- ACRONYMS AND DEFINITIONS
- BAS - Bile acid sequestrants
- GI - GastroIntestinal
- PI - Package insert
Cholestyramine (Questran®)
Dosage forms
Questran® powder
- 4 grams of cholestyramine resin per 9 grams of powder
- 378 gram can (42 doses)
- 9 gram packet (carton of 60)
Cholestyramine powder
- 4 grams of cholestyramine resin per 8.78 grams of powder
- 368.76 gram can (42 doses)
- 8.78 gram packet (carton of 60)
Cholestyramine powder
- 4 grams of cholestyramine resin per 8.3 grams of powder
- 348.6 gram can (42 doses)
- 8.3 gram packet (carton of 60)
Dosing
High cholesterol / Pruritus
- Starting: 4 grams of cholestyramine resin 1 - 2 times daily
- Maintenance: 8 - 16 grams of cholestyramine resin a day given in 2 divided doses
- Max: 24 grams of cholestyramine resin per day
- Increase dose at intervals of 1 week
- May be administered in 1 - 6 doses per day
- Mix with 2 - 6 oz of water or beverage. May also be mixed with applesauce or crushed pineapple.
- Best to take with meals, but may be taken at other times
- Color of powder may vary from batch to batch
Kidney and liver disease
- No dose adjustment necessary
Generic / Price
- Can - YES/$
- Packets (#60) - YES/$-$$
Cholestyramine light | Questran Light® | Prevalite®
Dosage forms
Questran® Light powder
- 4 grams of cholestyramine resin per 5 grams of powder
- 210 gram can (42 doses)
- 5 gram packets (carton of 60)
Prevalite® powder
- 4 grams of cholestyramine resin per 5.5 grams of powder
- 231 gram can (42 doses)
- 5.5 gram packets (carton of 42 or 60)
Cholestyramine light powder
- 4 grams of cholestyramine resin per 4.8 grams of powder
- 201.6 gram can (42 doses)
- 4.8 gram packets (carton of 60)
Cholestyramine light powder
- 4 grams of cholestyramine resin per 5.7 grams of powder
- 239.4 gram can (42 doses)
- 4.8 gram packets (carton of 60)
Dosing
High cholesterol / Pruritus
- Starting: 4 grams of cholestyramine resin 1 - 2 times daily
- Maintenance: 8 - 16 grams of cholestyramine resin a day given in 2 divided doses
- Max: 24 grams of cholestyramine resin per day
- Increase dose at intervals of 1 week
- May be administered in 1 - 6 doses per day
- Mix with 2 - 6 oz of water or beverage. May also be mixed with applesauce or crushed pineapple.
- Best to take with meals, but may be taken at other times
- Color of powder may vary from batch to batch
Kidney and liver disease
- No dose adjustment necessary
Generic / Price
- Can - YES/$
- Packets (#60) - YES/$
Colesevelam tablet (Welchol™)
Dosage forms
Tablet
- 625 mg
Powder for oral suspension
- 3.75 gram packet
- Comes in carton of 30
Dosing
Type 2 diabetes and primary hyperlipidemia
- Tablets
- Dosing: 6 tablets once daily or 3 tablets twice a day
- Max: 6 tablets a day
- Take with a meal and liquid
- Powder
- Dosing: one packet (3.75 grams) once daily
- Max: one packet (3.75 grams) once daily
- Empty one packet into a glass or cup. Add 1 cup (8 ounces) of water, fruit juice, or diet soft drinks. Stir well and drink.
