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Dr. Robert D. Fusco, Medical Director    
All About Cholestyramine (Questran, Questran Light, LoCholest, Colestid)

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Many patients are not as well-informed about prescription medications as they ought to be. We believe that the more you know about your medications, the better. Therefore, we have written this to explain more about cholestyramine and to explain the importance of taking it properly. Remember to keep all prescription drugs beyond the sight and reach of children when not in use. Store all drugs in their original labeled containers; the place of storage should be cool, dry, and away from light. Always read the label before each use.

What is Cholestyramine?

Cholestyramine (koe-less-TEAR-a-meen) is an usual medication exchange resin is taken by mouth as a power mixed in water. It is not absorbed into the body, but stays within the intestinal tract. As it passes down through the intestines, it traps excessive liver bile and carries it out in the stool. In this way, it removes excesive bile acids from the body. Cholestyramine is available only with your doctor's prescription. Common brand names are Questran, Questran Light, LoCholest, Colestid, Prevalite.

Why is Cholestyramine prescribed?

There are four major uses for this medication:
  • It is mainly prescribed to lower high blood cholesterol. This is really why the drug is marketed.
  • However, it is very helpful in controlling diarrhea that sometime occurs after an operation to remove the gallbladder.
  • It can also reduce servere itching in patients with liver disease, particularly those with jaundice, or a disease called Primary Biliary Cirrhosis.
  • It can be used as an antidote for overdosage of the heart drug, digitalis.
Taking Cholestyramine properly

Cholestyramine should not be taken in its dry form. The recommended starting adult dose is one packet or one level scoopful contain 4 grams of anhydrous cholestyramine resin once or twice a day. Place the contents of one single-dose packet or one level scoopful of in a glass or cup. Add at least 2 to 3 ounces of water or the beverage of your choice; do not use carbonated beverages. Stir to a uniform consistency. Then add an additional 2 to 4 ounces of beverage and again mix thoroughly (it will not dissolve) before drinking. After drinking all the liquid containing the medicine, rinse the glass with a little more liquid and drink that also, to make sure you get all the medicine. You may also mix this medicine with milk in hot or regular breakfast cereals, or in thin soups such as tomato or chicken noodle soup. Or you may add it to some pulpy fruits such as crushed pineapple, applesauce, pears, peaches, or fruit cocktail.

The best time to take cholestyramine is at mealtime, but this may be modified to avoid interference with absorption of other medications. Most patients who take other prescription medications in the morning, take their cholestyramine before lunch.

The standard dose for high blood cholesterol is, in fact, one to four doses per day. The maximum recommended daily dose is six packets a day, but this high dose is almost never used. Interesetingly, patients who use cholestyramine to control persistent diarrhea after gallbladder surgery do quite well on much lower doses - sometimes as little as one-half to one-fourth packet per day.

What are the side effects?

Cholestyramine may produce or worsen pre-existing constipation. Elderly patients are at special high risk. Severe crampy abdominal pain, indicating intestinal obstruction, is very rare, but may occur if constipation develops and the dosage is not reduced. Therefore, the dosage should be started at one packet/scoop or less daily. The dose may then be increased slowly to minimize the risk of developing fecal impaction (blockage of the bowels). Constipation associated with cholestyramine resin may aggravate hemorrhoids. If constipation develops, the medication should be stopped until the problems resolves. It can then usually be resumed at half the previous dose. If severe abdominal pain occurs, stop taking the drug and contact your doctor immediately.

Less frequent adverse reactions include abdominal discomfort and/or pain, bloating, belching, flatulence (gas), heartburn, nausea, vomiting,and loss of appetite. These side effects often improve over time and may be lessened by a reduction in cholestyramine dosage.

Precautions

Drink plenty of fluids. Sipping or holding the medication in the mouth for prolonged periods may lead to changes in the surface of the teeth resulting in discoloration, erosion of enamel or decay; good oral hygiene should be maintained.

Cholestyramine may bind other prescription drugs and prevent them from working properly. They should not be taken at the same time. It is recommended that patients should take other medications at least one hour before or 4 hours after taking cholestyramine. If you miss a dose, take it as soon as you remember. However, be aware that you cannot take it at the same time as other prescription medications. Do not double the next dose.

There are no known food interactions, but at higher doses, cholestyramine may interfere with absorption of some of the fat-soluble vitamins (vitamin A, D, E, K) A daily multivitamin supplement is advised during long term therapy.

Remember

Cholestyramine is a non-absorbable powder that traps excess liver bile and is helpful in treating high blood cholesterol. Another common use for cholestyramine is to control the persistent diarrhea that affects some patients after gallbladder surgery. Cholestyramine may be used safely for years with contipation as the only major side effect. which can usually be controlled by a reduction in dosage. If any of this information about cc causes you concern or if you want additional information about cholestyramine and its use, please check with your doctor or pharmacist.

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