CholestyramineCholestyramine resin

About Cholestyramine

Cholestyramine is a resin that binds bile acids in the gut, so the liver uses more cholesterol to replace them. The label approves it as an addition to diet to lower raised LDL cholesterol in primary hypercholesterolemia when diet alone is not enough, and to relieve itching caused by partial biliary obstruction. Adults start with one packet or level scoop (4 g of resin) once or twice a day, then usually 8 to 16 g a day in two doses, raised no faster than every four weeks, to a maximum of 24 g. Children are dosed by weight, and long-term effects in children are unknown.

There is no boxed warning. Cholestyramine must not be taken by people with complete biliary obstruction, where no bile reaches the intestine, or by anyone allergic to its ingredients. Constipation is the most common side effect, more likely at high doses and over age 60, and can lead to fecal impaction. Abdominal pain, gas, nausea and diarrhea also occur. Long-term use can lower absorption of vitamins A, D, E and K and of folate; vitamin K deficiency can cause bleeding. Hyperchloremic acidosis can occur, especially in younger, smaller patients and with kidney problems or spironolactone.

The resin binds many other oral drugs in the gut, so they are spaced away from each dose. Because it is not absorbed, it is not expected to reach the baby directly, but it can reduce the mother’s vitamin absorption in pregnancy and breastfeeding. The regular powder weighs 9 g per dose; the light versions weigh about 5 to 5.7 g per dose, depending on the maker, and are sweetened with aspartame, which contains phenylalanine, a concern for people with phenylketonuria (Prevalite lists 14.1 mg of phenylalanine per dose). The Questran and Questran Light brand names have been discontinued in the US.

Taking Cholestyramine

How to take it

Never take the powder dry. Stir one packet or level scoop into 2 to 6 ounces of water or another noncarbonated drink, or into a thin soup or a moist fruit such as applesauce or crushed pineapple, then rinse the glass and drink that too. It is usually taken with meals, and drinking plenty of fluids helps prevent constipation.

If you miss a dose

Take it when you remember, unless it is almost time for the next dose; then skip the missed dose. Do not take a double dose.

Storage

At room temperature, away from heat and moisture, out of reach of children. Return unwanted powder through a take-back program rather than flushing it.

Interactions to know about

Take other oral medicines at least 1 hour before or 4 to 6 hours after cholestyramine; the label names warfarin, thiazide diuretics, propranolol, tetracycline, thyroid hormone, estrogens and digitalis. If cholestyramine is stopped, drugs such as digitalis that were adjusted while on it may need rechecking.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Cholestyramine differs from pharmacy to pharmacy

Cholestyramine is an old drug with no brand-only form left: Prevalite and the generics are all approved as generics. Quotes still differ because the regular and light powders differ in weight per dose and sweetener, and makers sell cartons of packets or a bulk can or jar, so a pharmacy may stock only one version and need to order the one prescribed.

The number of doses a day (one to six) decides how many cartons or cans a month’s supply needs, and because treatment is usually long term, the dispensing fee repeats with each fill.

Ways to pay less for Cholestyramine without insurance

• Ask whether the prescription can be filled with any generic cholestyramine powder of the same type (regular or light), rather than a named product the pharmacy has to order.
• Ask the prescriber whether a bulk can with a scoop, rather than single-dose packets, suits your routine.
• Once your dose is stable, ask whether a ninety-day supply is possible, so you pay fewer dispensing fees.
• Ask the prescriber whether colesevelam or ezetimibe is a reasonable alternative if the powder is hard to fit around your other medicines.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Cholestyramine

1. 1.How should I time my other medicines, including my thyroid pill or blood thinner, around my cholestyramine doses?
2. 2.Does my powder contain aspartame, and does that matter for me?
3. 3.Should I take a vitamin A, D, E or K or folic acid supplement, and when, while I am on it?
4. 4.What should I do if I become constipated on my current dose?

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