Cholestyramine

DEA Class; Rx

Common Brand Names; Prevalite, Questran, Questran Light, LoCholest

Indicated for treatment of primary hypercholesterolemia or hyperlipoproteinemia as an adjunct to diet to reduce elevated total-C and LDL-C.

Hypersensitivity to bile-sequestering resins

Complete biliary obstruction

• 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

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

Pregnancy category: C

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