Cholestagel (UK), Welchol
Pharmacologic class: Bile acid sequestrant
Therapeutic class: Antihyperlipidemic
Pregnancy risk category B
Binds bile acids in GI tract and forms insoluble complex, impeding bile acid reabsorption and promoting its excretion. As a result, cholesterol and low-density lipoprotein (LDL) levels decrease.
Oral suspension: 3.75 g packet
Tablets: 625 mg
⊘Indications and dosages
➣ Adjunct to diet and exercise to reduce LDL cholesterol in patients with primary hypercholesterolemia
Adults and children ages 10 to 17: Three tablets (1,875 mg) P.O. b.i.d., or six tablets (3,750 mg) once daily; or, one 3.75-g packet P.O. once daily.
➣ Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus
Adults: Three tablets (1,875 mg) P.O. b.i.d., or six tablets (3,750 mg) P.O. once daily; or, one 3.75-g packet P.O. once daily
• Hypersensitivity to drug
• Bowel obstruction
• Serum triglyceride level above 500 mg/dl or history of hypertriglyceridemia-induced pancreatitis
Use cautiously in:
• susceptibility to vitamin K deficiency (such as patients on warfarin or those with malabsorption syndrome), concomitant use of fat-soluble vitamins
• patients with dysphagia or swallowing disorders, gastroparesis, other GI motility disorders; those who have had major GI tract surgery and who may be at risk for bowel obstruction
• children (safety and efficacy not established).
• Give with meals and fluids.
• Ensure that patient swallows tablets whole without crushing or chewing.
• Mix prescribed powder packet with 4 to 8 ounces of water, fruit juice, or diet soft drinks.
• Know that drug may be used alone or with HMG-CoA reductase inhibitor.
CNS: headache, anxiety, vertigo, dizziness, insomnia, fatigue, syncope
GI: nausea, vomiting, diarrhea, constipation, abdominal discomfort, flatulence, fecal impaction, loose stools, fatty stools, rectal or hemorrhoidal bleeding, other GI bleeding
GU: increased libido
Hematologic: anemia, bleeding tendency
Metabolic: malabsorption of vitamins A, D, E, and K
Musculoskeletal: back, muscle, or joint pain
Drug-drug.Fat-soluble vitamins (A, D, E, and K): decreased vitamin absorption
• Monitor lipid levels before starting therapy and periodically thereafter.
• Instruct patient to take drug with meals as directed.
• Instruct patient to mix powder packet for oral suspension with 4 to 8 ounces of water, fruit juice, or diet soft drinks; stir well, and drink. Tell patient not to take powder in its dry form.
• Instruct patient to take any vitamins at least 4 hours before taking this drug.
• Tell patient to report persistent GI upset, back or muscle pain or weakness, and respiratory problems.
• If drug causes constipation, instruct patient to increase exercise, drink plenty of fluids, consume more fruits and fiber, or take a stool softener.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.