Cholestyramine Resin

Effects on GI Absorption of Drugs

May bind to a number of drugs (e.g., phenylbutazone, warfarin, propranolol, tetracycline, penicillin G, phenobarbital, thyroid and thyroxine preparations, estrogens and progestins, digoxin, iron salts, loperamide) in the GI tract and may delay or reduce their absorption.100 Instruct patients to administer other drugs at least 1 hour before or 4–6 hours after cholestyramine (or allow as long a time interval as possible between ingestion of other drugs and cholestyramine).100

May interfere with the pharmacokinetics of drugs that undergo enterohepatic circulation.100

Consider the possibility that discontinuance of cholestyramine in patients stabilized on potentially toxic drugs that bind to the resin may lead to toxicity and that administration of cholestyramine to patients stabilized on other drugs may reduce the effect of these drugs.100

Specific Drugs

• Binds to bile acids in the intestine and forms a nonabsorbable complex that is excreted in feces.100 Partial removal of bile acids from the enterohepatic circulation results in increased conversion of cholesterol to bile acids in the liver.100 This causes an increased demand for cholesterol in liver cells, resulting in a compensatory increase in hepatic uptake (and thus systemic clearance) of circulating LDL-cholesterol.100

• Reduces serum total and LDL-cholesterol concentrations.100

• In patients with partial biliary obstruction, reduction of serum bile acid concentrations reduces excess bile acids deposited in dermal tissues, resulting in relief of pruritus.100

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

• Tell all of your health care providers that you take this medicine. This includes your doctors, nurses, pharmacists, and dentists.
• If you have phenylketonuria (PKU), talk with your doctor. Some products have phenylalanine.
• Have blood work checked as you have been told by the doctor. Talk with the doctor.
• If you have hard stools (constipation), talk with your doctor. There may be ways to lower this side effect.
• Take other drugs at least 1 hour before or 4 hours after you take cholestyramine resin.
• Follow the diet and workout plan that your doctor told you about.
• Sipping this medicine after mixing or holding it in your mouth for a long time may lead to tooth changes like change in color. Talk with your doctor.
• Take good care of your teeth. See a dentist often.
• If you are 60 or older, use cholestyramine resin with care. You could have more side effects.
• Very bad and sometimes deadly bowel block has rarely happened with this medicine in children. Talk with your doctor.
• Use with care in children. Talk with the doctor.
• Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using cholestyramine resin while you are pregnant.
• Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.

• If your symptoms or health problems do not get better or if they become worse, call your doctor.
• Do not share your drugs with others and do not take anyone else's drugs.
• Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
• Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
• Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about this medicine, please talk with your doctor, nurse, pharmacist, or other health care provider.
• If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

This information should not be used to decide whether or not to take cholestyramine resin or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to cholestyramine resin. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Review Date: October 4, 2017

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Packet, Oral:

Prevalite: 4 g (1 ea, 42 ea, 60 ea) [contains aspartame; orange flavor]

Questran: 4 g (1 ea, 60 ea) [orange flavor]

Questran Light: 4 g (1 ea [DSC], 60 ea [DSC]) [sugar free; contains aspartame]

Generic: 4 g (1 ea, 60 ea)

Powder, Oral:

Prevalite: 4 g/dose (231 g) [contains aspartame; orange flavor]

Questran: 4 g/dose (378 g) [orange flavor]

Questran Light: 4 g/dose (210 g) [sugar free; contains aspartame; orange flavor]

Generic: 4 g/dose (210 g, 239.4 g, 378 g)

Peak effect: 21 days

Refer to adult dosing.

There are no dosage adjustments provided in the manufacturer's labeling; however, use with caution in renal impairment; may cause hyperchloremic acidosis.

Increased prothrombin time