colestyramine anhydrous: clinical use

Prescribing considerations

• Investigate and manage secondary causes before use for hypercholesterolaemia.
• Avoid use for exudative or bloody diarrhoea; selected products are not supported for children under six years.
• Review medicines, supplements and contraceptives because gastrointestinal binding affects many agents.
• Assess pre-existing constipation, haemorrhoids, renal impairment and situations where straining should be avoided.
• Excipients may determine suitability for diabetes, hereditary sugar disorders or phenylketonuria.

Contraindications and cautions

• Hypersensitivity to colestyramine or a product excipient.
• Complete biliary obstruction, where bile does not enter the intestine.

Monitoring

• For lipid indications, monitor cholesterol response and triglycerides.
• Monitor constipation and symptoms of faecal impaction or bowel obstruction.
• During prolonged treatment, consider fat-soluble vitamin status and evidence of vitamin K-related bleeding.
• Consider folate status in children with familial hypercholesterolaemia.
• Consider acid-base assessment in younger or smaller patients and those with renal impairment.
• Monitor responses to interacting medicines, particularly anticoagulants, thyroid hormones and cardiac glycosides.

Clinical pharmacology

A non-absorbed, chloride-form anion-exchange resin that binds intestinal bile acids, interrupts enterohepatic recycling and increases faecal bile acid loss. It can also bind medicines and fat-soluble vitamins.

Formulation and product differences

• Colestyramine Powder for Oral Suspension contains sucrose and propylene glycol; consider diabetes and relevant hereditary sugar disorders.
• Questran Light contains aspartame, a phenylalanine source, and propylene glycol; assess suitability in phenylketonuria.
• Both selected products are orange-flavoured powders requiring dispersion before administration.

Oral suspension

Route: Oral

Strengths: 4 g