Bile Binding Resin

Aka: Bile Binding Resin, Bile Acid-Binding Resin, Cholestyramine, Colestipol, Colesevelam, Welchol

1. Effects
   1. LDL Cholesterol decreased (15-30%)
   2. HDL Cholesterol increased (3-5%)
   3. Triglycerides increased
2. Efficacy
   1. Lowers cardiovascular mortality by 30%
   2. Reduces Myocardial Infarction risk
      1. Eggertsen (1984) JAMA 251(3):349-50
3. Adverse effects
   1. Gastrointestinal
      1. Effects
         1. Constipation
         2. Flatulence
         3. Dyspepsia
      2. Reduce Adverse GI side effects
         1. Use moderate doses: 8-10 g per day
         2. Increase Dietary Fiber or supplement with Psyllium
         3. Colesevelam may have less GI intolerance
   2. Interferes with fat soluble Vitamin Absorption
      1. Take vitamin 2 hours before or 4 hours after Resin
      2. Colesevelam does not affect Vitamin Absorption
4. Contraindications
   1. Absolute
      1. Serum Triglycerides >500 mg/dl
      2. Bowel Obstruction
      3. Complete biliary obstruction
   2. Relative
      1. Triglycerides >200 mg/dl
5. Preparations
   1. Cholestyramine (Questran)
      1. Dose: 4g (9g packet) bid ($54) MAX: 24 g/day
   2. Colestipol (Colestid)
      1. Dose: 5g bid ($47) MAX: 30 g/day
   3. Colesevelam (Welchol)
      1. Most expensive agent of the class
      2. May be preferred agent of class
         1. Lower adverse effect profile (see above)
         2. May be taken concurrently with Statin
         3. Lowers A1C by 0.5%
            1. Zieve (2007) Clin Ther 29(1):74-83
      3. Dosing
         1. One Dose: Six 325 mg tablets daily with food, liquid
         2. Two Doses: Three 325 mg tablets bid with food, liquid
6. Drug Interactions
   1. Take at least 2 hours apart from Warfarin, Digoxin and Amiodarone
   2. Take with water or orange juice before meals
7. References
   1. (2000) Med Lett Drugs Ther 42:102-4