II. Effects
- LDL Cholesterol decreased (15-30%)
- HDL Cholesterol increased (3-5%)
- Triglycerides increased
III. Efficacy
- Lowers cardiovascular mortality by 30%
- Reduces Myocardial Infarction risk
IV. Adverse effects
- Gastrointestinal
- Effects
- Reduce Adverse GI side effects
- Use moderate doses: 8-10 g per day
- Increase Dietary Fiber or supplement with Psyllium
- Colesevelam may have less GI intolerance
- Interferes with fat soluble Vitamin Absorption
V. Contraindications
- Absolute
- Serum Triglycerides >500 mg/dl
- Bowel Obstruction
- Complete biliary obstruction
- Relative
- Triglycerides >200 mg/dl
VI. Preparations
- Cholestyramine (Questran)
- Dose: 4g (9g packet) bid ($54) MAX: 24 g/day
- Colestipol (Colestid)
- Dose: 5g bid ($47) MAX: 30 g/day
- Colesevelam (Welchol)
- Most expensive agent of the class
- May be preferred agent of class
- Lower adverse effect profile (see above)
- May be taken concurrently with Statin
- Lowers A1C by 0.5%
- Dosing
- One Dose: Six 325 mg tablets daily with food, liquid
- Two Doses: Three 325 mg tablets bid with food, liquid
VII. Drug Interactions
- Take at least 2 hours apart from Warfarin, Digoxin and Amiodarone
- Take with water or orange juice before meals
VIII. References
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Related Studies
cholestyramine (on 1/19/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
CHOLESTYRAMINE LIGHT PACKET | Generic | $0.98 each |
CHOLESTYRAMINE LIGHT POWDER | Generic | $0.24 per gram |
CHOLESTYRAMINE PACKET | Generic | $1.06 each |
CHOLESTYRAMINE POWDER | Generic | $0.14 per gram |
colestipol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
COLESTIPOL HCL 1 GM TABLET | Generic | $0.79 each |
COLESTIPOL HCL GRANULES PACKET | Generic | $2.79 each |
colesevelam (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
COLESEVELAM 625 MG TABLET | Generic | $0.38 each |
COLESEVELAM HCL 3.75 G PACKET | Generic | $4.33 each |
welchol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
WELCHOL 625 MG TABLET | Generic | $0.38 each |