• See Also
  1. Bile Acid Sequestrant
  2. Hyperlipidemia
  3. Hyperlipidemia Management
  4. Colestipol
  5. Colesevelam
  • Indications
  1. Hyperlipidemia adjunctive management (rare use)
  2. Cholestasis associated Pruritus (not FDA approved)
  3. Diarrhea Dominant Irritable Bowel Syndrome (not FDA approved)
  • Contraindications
  1. See Bile Acid Sequestrant
  2. Serum Triglycerides >400 mg/dl
  • Mechanism
  1. See Bile Acid Sequestrant
  2. Binds bile salts
    1. Results in insoluble complexes that are excreted in the stool
  • Medications
  1. Questran contains 4 grams Cholestyramine per 9 grams powder packet
  2. Questran Light contains 4 grams Cholestyramine per 5 grams powder packet
  3. Prevalite contains 4 grams Cholestyramine per 5.5 grams powder packet
  • Dosing
  • Adult
  1. Hyperlipidemia
    1. Start 4 grams orally twice daily before meals
    2. Target 12 to 24 grams orally per day divided 2 to 4 times daily
    3. Maximum: 24 grams per day
  2. Cholestasis associated Pruritus (not FDA approved)
    1. Start 4 grams orally twice daily before meals
    2. Target 4 to 8 grams orally 2 to 3 times daily
  3. Diarrhea Dominant Irritable Bowel Syndrome (not FDA approved)
    1. Start 4 grams orally twice daily before meals
    2. Target 4 to 8 grams orally once to twice daily
  • Dosing
  • Child
  1. Not FDA approved in children
  2. Start 240 mg/kg/day orally up to 8 to 16 g/day divided three times daily before meals
  3. Maximum: 16 g/day
  • Drug Interactions
  1. See Bile Acid Sequestrant
  2. Take other medications at least 2 hours before or 4 to 6 hours after (esp. Warfarin, Digoxin and Amiodarone)
  3. Take with 2 to 6 ounces water, milk or fruit juice (e.g. orange juice) before meals
    1. Do not mix with carbonated beverages
  • Efficacy
  1. See Bile Acid Sequestrant
  • Adverse Effects
  1. See Bile Acid Sequestrant
  2. Constipation
  3. Gastroesophageal Reflux
  4. Nausea
  5. Eructation
  6. Bloating
  • Safety
  1. Pregnancy Category C
  2. Considered Safe in Lactation
  • Metabolism
  1. Not absorbed
  • Resources
  1. Cholestyramine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2835b6f5-93da-4554-9d84-79132fd928ee
  • References
  1. (2022) Non-StatinLipid Lowering Agents, Presc Lett, Resource #380202
  2. (2022) Med Lett Drugs Ther 64(1659): 145-52
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  4. (2000) Med Lett Drugs Ther 42:102-4 [PubMed]