cholestyramine (koh les TIR a meen)
What is cholestyramine?
Cholestyramine acts like a microscopic vacuum cleaner sucking up certain body substances and even medicines. The drug binds up bile salts in the GI tract preventing them from being active in the lower bowel. It also absorbs cholesterol, thereby reducing the cholesterol in the blood.
What is it used for?
This medication is used to treat the itching that occurs with certain types of liver disease. Itching occurs because of retention of bile salts which are made by the liver. Cholestyramine binds these bile salts in the intestinal tract, thereby reducing them in the blood and relieving the itching that elevated bile salts can cause. Diarrhea occurs in some people after they have had their gallbladder removed or after an operation where the lower small bowel (ileum) is removed, as in Crohn’s disease. In these circumstances, bile reaches the colon unimpeded and acts like a laxative, causing diarrhea. Cholestyramine absorbs and binds these bile salts, helping to improve the diarrhea problem. Cholestyramine is also used to lower the cholesterol level and to bind up various toxins or poisons that may have been ingested.
How do I take it?
Follow your physician’s instructions carefully. Always take this drug 1 hour before or 2 hours after taking any other drug. Take it just before or with a meal. Mix with 4 to 6 ounces of water, fruit juice, milk, soup or soft food such as applesauce. Do not use carbonated beverages with this medication. Store it in a tightly closed container at room temperature and protect it from moisture and high humidity. Keep all medications away from children. Never share your medications with anyone else.
What do I do for a missed dose?
If you miss a dose of this medicine, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and return to your regular schedule. Do not double up on this medication.
Are there interactions with food or beverages?
This drug may interfere with the absorption and digestion of fats and fat soluble vitamins such as A, D, E and K. It may be necessary to supplement these vitamins as well as calcium and folic acid. Check with your physician. There is no interaction with alcohol.
Are there interactions with other drugs?
An interaction generally means that one drug may increase or decrease the effect of another drug. Also, the more medications a person takes, the more likely there will be a drug interaction. It is advisable to take all other drugs 1 hour before or 2 hours after taking this drug.
Interactions with this drug may occur with the following:
- blood thinners (Coumadin)
- amiodarone (Cordarone)
- arthritis medications (ibuprofen, Advil, Motrin Naprosyn, many others)
- gemfibrozil (Lopid)
- ursodiol (Actigall, URSO)
- propranolol (Inderal)
- digoxin (Lanoxin)
- furosemide (Lasix)
- thiazide diuretics (Dyazide, hydrochlorothiazide)
- thyroid (Synthroid)
- oral antidiabetic agents
Is there a problem if I have another disorder or disease?
At times, a drug may have a different or enhanced effect when other diseases are present. At other times, the drug may worsen or effect another disease. Patients who already have problems with constipation or bloating may find that the drug aggravates these problems. Discuss this with your physician. This is one of the older medications to lower cholesterol. The drug may be difficult to take up to 4 times a day long-term because of gastrointestinal side effects. A pill to reduce cholesterol may be easier from a compliance standpoint.
What about allergies?
People who have known allergies or asthma may be at an increased risk for a reaction from any new medication. The physician should always know a patient’s allergy history. Signs of an allergic reaction are skin rash, hives or itching. Of course, a person should not take cholestyramine if there has been a previous reaction to this or a similar drug.
What if I’m pregnant, considering pregnancy or breast-feeding?
Most females now know that, if possible, no drug, including alcohol, should be taken during pregnancy or lactation. The potential danger, of course, is an injury to the baby. However, some drugs are much safer than others in this regard. So, the FDA has a grading system for each drug which reflects what is known medically. It ranks drugs from A, where medical studies show no evidence for danger to the fetus or mother, to B, C, D and X, where the medical evidence indicates that the risk to the fetus outweighs any benefit to the mother. Cholestyramine is ranked C. However, since this drug is not absorbed but remains in the intestinal tract, it is probably safe during pregnancy. Always consult your physician before taking any drug during or when planning pregnancy.
What are the effects on sexual function?
There are a few questionable medical reports that this drug may increase the sex drive. Since the drug is not absorbed, it is completely unclear how this could occur.
Are there other precautions?
- Sipping cholestyramine mixtures or holding it in your mouth for a long period of time can lead to tooth discoloration, enamel erosion or decay. Be sure to brush and floss teeth regularly.
- Avoid foods that tend to constipate such as cheeses.
- Be sure to have an adequate liquid intake of up to 2 quarts daily while on this medication.
How long is it safe to take cholestyramine?
Long-term use of this drug is safe but does require periodic medical evaluation. Use of this medication on a regular schedule for 3 weeks is needed to determine its effectiveness in lowering high blood cholesterol.
How about side effects?
Adverse reactions can occur with any drug, even over-the-counter medications. Some of these are mild such as a stomach upset, which may be avoided by taking the medication with food. Minor reactions may go away on their own but if they persist, contact the physician. For major reactions, the patient should contact the physician immediately.
For cholestyramine, the following are the observed side effects:
- severe constipation
- severe stomach pain
- weight loss
A physician’s comment…
In gastroenterology, this drug has a role in relieving itching from chronic liver disease and in treating diarrhea. Its main shortcoming is the gritty taste and the side effect of bloating and even constipation.