Pharm
Bile Binding Resin
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Bile Binding Resin
, Bile Acid-Binding Resin, Cholestyramine, Colestipol, Colesevelam, Welchol
Effects
LDL Cholesterol
decreased (15-30%)
HDL Cholesterol
increased (3-5%)
Triglyceride
s increased
Efficacy
Lowers cardiovascular mortality by 30%
Reduces
Myocardial Infarction
risk
Eggertsen (1984) JAMA 251(3):349-50 [PubMed]
Adverse effects
Gastrointestinal
Effects
Constipation
Flatulence
Dyspepsia
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 A
bsorption
Take
Vitamin
2 hours before or 4 hours after Resin
Colesevelam does not affect
Vitamin A
bsorption
Contraindications
Absolute
Serum Triglyceride
s >500 mg/dl
Bowel Obstruction
Complete biliary obstruction
Relative
Triglyceride
s >200 mg/dl
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%
Zieve (2007) Clin Ther 29(1):74-83 [PubMed]
Dosing
One Dose: Six 325 mg tablets daily with food, liquid
Two Doses: Three 325 mg tablets bid with food, liquid
Drug Interactions
Take at least 2 hours apart from
Warfarin
,
Digoxin
and
Amiodarone
Take with water or orange juice before meals
References
(2000) Med Lett Drugs Ther 42:102-4 [PubMed]
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