II. Indications
- Hyperlipidemia adjunctive management (rare use)
- Cholestasis associated Pruritus (not FDA approved)
- Diarrhea Dominant Irritable Bowel Syndrome (not FDA approved)
III. Contraindications
- See Bile Acid Sequestrant
- Serum Triglycerides >400 mg/dl
IV. Mechanism
- See Bile Acid Sequestrant
- Binds bile salts
- Results in insoluble complexes that are excreted in the stool
V. Medications
- Questran contains 4 grams Cholestyramine per 9 grams powder packet
- Questran Light contains 4 grams Cholestyramine per 5 grams powder packet
- Prevalite contains 4 grams Cholestyramine per 5.5 grams powder packet
VI. Dosing: Adult
-
Hyperlipidemia
- Start 4 grams orally twice daily before meals
- Target 12 to 24 grams orally per day divided 2 to 4 times daily
- Maximum: 24 grams per day
-
Cholestasis associated Pruritus (not FDA approved)
- Start 4 grams orally twice daily before meals
- Target 4 to 8 grams orally 2 to 3 times daily
-
Diarrhea Dominant Irritable Bowel Syndrome (not FDA approved)
- Start 4 grams orally twice daily before meals
- Target 4 to 8 grams orally once to twice daily
VII. Dosing: Child
- Not FDA approved in children
- Start 240 mg/kg/day orally up to 8 to 16 g/day divided three times daily before meals
- Maximum: 16 g/day
VIII. Drug Interactions
- See Bile Acid Sequestrant
- Take other medications at least 2 hours before or 4 to 6 hours after (esp. Warfarin, Digoxin and Amiodarone)
- Take with 2 to 6 ounces water, milk or fruit juice (e.g. orange juice) before meals
- Do not mix with carbonated beverages
IX. Efficacy
X. Adverse Effects
XI. Safety
- Pregnancy Category C
- Considered Safe in Lactation
XII. Metabolism
- Not absorbed
XIII. Resources
- Cholestyramine (DailyMed)
XIV. References
- (2022) Non-StatinLipid Lowering Agents, Presc Lett, Resource #380202
- (2022) Med Lett Drugs Ther 64(1659): 145-52
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- (2000) Med Lett Drugs Ther 42:102-4 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| 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 |
| prevalite (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| PREVALITE PACKET | Generic | $0.98 each |
| PREVALITE POWDER | Generic | $0.22 per gram |