Colestyramine

Registered South African indications:

• Familial hypercholesterolaemia
• Familial combined hyperlipidaemia
• Polygenic hypercholesterolaemia
• Hyperbilirubinaemia-associated pruritus
• Diarrhoea secondary to bile-acid malabsorption

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Complete biliary obstruction

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment
• Children with familial hypercholesterolaemia
• Prolonged, high dose administration

Forms avail. in SA and covered in this monograph: sac

Familial hypercholesterolaemia
Familial combined hyperlipidaemia
Polygenic hypercholesterolaemia
Diarrhoea secondary to bile acid malabsorption

• Oral (sac): Initial: 4g, dly; Titrate by 4g at intervals of 1 month; Maintenance: 12-24g/day, in 1-4 divided doses; Max dose: 24g/24hrs

Should not be taken in dry form

Should be administered mixed with water or juice and stirred to a uniform consistency

Other medication should be taken 1hr before or 4-6hrs after colestyramine to minimise interference with absorption

Pruritus secondary to biliary obstruction

• Oral (sac): 4-8g/day, in divided doses

Paed. forms avail. in SA and covered in this monograph: sac

Familial hypercholesterolaemia
Familial combined hyperlipidaemia
Polygenic hypercholesterolaemia 

Younger than 6 years

• Not established for use

Between 6-12 years

• Oral (sac): 240mg/kg/day, in 2-3 divided doses; Max: 8g/24hrs

Older than 12 years

• See adult dosage

Should not be taken in dry form

Should be administered mixed with water or juice and stirred to a uniform consistency

Other medication should be taken 1hr before or 4-6hrs after colestyramine to minimise interference with absorption

Pregnancy

• Caution
• The safety of colestyramine in pregnancy has not been established and the possibility of interference with absorption of fat soluble vitamins should be considered

Breastfeeding

• Caution
• The safety of colestyramine in breastfeeding has not been established and the possibility of interference with absorption of fat soluble vitamins should be considered

Renal Impairment

• Caution; no dose adjustment recommended

Hepatic Impairment

• No dose adjustment recommended 

Elderly

• No dose adjustment recommended 

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Gastrointestinal Disorders

• Constipation
• Abdominal discomfort
• Flatulence
• Nausea and vomiting
• Diarrhoea
• Heartburn
• Dyspepsia
• Intestinal obstruction
• Steatorrhea 

Endocrine and Metabolic Disorders

• Anorexia
• Hyperchloremic acidosis
• Vitamin A, D, E, K deficiency

Musculoskeletal Disorders

• Osteoporosis

Skin and Subcutaneous Tissue Disorders

• Rash
• Irritation of skin, tongue and perianal area

Immune, Blood and Lymphatic System Disorders

• Hypoprothrombniaemia (Vitamin K deficiency) leading to bleeding tendencies

• Digoxin
• Tetracycline
• Hydrochlorothiazide
• Warfarin
• Thyroxine

• Lipid profile

Colestyramine resin absorbs and combines with the bile acids in the intestine to form an insoluble complex which is excreted in the faeces. This results in a continuous removal of bile acids from the enterohepatic circulation by preventing their reabsorption. The increased faecal loss of bile acids leads to an increased oxidation of cholesterol to bile acids and a decrease in serum cholesterol levels and low-density lipoprotein serum levels.

Sachet 4g

• Questran Lite (Bristol Myers) originator