cholestyramine (Rx)

Brand and Other Names:Prevalite, Questran, more...Questran Light, LoCholest
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

packet

  • 4g

powder for oral suspension

  • 4g/dose (231g)
  • 4g/dose (378g)
  • 4g/dose (210g)

Hyperlipidemia

4 g PO q12-24hr; increase gradually over ≥1 month intervals

Maintenance: 8-16 g/day PO divided q12hr; not to exceed 24 g/day

Overdose: Symptoms include gastrointestinal (GI) obstruction; treatment is supportive

Dosing Modifications

Renal impairment: Supplemental doses not necessary with peritoneal dialysis (PD) or hemodialysis (HD)

Administration

Always mix with fluids or food

Take before or with meals

Dosage Forms & Strengths

powder for oral suspension

  • 4g resin/5g powder
  • 4g resin/5.5g powder
  • 4g resin/5.7g powder
  • 4g resin/6.4g powder
  • 4g resin/9g powder

Hyperlipidemia

240 mg/kg/day PO divided q8-12hr; generally not to exceed 8 g/day  

Next:

Interactions

Interaction Checker

and cholestyramine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (1)

            • mycophenolate

              cholestyramine decreases levels of mycophenolate by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Cholestyramine binds bile acids and reduces mycophenolic acid exposure.

            Serious - Use Alternative (0)

              Monitor Closely (66)

              • amiodarone

                cholestyramine decreases levels of amiodarone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • atorvastatin

                cholestyramine decreases levels of atorvastatin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • bendroflumethiazide

                cholestyramine decreases levels of bendroflumethiazide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • beta carotene

                cholestyramine decreases levels of beta carotene by drug binding in GI tract. Use Caution/Monitor.

              • budesonide

                cholestyramine decreases levels of budesonide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • calcifediol

                cholestyramine will decrease the level or effect of calcifediol by drug binding in GI tract. Modify Therapy/Monitor Closely. Dose adjustment of calcifediol may be required, and serum total 25-hydroxyvitamin D, intact PTH, and serum calcium concentrations should be monitored closely if cholestyramine is initiated or discontinued.

              • chlorothiazide

                cholestyramine decreases levels of chlorothiazide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • chlorthalidone

                cholestyramine decreases levels of chlorthalidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • cholic acid

                cholestyramine will decrease the level or effect of cholic acid by drug binding in GI tract. Use Caution/Monitor. Take cholic acid at least 1 hr before or 4-6 hr (or as great an interval as possible) after a bile acid binding resin.

              • clobetasone

                cholestyramine decreases levels of clobetasone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • cortisone

                cholestyramine decreases levels of cortisone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • deferasirox

                cholestyramine decreases levels of deferasirox by Other (see comment). Use Caution/Monitor. Comment: Avoid concomitant use of cholestyramine with deferasirox. If co-administration is required then consider increasing initial dose of deferasirox to 30 mg/kg and monitor serum ferritin levels and clinical response.

              • deflazacort

                cholestyramine decreases levels of deflazacort by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • demeclocycline

                cholestyramine decreases levels of demeclocycline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • dexamethasone

                cholestyramine decreases levels of dexamethasone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • diclofenac

                cholestyramine decreases levels of diclofenac by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • digoxin

                cholestyramine decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • doxercalciferol

                cholestyramine decreases levels of doxercalciferol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. (Vitamin D analog).

              • doxycycline

                cholestyramine decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • ezetimibe

                cholestyramine decreases levels of ezetimibe by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2-4 hours.

