ColesevelamColesevelam hydrochloride

About Colesevelam

Colesevelam stays in the gut, where it binds bile acids; the liver then turns more cholesterol into bile acids and clears more LDL cholesterol from the blood. How it improves blood sugar is not known. With diet and exercise, it is approved to lower LDL cholesterol in adults with primary hyperlipidemia and in boys, and girls who have started menstruating, aged 10 to 17 with heterozygous familial hypercholesterolemia who cannot reach their LDL goal with diet and lifestyle changes, and to improve blood sugar control in adults with type 2 diabetes; it is not for type 1 diabetes or diabetic ketoacidosis. The dose is 3.75 g a day: six 625 mg tablets once a day, or three twice a day, with a meal and liquid; or one packet stirred into a cup (8 ounces) of water, fruit juice or diet soft drink and taken with a meal. The label recommends the powder for children because of the tablet size.

There is no boxed warning. Colesevelam can raise triglycerides, sometimes enough to cause pancreatitis, so it is not taken with triglycerides above 500 mg/dL, after pancreatitis caused by high triglycerides, or after a bowel obstruction. Triglycerides are checked before starting and periodically, and it is stopped if they rise above 500 mg/dL. It can cause bowel obstruction, and the tablets can cause trouble swallowing or block the esophagus, so people who have difficulty swallowing tablets use the powder. Severe stomach pain or severe constipation means stopping it and getting medical attention. Constipation, indigestion and nausea are the most common side effects.

It can lower the absorption of vitamins A, D, E and K and of other medicines, so vitamin supplements and several drugs, including levothyroxine, glyburide, glimepiride, glipizide, phenytoin, olmesartan, cyclosporine and some birth control pills, are taken at least four hours before it. People on warfarin have their INR checked often when starting, and it raises levels of extended-release metformin. The powder contains phenylalanine, which matters in phenylketonuria. Because it is not absorbed, a developing baby or a breastfed child is not expected to be exposed. Welchol tablets and 3.75 g packets are still sold; the Orange Book lists the 1.875 g packet, a capsule and a chewable bar as discontinued.

Taking Colesevelam

How to take it

Take tablets with a meal and a drink, once or twice a day as prescribed. Empty a powder packet into a glass, add a cup (8 ounces) of water, fruit juice or diet soft drink, stir, and drink it all with a meal; never take the powder dry.

If you miss a dose

Take it as soon as you remember, with food, 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 (not in the bathroom), out of reach of children. Use a take-back program rather than flushing it.

Interactions to know about

Take levothyroxine, glyburide, glimepiride, glipizide, phenytoin, olmesartan, cyclosporine, birth control pills and vitamins at least four hours before colesevelam. If you take warfarin, your INR is checked often at first. It raises levels of extended-release metformin, so blood sugar is watched.

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 Colesevelam differs from pharmacy to pharmacy

Generic tablets come from many makers, but the full dose is six large tablets a day, so a month’s supply is a big count (the label’s bottle of 180 lasts about a month at that dose), and per-tablet pricing shapes the quote more than for a one-a-day pill.

The powder packets have fewer generic makers, so fewer pharmacies stock them and their quotes vary more. Tablets and packets are different dosage forms, so a pharmacy fills the form written, and a prescription that names Welchol and blocks substitution is priced as a brand.

Ways to pay less for Colesevelam without insurance

• Ask for generic colesevelam, and make sure the prescription allows substitution.
• Ask whether it is on the pharmacy’s flat-price generic list, and compare more than one pharmacy, since the monthly count is high.
• Once your dose is settled, ask for a ninety-day supply.
• If packets are quoted high and you can swallow large tablets, ask the prescriber whether tablets would suit you.
• 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 Colesevelam

1. 1.Which of my medicines and vitamins need to be taken at least four hours before it?
2. 2.How should I time it with my thyroid medicine or birth control pill?
3. 3.When will my triglycerides be checked?
4. 4.What should I do if I get severe constipation or stomach pain?

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