cholestyramine

LoCHOLEST, LoCHOLEST Light, Novo-Cholamine (CA), Novo-Cholamine Light (CA), Prevalite, Questran, Questran Light

Pharmacologic class: Bile acid sequestrant

Therapeutic class: Lipid-lowering agent

Pregnancy risk category C

Action

Combines with bile acid in GI tract to form insoluble complex excreted in feces. Complex regulates and increases cholesterol synthesis, thereby decreasing serum cholesterol and low-density lipoprotein levels.

Availability

Powder for suspension; powder for suspension with aspartame: 4 g cholestyramine/packet or scoop

Indications and dosages

➣ Primary hypercholesterolemia and pruritus caused by biliary obstruction; primary hyperlipidemia

Adults: Initially, 4 g P.O. once or twice daily. May increase as needed and tolerated, up to 24 g/day in six divided doses.

Off-label uses

• Antibiotic-induced pseudomembranous colitis

• Adjunct in infantile diarrhea

• Digoxin toxicity

Contraindications

• Hypersensitivity to drug, its components, or other bile-acid sequestering resins

• Complete biliary obstruction

• Phenylketonuria (suspension containing aspartame)

Precautions

Use cautiously in:

• history of constipation or abnormal intestinal function

• pregnant patients

• children.

Administration

• Mix powder with soup, cereal, pulpy fruit, juice, milk, or water.

• Administer 1 hour before or 4 to 6 hours after other drugs.

• Be aware that fat-soluble vitamin supplements may be necessary with long-term drug use.

Adverse reactions

CNS: headache, anxiety, vertigo, dizziness, insomnia, fatigue, syncope

EENT: tinnitus

GI: nausea, vomiting, constipation, abdominal discomfort, fecal impaction, flatulence, hemorrhoids, perianal irritation, steatorrhea

GU: hematuria, dysuria, diuresis, burnt odor to urine

Hematologic: anemia, ecchymosis

Hepatic: hepatic dysfunction

Metabolic: vitamin A, D, E, and K deficiencies; hyperchloremic acidosis

Musculoskeletal: joint pain, arthritis, back pain, muscle pain

Respiratory: wheezing, asthma

Skin: hypersensitivity reaction (irritation, rash, urticaria)

Other: tongue irritation

Interactions

Drug-drug. Acetaminophen, amiodarone, clindamycin, clofibrate, corticosteroids, digoxin, diuretics, fat-soluble vitamins (A, D, E, and K), gemfibrozil, glipizide, imipramine, methotrexate, methyldopa, mycophenolate, niacin, nonsteroidal anti-inflammatory drugs, penicillin, phenytoin, phosphates, propranolol, tetracyclines, tolbutamide, thyroid preparations, ursodiol, warfarin: decreased absorption and effects of these drugs

Drug-diagnostic tests. Alkaline phosphatase: increased level

Hemoglobin: decreased value

Prothrombin time: increased

Patient monitoring

• Monitor CBC with white cell differential and liver function test results.

• If bleeding or bruising occurs, monitor prothrombin time. Drug may reduce vitamin K absorption.

• Watch for constipation, especially in patients with coronary artery disease. Take appropriate steps to prevent this problem.

Patient teaching

☞ Instruct patient to immediately report yellowing of skin or eyes or easy bruising or bleeding.

• Tell patient to take drug 1 hour before or 4 to 6 hours after other drugs.

• Teach patient about role of diet in controlling cholesterol level and preventing constipation.

• Instruct patient to avoid inhaling or ingesting raw powder. Tell him to mix powder with food, juice, or milk before consuming.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

Questran

(kwĕs′trən)

A trademark for the drug cholestyramine.

Cholestyramine (Questran)

A drug used to bind with bile acids and prevent their reabsorption and to stimulate fat absorption.

Mentioned in: Thyroid Function Tests

Mentioned in

References in periodicals archive

Upon treatment with Piper guineense or Sesamum indicum) and Questran, there was a significant reduction in body weight gain as well as high-density lipoprotein cholesterol (HDL-C) when compared with untreated rats with high blood cholesterol levels, confirming the cholesterol-lowering potential of these plant extracts.

Spices, also good for healthy hearts

Upon treatment with Piper guineense (PG) or Sesamum indicum (SI) and Questran, there was a significant reduction in body weight gain in treated-hypercholesterolemic animal compared to hypercholesterolemic control.

The effects of Piper guineense versus Sesamum indicum aqueous extracts on lipid metabolism and antioxidants in hypercholesterolemic rats

Welchol: Daiichi Sankyo Inc, Tokyo, Japan; Colestid: Pfizer Inc, New York, New York; LoCholest: Warner Chilcott Inc, Rockaway, New Jersey; Prevalite: Upsher-Smith Laboratories, Maple Grove, Minnesota; Questran: Par Pharmaceutical, Woodcliff Lake, New Jersey; Kayexalate: Concordia International Corp, Oakville, Ontario, Canada; and Renvela and Renagel: Sanofi SA, Paris, France.

Challenges in Diagnosing Medication Resins in Surgical Pathology Specimens: A Crystal-Clear Review Guide

These include Dilantin (used for seizures), steroid medications such as prednisone used to reduce inflammation or treat asthma, and Questran (cholestyramine), a cholesterol-lowering medication.

An application of integrative medicine: nutritional and other therapies can assist with co-occurring substance use and eating disorders

Bile acid sequestrants--cholestyramine (Questran and various other names), colestipol (Colestid), and colesevelam (WelChol)--are anion exchange resins that form insoluble complexes with bile acids in the intestine.

Antihyperlipidemic agents

to market two oral suspensions of cholestyramine, the generic version of Bristol-Myers Squibb Co.'s Questran.

FDA gives O.K. to range of products

The Flagyl and Questran were stopped and Ciprofloxacin 500 mg p.o.

An unusual case of diarrhea

Compound Dose Cholestryramine (CSM, Questran) One scoop, 9 g, on an empty stomach 30 min before food or taking other medication, four times a day for 2 weeks (FDA exemption letter issued 28 June 1999); CSM should be mixed well in water or apple juice Sorbitol, 70% solution 15 cc three times a day as needed to relieve constipation Prilosec (or Prevacid) Daily, one capsule as needed to treat reflux The dose of CSM used is approved for treatment of hypercholestrolemia by the FDA.

Possible Estuary-Associated Syndrome: Symptoms, Vision, and Treatment

An OTC switch for Questran, also a Bristol-Myers Squibb product, has been reviewed twice at hearings over the past 5 years, but the idea has been rejected twice.

FDA Panels Reject Making Low-Dose Statins Available OTC

There is a drug to control the itching (cholestyramine or Questran), and if you want to know more about it, and the condition in general, I suggest you write to the PBC Foundation at The Dean, Longniddry, East Lothian EH32 0PN.

Why can't I toe the line?

Two such medications are Cholestyramine (Questran) and Colestipol.

Linking learning with health behaviors in high school adolescents

Some medications can alter the sense of taste, either blunting flavors or making some foods taste different or "off." Among the drugs that may have this effect are penicillin, an antifungal medication called griseofulvin (Fulvicin, Grifulvin), the cholesterol-lowering drug cholestyramine (Questran), and medications used in chemotherapy for cancer.

Foods to watch out for when taking medication