colesevelam hydrochloride: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
colesevelam hydrochloride: clinical details
Prescribing considerations
- Exclude and manage secondary causes of hypercholesterolaemia before initiation.
- Use caution with raised triglycerides, dysphagia, severe gastrointestinal motility disorders, inflammatory bowel disease, liver failure, major gastrointestinal surgery or significant constipation.
- Safety and efficacy have not been established in children and adolescents.
- Consider whether the tablet size and need to swallow it whole are suitable for the patient.
Contraindications and cautions
- Hypersensitivity to colesevelam hydrochloride or an excipient
- Bowel obstruction
- Biliary obstruction
Monitoring
- Check total cholesterol, LDL cholesterol and triglycerides to assess response and detect triglyceride elevation.
- Monitor anticoagulation closely with warfarin or similar agents.
- Monitor ciclosporin concentrations when colesevelam is started or stopped.
- For patients susceptible to malabsorption or deficiency, consider vitamins A, D and E and vitamin K status through coagulation parameters.
Clinical pharmacology
Colesevelam is a non-absorbed polymeric bile acid sequestrant. Interruption of enterohepatic bile acid recycling increases hepatic conversion of cholesterol to bile acids and LDL-receptor activity, increasing LDL clearance; triglycerides may rise.
Formulation and product differences
- The selected product is an off-white to light-yellow, capsule-shaped film-coated tablet.
- The tablets must remain intact and are supplied in a moisture-protective bottle containing an oxygen-absorber sachet.
colesevelam hydrochloride preparations and strengths
Tablet
Route: Oral
Strengths: 625 mg
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.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.