BILE ACID SEQUESTRANT DOSING









Cholestyramine (Questran®)

Dosage forms

Powder
  • 4 grams of cholestyramine resin per 9 grams of powder
  • Comes in 378 gram can (contains 42 doses of 4 grams of cholestyramine resin)
  • Comes in carton with 60 packets each with 4 grams of cholestyramine resin

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
  • Best to take with meals, but may be taken at other times

Generic / Price

- YES/$ (1 can)

Other

  • Mix with 2 - 6 oz of water or beverage
  • May also be mixed with applesauce or crushed pineapple
  • Color of powder may vary from batch to batch

Cholestyramine light (Questran Light®)

Dosage forms

Powder
  • 4 grams of cholestyramine resin per 5.7 grams of powder
  • Comes in 239 gram can (contains 42 doses of 4 grams of cholestyramine resin)
  • Comes in carton with 60 packets each with 4 grams of cholestyramine resin

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
  • Best to take with meals, but may be taken at other times

Generic / Price

- YES/$ (1 can)

Other

  • Mix with 2 - 6 oz of water or beverage
  • May also be mixed with applesauce or crushed pineapple
  • Color of powder may vary from batch to batch

Colesevelam tablet (Welchol™)

Dosage forms

Tablet
  • 625 mg

Dosing

High cholesterol
  • Dosing: 6 tablets once daily or 3 tablets twice a day
  • Max: 6 tablets a day
  • Take with a meal and liquid
Type two diabetes
  • Dosing: 6 tablets once daily or 3 tablets twice a day
  • Max: 6 tablets a day
  • Take with a meal and liquid

Generic / Price

- YES/$$$$ (180 tablets)

Colesevelam powder (Welchol™)

Dosage forms

Powder
  • Comes in packets of 1.875 grams (60 per carton) and 3.75 grams (30 per carton)

Dosing

High cholesterol
  • Dosing: 3.75 grams once daily or 1.875 grams twice a day
  • Max: 3.75 grams a day
  • Take with a meal
Type 2 diabetes
  • Dosing: 3.75 grams once daily or 1.875 grams twice a day
  • Max: 3.75 grams a day
  • Take with a meal

Generic / Price

- NO/$$$$ (30 packets)

Other

  • Mix with 4 - 8 oz of water, fruit juice, or diet drink

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

Generic / Price

- YES/$ (60 tablets)

Other

  • Do not crush, cut, or chew 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

Generic / Price

- YES/$ (30 packets)

Other

  • Mix with ≥ 3 oz of liquid of choice
  • May also be mixed with cereals, soups, and fruits



Kidney disease



Liver disease



All bile acid sequestrants

Drug absorption
  • In addition to binding bile acids, BAS can bind other drugs. This can interfere with the absorption of a number of drugs. To minimize this risk, other medications should be taken apart from BAS.
  • The Questran and Colestid PIs both say 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. See the Welchol PI [sec 7] for specific recommendations regarding certain medications.
  • A small study looked at the effect of Welchol on the absorption of pioglitazone, repaglinide, estrogen estradiol, norethindrone, levothyroxine, and glyburide. When taken at the same time, Welchol had no effect on pioglitazone, but it significantly reduced the absorption of the other drugs. When glyburide and estrogen estradiol were given one hour before Welchol, their absorption was decreased. When glyburide, estrogen estradiol, and levothyroxine were given 4 hours before Welchol, absorption was not affected. [PubMed abstract]
  • 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®) [1]

Colesevelam

  • Metformin extended-release - colesevelam has been shown to increase levels of metformin extended-release. Monitor for side effects when combining.

Metabolism and clearance



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