              • fenofibrate

                cholestyramine decreases levels of fenofibrate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • fenofibrate micronized

                cholestyramine decreases levels of fenofibrate micronized by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • fenofibric acid

                cholestyramine decreases levels of fenofibric acid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • fludrocortisone

                cholestyramine decreases levels of fludrocortisone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • fluvastatin

                cholestyramine decreases levels of fluvastatin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • furosemide

                cholestyramine decreases levels of furosemide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • gemfibrozil

                cholestyramine decreases levels of gemfibrozil by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • hydrochlorothiazide

                cholestyramine decreases levels of hydrochlorothiazide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • hydrocortisone

                cholestyramine decreases levels of hydrocortisone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • imipramine

                cholestyramine decreases levels of imipramine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • indapamide

                cholestyramine decreases levels of indapamide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • leflunomide

                cholestyramine decreases levels of leflunomide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • levothyroxine

                cholestyramine decreases levels of levothyroxine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • liothyronine

                cholestyramine decreases levels of liothyronine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • lomitapide

                cholestyramine decreases levels of lomitapide by drug binding in GI tract. Use Caution/Monitor. Separate lomitapide and administration of bile acid sequestrants by at least 4 hours; bile acid sequestrants can interfere with the absorption of oral medications.

              • lovastatin

                cholestyramine decreases levels of lovastatin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • meloxicam

                cholestyramine decreases levels of meloxicam by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • methotrexate

                cholestyramine decreases levels of methotrexate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. To minimize drug interactions, administer other drugs at least 1 hour before or at least 4-6 hours after the administration of cholestyramine.

              • methyclothiazide

                cholestyramine decreases levels of methyclothiazide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • methylprednisolone

                cholestyramine decreases levels of methylprednisolone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • metolazone

                cholestyramine decreases levels of metolazone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • metronidazole

                cholestyramine decreases levels of metronidazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • minocycline

                cholestyramine decreases levels of minocycline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • niacin

                cholestyramine decreases levels of niacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • obeticholic acid

                cholestyramine will decrease the level or effect of obeticholic acid by drug binding in GI tract. Modify Therapy/Monitor Closely. Administer obeticholic acid at least 4 hr before or 4 hr after taking a bile acid binding resins.

              • odevixibat

                cholestyramine will decrease the level or effect of odevixibat by drug binding in GI tract. Modify Therapy/Monitor Closely. Administer bile acid sequestrants 4 hr before or after odevixibat.

              • omadacycline

                cholestyramine will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Monitor for decreased effects of tetracyclines if coadministered with a bile acid sequestrant. Separate doses 2 or more hours if these agents are used concomitantly.

              • oxytetracycline

                cholestyramine decreases levels of oxytetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • paricalcitol

                cholestyramine decreases levels of paricalcitol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. (Vitamin D analog).

              • piroxicam

                cholestyramine decreases levels of piroxicam by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • pitavastatin

                cholestyramine decreases levels of pitavastatin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • pravastatin

                cholestyramine decreases levels of pravastatin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • prednisolone

                cholestyramine decreases levels of prednisolone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • prednisone

                cholestyramine decreases levels of prednisone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • raloxifene

                cholestyramine decreases levels of raloxifene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • rosuvastatin

                cholestyramine decreases levels of rosuvastatin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • sarecycline

                cholestyramine will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Monitor for decreased effects of tetracyclines if coadministered with a bile acid sequestrant. Separate doses by 2 or more hours if coadministered.

              • simvastatin

                cholestyramine decreases levels of simvastatin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • spironolactone

                cholestyramine, spironolactone. unspecified interaction mechanism. Use Caution/Monitor. Hyperkalemic metabolic acidosis reported when coadministered.

              • tetracycline

                cholestyramine decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • thyroid desiccated

                cholestyramine decreases levels of thyroid desiccated by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • tinidazole

                cholestyramine will decrease the level or effect of tinidazole by Other (see comment). Use Caution/Monitor. Coadministration of cholestyramine with tinidazole may decrease absorption of tinidazole. Advise to separate dosing regimens for cholestyramine and tinidazole to minimize any potential effect on the oral bioavailability of tinidazole.

              • triamcinolone acetonide injectable suspension

                cholestyramine decreases levels of triamcinolone acetonide injectable suspension by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • valproic acid

                cholestyramine decreases levels of valproic acid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • vitamin D

                cholestyramine will decrease the level or effect of vitamin D by Other (see comment). Use Caution/Monitor. Bile acid sequestrants may decrease the absorption of fat-soluble vitamins. Administer vitamin supplementation at least 4 hours prior to cholestyramine.

