Cholestyramine

Brand names

• Novo-Cholamine
• PMS-Cholestyramine
• Prevalite
• Questran
• Questran Light

Usage

To reduce cholesterol in people with high blood levels of low-density lipoprotein (LDL), as part of a comprehensive treatment program that includes exercise and special diet. The medicament is also used to relieve itching caused by high levels of bile acids in the blood, a problem associated with blockage of the bile ducts. Cholestyramine may also be used to prevent some types of diarrhea.

How it works

Cholestyramine binds with bile acids in the intestine, forming an insoluble complex that is excreted in the feces. This process reduces the bile acids in the blood. In response to the lower levels of bile acids, the liver converts more cholesterol to bile acids. Consequently, the amount of cholesterol in liver cells declines, and the liver makes more LDL receptors. The resulting increased removal of LDL from the blood lowers LDL cholesterol.

Side effects

Serious

Severe abdominal pain (a very rare reaction, indicating intestinal obstruction). Seek medical assistance immediately.

Common

Constipation, heartburn, bloating, belching, abdominal discomfort, irritation of the anal area.

Less common

Hives, rash, gas, diarrhea, nausea, vomiting, gallstones, loss of appetite.

Possible interactions

Other medicaments:

Cholestyramine may decrease the effects of:

• acetaminophen; take 2 hours before cholestyramine.
• benzafibrate (various), take 2 hours before cholestyramine.
• cephalexin (Keflex), take 2 hours before cholestyramine.
• cerivastatin (Baycol), take 2 hours before cholestyramine.
• chlorothiazide (Diuril, others), take 2 hours before cholestyramine.
• diclofenac (various), take 2 hours before cholestyramine.
• digitoxin and digoxin (Lanoxin), take 2 hours before cholestyramine.
• fluvastatin (Lescol), separate doses by four hours.
• furosemide (Lasix).
• iron; separate from cholestyramine doses by 4 hours.
• leflunomide (Arava), take 2 hours before cholestyramine.
• levothyroxine (Euthroid, others), take 2 hours before cholestyramine.
• methotrexate (Mexate); take 3 hours before cholestyramine.
• metronidazole (Flagyl).
• NSAIDs (some acidic ones, such as piroxicam and sulindac).
• oral antidiabetic medicaments.
• penicillin G (Pentids).
• phenobarbital; take 2 hours before cholestyramine.
• raloxifene (Evista), take 2 hours before cholestyramine.
• tetracycline (various), take 1 hour before or 4-6 hours after cholestyramine.
• thiazide diuretics; take 2 hours before cholestyramine.
• thyroxin; take 5 hours before cholestyramine.
• valproic acid (Depakene, others), take 2 hours before cholestyramine.
• warfarin; take 6 hours after cholestyramine.

Cholestyramine taken concurrently with:

• amiodarone (Cordarone) can result in lowered amiodarone blood levels and decreased effectiveness.
• entacapone (Comtan), may increase risk of adverse effects such as diarrhea and movement disorders.
• pravastatin (Pravachol) or other HMG-CoA reductase inhibitors may work well in further lowering cholesterol if pravastatin dose is taken 1 hour before or 4 hours after cholestyramine is taken.
• salicylates (aspirin, others) can result in lowered aspirin levels and decreased effectiveness. Separate doses by at least half an hour.

Foods:

Avoid foods that tend to constipate (cheeses, etc.). Follow your doctor's recommended diet.

Herbal medicines or minerals:

Some studies show garlic to reduce cholesterol. Since it probably works by a different mechanism than cholestyramine, the combination use may be reasonable if dosing is separated. Discuss this with your doctor. Soy milk may also offer some lowering of cholesterol. Current cholesterol therapy sets a goal for treatment, and these herbs may help reach that goal when combined with this prescription medicine.
Ask your doctor about the need for supplements of vitamins A, D, E and K, folic acid, niacin and calcium.

Beverages:

Avoid carbonated beverages.

Discontinuation:

The dose of any potentially toxic medicament taken concurrently must be reduced appropriately when this medicament is discontinued.

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