Cholestyramine

Indications

Cholestyramine is used for: Bile acid-induced diarrhoea; Hyperlipidaemias, Pruritus associated w/ partial biliary obstruction or primary biliary cirrhosis

Adult Dose

Hyperlipidaemias Adult: 12-24 g daily in single dose or up to 4 divided doses. Bile acid-induced diarrhoea Adult: 12-24 g daily in single dose or up to 4 divided doses. Pruritus associated with partial biliary obstruction or primary biliary cirrhosis Adult: 4-8 g daily.

Child Dose

Hyperlipidaemias Child: >6 yr: 240 mg/kg daily in divided doses. Bile acid-induced diarrhoea Child: >6 yr: 240 mg/kg daily in divided doses. Pruritus associated with partial biliary obstruction or primary biliary cirrhosis Child: >6 yr: 240 mg/kg daily in divided doses.

Renal Dose

Administration

May be taken with or without food. Do not take in the dry form. Mix w/ 150 mL of water or fruit juice, stir to a uniform consistency before taking. Reconstitution: Mix the powder w/ 60-180 mL of water or another noncarbonated beverage (e.g. fruit juice) and stir to a uniform consistency. Alternatively, it may also be mixed w/ skimmed milk, thin soup or a pulpy fruit w/ high moisture content (e.g. applesauce or crushed pineapple).

Contra Indications

Complete biliary obstruction; hypersensitivity.

Precautions

Admin as a suspension in water or a flavored vehicle to minimise risk of oesophageal obstruction. May interfere with absorption of fat-soluble vitamins and folic acid and prolonged use may be associated with an increased bleeding tendency. Pregnancy; lactation. Lactation: Drug does not enter breast milk; use with caution because of potential vitamin loss in mother

Pregnancy-Lactation

Interactions

Delayed or reduced absorption of folic acid, thiazide diuretics, propranolol, digoxin and related glycosides, loperamide, phenylbutazone, barbiturates, oestrogens, progestogens, thyroid hormones, warfarin and other coumarin-derivative anticoagulants, iron salts, deferasirox and some antibacterials (e.g. tetracycline, penicillin G). May prevent absorption of fat-soluble vit. Slightly decreased rate of absorption of clofibrate. May interfere w/ absorption of oral phosphate supplements.

Adverse Effects

Side effects of Cholestyramine : Constipation; faecal impaction; haemorrhoids; abdominal discomfort or pain; heartburn; flatulence; nausea; vomiting; diarrhoea; increased bleeding tendency (chronic use); osteoporosis; steatorrhoea (high doses); skin rashes; pruritus of the tongue, skin and perianal region; hyperchloraemic acidosis.

Mechanism of Action

Colestyramine binds with bile acids to form an insoluble complex which is excreted in the feces, resulting in increased loss of bile acid, thus increasing the oxidation of cholesterol to bile acids.