cholestyramine (Rx)

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Brand and Other Names:Prevalite, Questran, more...Questran Light, LoCholest

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for oral suspension

  • 4g resin/5g powder
  • 4g resin/5.5g powder
  • 4g resin/5.7g powder
  • 4g resin/6.4g powder
  • 4g resin/9g powder
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Hyperlipidemia

4 g PO q12-24hr; not to exceed 24 g/day (4 g q4hr)

Overdose: Symptoms include gastrointestinal (GI) obstruction; treatment is supportive

Dosing Modifications

Renal impairment: Supplemental doses not necessary with peritoneal dialysis (PD) or hemodialysis (HD)

Administration

Always mix with fluids or food

Take before or with meals

Dosage Forms & Strengths

powder for oral suspension

  • 4g resin/5g powder
  • 4g resin/5.5g powder
  • 4g resin/5.7g powder
  • 4g resin/6.4g powder
  • 4g resin/9g powder
more...

Hyperlipidemia

240 mg/kg/day PO divided q8-12hr; generally not to exceed 8 g/day  

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Interactions

Interaction Checker

and cholestyramine

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      Serious - Use Alternative

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            Adverse Effects

            Frequency Not Defined

            Belching

            Constipation

            Dental erosion

            Diarrhea

            Duodenal ulcer bleeding

            Flatulence

            Gallstones

            Heartburn

            Hypoprothrombinemia

            Malabsorption of fat-soluble vitamins

            Nausea and vomiting

            Pancreatitis

            Perianal irritation

            Rectal pain

            Steatorrhea

            Stomach pain

            Weight gain or loss

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            Warnings

            Contraindications

            Hypersensitivity to bile-sequestering resins

            Complete biliary obstruction

            Cautions

            Use with caution in renal impairment

            Volume depletion

            Concomitant spironolactone therapy

            Secondary causes of hyperlipidemia must be ruled out before therapy is initiated

            Not to be used as monotherapy in hypertriglyceridemia

            With prolonged use, increased risk of bleeding because of hypoprothrombinemia from vitamin K deficiency

            May interfere with fat absorption and decrease absorption of fat-soluble vitamins (A, D, E, K)

            May exacerbate preexisting constipation (initiate therapy at lower dosage in patients with history of constipation)

            Special care must be taken to avoid constipation in patients with symptomatic coronary heart disease

            Always mix with water or fluids; never ingest dry powder

            Some formulations contain phenylalanine

            Because of large quantities of chloride ion released from resin (which may lead to hyperchloremic acidosis and increase urinary calcium excretion on prolonged use), it may be advisable to reduce chloride intake

            Take other drugs at least 1 hour before or 4-6 hours after taking cholestyramine to minimize possible interference with absorption

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Drug does not enter breast milk; use with caution because of potential vitamin loss in mother

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Forms complex with bile acids that is not absorbed through intestine; inhibits enterohepatic reuptake of intestinal bile salts, and this, in turn, increases fecal loss of bile salt-bound LDL and consequently reduces serum cholesterol in patients with primary hypercholesterolemia

            Absorption

            Not absorbed

            Peak effect: 21 days

            Metabolism

            Not metabolized

            Elimination

            Excretion: Feces (insoluble complex with bile acids)

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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