- Take with meals
Kidney and liver disease
- No dose adjustment necessary
Other
- Approved for diabetes in adults and primary hyperlipidemia in adults and boys and postmenarchal girls, 10 to 17 years of age
- Colesevelam can be dosed at the same time as a statin, or colesevelam and the statin can be dosed apart
- Monitor lipid levels within 4 to 6 weeks after initiation of colesevelam
Generic / Price
- Tablet (#180) - YES/$$
- Powder (#30) - YES/$$$$
Colestipol tablet (Colestid®)
Dosage forms
Tablet
- 1 gram
Dosing
High cholesterol
- Starting: 2 grams once or twice daily
- Maintenance: 2 - 16 grams a day given in one or two divided doses
- Max: 16 grams of colestipol per day
- Increase dose in increments of 2 - 4 grams a day at intervals of 1 - 2 months
- Best to take with meals, but may be taken at other times
- Do not crush, cut, or chew tablets
Kidney and liver disease
- No dose adjustment necessary
Generic / Price
- YES/$ (60 tablets)Colestipol granules (Colestid®)
Dosage forms
Granules
- Each packet or teaspoon contains 5 grams of colestipol
- Comes in cartons of 30 or 90 packets
- Comes in bottles of 300 grams and 500 grams
Flavored Granules
- 7.5 grams of flavored granules contains 5 grams of colestipol
- Comes in carton of 60 packets
- Comes in bottle of 450 grams
Dosing
High cholesterol
- Starting: 5 grams of colestipol once or twice daily
- Maintenance: 5 - 30 grams of colestipol a day given 1 or 2 divided doses
- Max: 30 grams of colestipol per day
- Increase dose in increments of 5 grams a day at intervals of 1 - 2 months
- Best to take with meals, but may be taken at other times
- Mix with ≥ 3 oz of liquid of choice
- May also be mixed with cereals, soups, and fruits
Kidney and liver disease
- No dose adjustment necessary
Generic / Price
- YES/$ (30 packets)- Kidney disease dosing
- No dose adjustment necessary
- Liver disease dosing
- No dose adjustment necessary
- DRUG INTERACTIONS
- NOTE: The drug interactions presented here are NOT all-inclusive. Other interactions may exist. Drug interaction checkers provide the most efficient and practical way to check for interactions among multiple medications. A free interaction checker is available from Drugs.com (see Drugs.com interactions checker).
- All bile acid sequestrants
- Drug absorption
- Bile acid sequestrants can bind other drugs and inhibit their absorption. To help prevent this, dosing of BAS and other drugs should be spaced out. The Questran and Colestid PIs state that other medications should be taken at least 1 hour before or 4 hours after BAS are taken. The Welchol PI states that other medications should be taken at least 4 hours before Welchol is taken.
- A small study looked at the effect of Welchol on the absorption of pioglitazone, repaglinide, estradiol, norethindrone, levothyroxine, and glyburide. When taken simultaneously, Welchol did not affect pioglitazone, but it significantly reduced the absorption of the other drugs. When glyburide and estradiol were given one hour before Welchol, their absorption was reduced. When glyburide, estradiol, and levothyroxine were given 4 hours before Welchol, their absorption was unaffected. [PMID 19789374]
- Below is an abbreviated list of drugs whose absorption is known to be affected by BAS. Patients should consult their pharmacist when taking other medications with BAS.
- Drugs that are known to be affected by BAS:
- Cyclosporine
- Valproic acid (Depakene®)
- Digoxin (Lanoxin®)
- Furosemide (Lasix®)
- Gemfibrozil (Lopid®)
- Glimepiride (Amaryl®)
- Glipizide (Glucotrol®)
- Glyburide (Diabeta®, Micronase®)
- Hydrochlorothiazide (HCTZ)
- Tetracycline
- Thyroid medications (Synthroid®, Levoxyl®)
- Mycophenolic acid (Myfortic®)
- Olmesartan (Benicar®)
- Oral Contraceptives
- Penicillin (Pen G®)
- Phenobarbital
- Phenytoin (Dilantin®)
- Propranolol (Inderal®)
- Repaglinide (Prandin®)
- Vitamin supplements
- Warfarin (Coumadin®)
- Colesevelam
- Metformin, extended-release - colesevelam has been shown to increase extended-release metformin exposure. Monitor for side effects when combining.
- Metabolism and clearance
- BAS are not absorbed systemically, and therefore, they do not undergo metabolism or significant renal clearance
- PRICE ($) INFO
Pricing legend
- $ = 0 - $50
- $$ = $51 - $100
- $$$ = $101 - $150
- $$$$ = > $151
- Pricing based on one month of therapy at standard dosing in an adult
- Pricing based on information from GoodRX.com®
- Pricing may vary by region and availability
- BIBLIOGRAPHY
- 1 - Manufacturer's PI