin
- Lowers A1C by 0.5%
- Dosing
- One Dose: Six 325 mg tablets daily with food, liquid
- Two Doses: Three 325 mg tablets bid with food, liquid
VII. Drug Interactions
- Take at least 2 hours apart from Warfarin, Digoxin and Amiodarone
- Take with water or orange juice before meals
VIII. References
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Related Studies (from Trip Database) Open in New Window
| cholestyramine (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| CHOLESTYRAMINE LIGHT PACKET | Generic | $1.90 each |
| CHOLESTYRAMINE LIGHT POWDER | Generic | $0.23 per gram |
| CHOLESTYRAMINE PACKET | Generic | $1.66 each |
| CHOLESTYRAMINE POWDER | Generic | $0.21 per gram |
| colestipol (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| COLESTIPOL HCL 1 GM TABLET | Generic | $0.83 each |
| COLESTIPOL HCL GRANULES PACKET | Generic | $2.93 each |
| COLESTIPOL MICRONIZED 1 GM TAB | Generic | $0.83 each |
| welchol (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| WELCHOL 3.75G PACKET | $19.08 each | |
| WELCHOL 625 MG TABLET | $3.17 each | |
Ontology: Cholestyramine Resin (C0008402)
| Definition (MSH) | A strongly basic anion exchange resin whose main constituent is polystyrene trimethylbenzylammonium Cl(-) anion. |
| Definition (NCI) | An anion exchange resin with hypolipidemic activity. Cholestyramine resin adsorbs and combines with bile acids in the intestine to form an insoluble complex, which is then excreted in the feces, resulting in an increased oxidation of cholesterol to bile acids, a decrease in low density lipoprotein in the plasma, and a decrease in serum cholesterol levels. |
| Definition (CSP) | strongly basic anion exchange resin used to extract bile salts and cholesterol, to treat diarrhea and biliary obstruction, and as an antipruritic. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D002792 |
| SnomedCT | 72824008, 317391006, 319945002, 387408001 |
| English | Colestyramin, Colestyramine, Resin, Cholestyramine, Cholestyramine [diarr], Cholestyramine [lipid low], Cholestyramine [antidiarrheal use], Cholestyramine [antidiarrhoeal use], Cholestyramine [lipid lowering use], cholestyramine, cholestyramine (medication), Cholestyramine Resins, Cholestyramines, Cholestyramine Resin, Cholestyramine, Colestyramins, Resins, Cholestyramine, Colestyramines, CHOLESTYRAMINE, Cholestyramine Resin [Chemical/Ingredient], cholestyramine resin, colestyramine, Colestyramine [antidiarrheal use], Cholestyramine [lipid lowering use] (product), Cholestyramine [antidiarrheal use] (product), Colestyramine [lipid lowering use], Colestyramine [antidiarrhoeal use], Cholestyramine resin, Cholestyramine product, Cholestyramine (product), Cholestyramine (substance), Cholestyramine [antidiarrheal use] (substance), Cholestyramine [lipid lowering use] (substance), Colestyramine product |
| Finnish | Kolestyramiini |
| Russian | KHOLESTIRAMIN, KOLESTIRAMIN, ХОЛЕСТИРАМИНОВАЯ СМОЛА, ХОЛЕСТИРАМИН, KHOLESTIRAMINOVAIA SMOLA, MK-135, КОЛЕСТИРАМИН |
| Japanese | コレスチラミン樹脂, クエストラン, コレスチラミン |
| French | Colestyramine, Résine de cholestyramine, Cholestyramine |
| Italian | Colestiramina, Resina colestiramina |
| Portuguese | Colestiramina, Resina de Colestiramina, Resina Colestiramina |
| Spanish | Colestiramina, Resina de Colestiramina, colestiramina [uso como antidiarreico] (producto), colestiramina [uso como antidiarreico], colestiramina (como hipolipemiante), colestiramina (como hipolipemiante) (producto), colestiramina (producto), colestiramina (sustancia), colestiramina (uso como hipolipemiante) (producto), colestiramina (uso como hipolipemiante), colestiramina, resina de colestiramina |
| Croatian | KOLESTIRAMIN |
| Swedish | Kolestyraminresin |
| Czech | cholestyraminová pryskyřice, cholestyramin |
| Polish | Cholestyramina, Żywica cholestyraminowa |
| Norwegian | Kolestyramin |
| German | Cholestyramin-Harz, Cholestyramin, Colestyramin |
Ontology: Colestipol (C0009279)
| Definition (NCI) | A positively charged, non-digestible, triamine and epoxypropane copolymer anion-exchange resin that binds to bile acids in the intestine to form an insoluble complex, which is excreted in the feces. |
| Definition (MSH) | Highly crosslinked and insoluble basic anion exchange resin used as anticholesteremic. It may also may reduce triglyceride levels. |
| Definition (CSP) | highly crosslinked and insoluble basic anion exchange resin used as anticholesteremic, it may also may reduce triglyceride levels. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D003084 |
| SnomedCT | 372811005, 66971004 |
| English | Colestipol, colestipol, Colestipol [Chemical/Ingredient], COLESTIPOL, Colestipol (product), Colestipol (substance) |
| Swedish | Kolestipol |
| Czech | kolestipol |
| Finnish | Kolestipoli |
| Russian | KOLESTIPOL, КОЛЕСТИПОЛ |
| Japanese | コレスチポール |
| Polish | Kolestipol |
| Norwegian | Kolestipol |
| Spanish | colestipol (producto), colestipol (sustancia), colestipol, Colestipol |
| French | Colestipol |
| German | Colestipol |
| Italian | Colestipolo |
| Portuguese | Colestipol |
Ontology: colesevelam (C0541155)
| Definition (NCI) | A non-absorbed polymer that binds bile acids in the intestine, impedes their reabsorption and lowers serum lipids. In patients with type 2 diabetes mellitus, colesevelam also lowers blood glucose levels by an unknown mechanism. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C107058 |
| SnomedCT | 442510005, 441851004 |
| English | Colesevelam, Colesevelam (substance), Colesevelam (product), colesevelam [Chemical/Ingredient], colesevelam, Allylamine Polymer with 1-chloro-2,3-epoxypropane, (6-(allylamino)hexyl)trimethylammonium Chloride and N-allyldecylamine, COLESEVELAM |
| Spanish | colesevelam, colesevelam (sustancia), colesevelam (producto) |
Ontology: Welchol (C0939530)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C107058 |
| English | Welchol, welchol |