              • warfarin

                cholestyramine decreases levels of warfarin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              Minor (7)

              • acetaminophen

                cholestyramine decreases levels of acetaminophen by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • acetaminophen IV

                cholestyramine decreases levels of acetaminophen IV by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • acetaminophen rectal

                cholestyramine decreases levels of acetaminophen rectal by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • chenodiol

                cholestyramine decreases levels of chenodiol by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • ursodiol

                cholestyramine decreases effects of ursodiol by pharmacodynamic antagonism. Minor/Significance Unknown.

              • vitamin A

                cholestyramine decreases levels of vitamin A by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. (Vitamin A).

              • vitamin K1 (phytonadione)

                cholestyramine decreases levels of vitamin K1 (phytonadione) by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. (Vitamin K).

              Previous
              Next:

              Adverse Effects

              Frequency Not Defined

              Belching

              Constipation

              Dental erosion

              Diarrhea

              Duodenal ulcer bleeding

              Flatulence

              Gallstones

              Heartburn

              Hypoprothrombinemia

              Malabsorption of fat-soluble vitamins

              Nausea and vomiting

              Pancreatitis

              Perianal irritation

              Rectal pain

              Steatorrhea

              Stomach pain

              Weight gain or loss

              Previous
              Next:

              Warnings

              Contraindications

              Hypersensitivity to bile-sequestering resins

              Complete biliary obstruction

              Cautions

              Use with caution in renal impairment

              Volume depletion

              Concomitant spironolactone therapy

              Not for use with baseline fasting triglyceride levels ≥300 mg/dL or type III hyperlipoproteinemia; use with caution in patients with triglyceride levels 250-299 mg/dL; perform fasting lipid panel in 4-6weeks after initiation; discontinue use if triglycerides are >400 mg/dL; secondary causes of hyperlipidemia must be ruled out before therapy is initiated

              Not to be used as monotherapy in hypertriglyceridemia

              With prolonged use, increased risk of bleeding because of hypoprothrombinemia from vitamin K deficiency

              May interfere with fat absorption and decrease absorption of fat-soluble vitamins (A, D, E, K)

              May exacerbate preexisting constipation (initiate therapy at lower dosage in patients with history of constipation)

              Special care must be taken to avoid constipation in patients with symptomatic coronary heart disease

              Always mix with water or fluids; never ingest dry powder

              Some formulations contain phenylalanine

              Because of large quantities of chloride ion released from resin (which may lead to hyperchloremic acidosis and increase urinary calcium excretion on prolonged use), it may be advisable to reduce chloride intake

              Take other drugs at least 1 hour before or 4-6 hours after taking cholestyramine to minimize possible interference with absorption

              Previous
              Next:

              Pregnancy & Lactation

              Pregnancy category: C

              Lactation: Drug does not enter breast milk; use with caution because of potential vitamin loss in mother

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

              Previous
              Next:

              Pharmacology

              Mechanism of Action

              Forms complex with bile acids that is not absorbed through intestine; inhibits enterohepatic reuptake of intestinal bile salts, and this, in turn, increases fecal loss of bile salt-bound LDL and consequently reduces serum cholesterol in patients with primary hypercholesterolemia

              Absorption

              Not absorbed

              Peak effect: 21 days

              Metabolism

              Not metabolized

              Elimination

              Excretion: Feces (insoluble complex with bile acids)

              Previous
              Next:

              Images

              No images available for this drug.
              Previous
              Next:

              Patient Handout

              A Patient Handout is not currently available for this monograph.
              Previous
              Next:

              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
              Additional Offers
              Email to Patient

              From:

              To:

              The recipient will receive more details and instructions to access this offer.

              By clicking send, you acknowledge that you have permission to email the recipient with this information.

              Email Forms to Patient

              From:

              To:

              The recipient will receive more details and instructions to access this offer.

              By clicking send, you acknowledge that you have permission to email the recipient with this information.

              Previous
              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.