colesevelam hydrochloride at a glance
Medicine class
Bile acid sequestrant
Licensed use
Primary hypercholesterolaemia in adults
Where it works
Within the gastrointestinal tract, without entering the bloodstream
Administration
Take with a meal and liquid, swallowing the tablets whole
What is colesevelam hydrochloride used for?
Licensed and non-licensed uses should be distinguished.
Licensed: lowering total and LDL cholesterol in adults with primary hypercholesterolaemia when a statin is inappropriate or not tolerated.
Licensed: additional LDL-cholesterol lowering with a statin when statin treatment alone is insufficient.
Licensed: use with ezetimibe, with or without a statin, including in familial hypercholesterolaemia.
Non-licensed: specialist treatment of diarrhoea caused by bile acid malabsorption, commonly when another bile acid sequestrant is ineffective or not tolerated.
How does colesevelam hydrochloride work?
Colesevelam binds bile acids inside the intestine and prevents their usual recycling. The liver then converts more cholesterol into bile acids and removes more LDL cholesterol from the blood. Colesevelam itself is not absorbed from the gastrointestinal tract.
colesevelam hydrochloride preparations and strengths
Tablet
Route: Oral
Strengths: 625 mg
How to take colesevelam hydrochloride
Follow the prescriber's instructions and continue any recommended cholesterol-lowering diet.
Take the tablets with a meal and liquid.
Swallow them whole; do not break, crush or chew them.
Check the timing of other medicines with a pharmacist or prescriber because colesevelam can alter their absorption.
Keep the bottle tightly closed to protect the tablets from moisture.
colesevelam hydrochloride side effects
Common or expected effects
- Wind and constipation
- Nausea, vomiting or diarrhoea
- Indigestion, abdominal pain or bloating
- Changes in stools
- Headache
- Raised blood triglycerides
Get urgent medical advice
- Possible bowel obstruction: severe or cramping abdominal pain, vomiting, swelling, or inability to pass stool or wind
- Possible pancreatitis: sudden severe upper abdominal pain, particularly if it spreads to the back
- Severe allergic reaction: throat or tongue swelling, breathing difficulty, faintness or collapse
colesevelam hydrochloride in pregnancy
Direct fetal exposure is expected to be low because colesevelam is not absorbed from the gut. However, human pregnancy data are very limited, and prolonged treatment may reduce fat-soluble vitamin availability. Discuss pregnancy or plans for pregnancy with the prescriber or specialist rather than stopping treatment without advice.
colesevelam hydrochloride while breastfeeding
Direct infant exposure is expected to be low because colesevelam is not absorbed, but safety during breastfeeding has not been established. Review the need for treatment and the possibility of maternal fat-soluble vitamin deficiency with the prescriber, particularly with prolonged use or malabsorption.
colesevelam hydrochloride interactions
Colesevelam can bind medicines in the gut or otherwise alter their exposure. Confirm timing and monitoring requirements with a pharmacist or prescriber.
Levothyroxine
Colesevelam can reduce levothyroxine absorption.
Oral contraceptive pills
Taking them together can reduce hormone exposure.
Warfarin and similar anticoagulants
Reduced vitamin K absorption may alter anticoagulation, requiring closer monitoring.
Ciclosporin
Colesevelam lowers ciclosporin exposure; blood concentrations require monitoring when either medicine is started or stopped.
Common questions about colesevelam hydrochloride
Answers are fully visible for fast scanning and source review.
Is colesevelam hydrochloride a statin?
No. It is a bile acid sequestrant that works in the intestine and may be used alone or with a statin or ezetimibe.
Is it used for bile acid diarrhoea?
Some specialist services use it for diarrhoea associated with proven bile acid malabsorption, but this is a non-licensed use.
Can it raise triglycerides?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.