Colestyramine oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations of colestyramine resin.
Drugs List
Therapeutic Indications
Uses
Diarrhoea (after vagotomy)
Diarrhoea (from ileal disease or resection)
Hyperlipidaemia type 2
Management of radiation induced diarrhoea
Pruritus due to liver disease
Treatment of primary hypercholesterolaemia resistant to diet
Dosage
Adults
Primary prevention of coronary heart disease, cholesterol reduction
Colestyramine dosage regime should be gradually introduced over a three to four week period to reduce the risk of gastrointestinal upsets. The dose is given either as a single daily dose or divided doses up to four times daily, according to patient acceptability and dosage requirements. The final dose is usually in the range of three to six sachets per day and may be increased up to nine sachets a day if necessary.
The following schedule can be used to guide the phasing in of colestyramine:
Initiate treatment at 4g daily and increase in steps of 4g weekly, to between 12g and 24g daily given in one to four divided doses. The maximum dose is 36g daily.
Relief of diarrhoea
Same as above, although dose reduction may be possible.
Relief of pruritus
4g to 8g daily.
Children
To minimise potential gastrointestinal side effects, it is desirable to begin all therapy in children with one dose of colestyramine daily.
Children aged 12 to 18 years
(See Dosage; Adult)
Children aged 6 to 12 years
Initial dose = (Bodyweight in kg x Adult dose) divided by 70.
Subsequent dosage adjustment may be necessary where clinically indicated.
The following alternative dosing schedule may be suitable:
Familial hypercholesterolaemia
Children aged 12 to 18 years: Initial dose: 4g daily. Increase in steps of 4g weekly, to between 12g and 24g daily given in one to four divided doses. The maximum dose is 36g daily.
Children aged 6 to 12 years: Initial dose: 4g daily. Increase up to 4g three times daily titrated to response.
Pruritus; Diarrhoea
Children aged 12 to 18 years: 4g to 8g once daily (up to a maximum of 36g daily).
Children aged 6 to 12 years: 4g once daily (up to a maximum of 24g daily).
Children aged 1 to 6 years: 2g once daily (up to a maximum of 18g daily).
Children aged 1 month to 1 year: 1g once daily (up to a maximum of 9g daily).
If diarrhoea does not resolve within three days, an alternative agent should be considered.
Add powder to a suitable liquid and titrate dose according to response. The total daily dose may alternatively be given in two to four divided doses
Contraindications
Neonates under 1 month
Complete biliary obstruction
Precautions and Warnings
Children aged 1 month to 6 years
Breastfeeding
Glucose-galactose malabsorption syndrome
Hereditary fructose intolerance
Phenylketonuria
Pregnancy
Some formulations contain aspartame - caution in phenylketonuria
Folate supplementation may be necessary in some patients
Contains polyethylene glycol
Some formulations contain sucrose
Administer concurrent drugs 1 hour before or 4-6 hrs after this medication
Bile acid malabsorption diarrhoea: change therapy if no response in 3 days
Chronic use may cause increased bleeding tendency due to vit K deficiency
Doses > 24g/day of colestyramine may interfere with normal fat metabolism
Prolonged use may cause hyperchloremic acidosis especially in children
Supplements of fat-soluble vitamins A,D,E and K may be required
This product should not be taken in the dry form-mix with fluid as directed
Reduction of serum folate concentrations have been reported in children with familial hypercholesterolaemia.
Vitamin K deficiency will usually respond to parenteral vitamin K administration promptly. Recurrences can be prevented by oral administration of vitamin K.
Pregnancy and Lactation
Pregnancy
Colestyramine should be used with caution during pregnancy.
The safety of colestyramine in pregnancy has not been established and the possibility that interference may occur with the absorption of fat-soluble vitamins should be considered. Because this may be detrimental to the foetus, colestyramine should not be given during pregnancy unless considered essential.
Lactation
Colestyramine should be used with caution during breastfeeding.
The safety of colestyramine in breastfeeding has not been established and the possibility that interference may occur with the absorption of fat-soluble vitamins should be considered.
Side Effects
Abdominal discomfort
Anorexia
Constipation
Diarrhoea
Dyspepsia
Flatulence
Heartburn
Hyperchloraemic acidosis
Increased bleeding tendency
Interference with absorption of fat soluble vitamins
Intestinal obstruction
Nausea
Night blindness
Osteoporosis
Perianal irritation
Rash
Skin irritation
Steatorrhoea
Tongue irritation
Vomiting
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: May 2016
Reference Sources
Summary of Product Characteristics: Questran 4g/sachet Powder for Oral Suspension. Neon Healthcare Limited. Revised February 2022.
Summary of Product Characteristics: Questran Light. Bristol-Myers Squibb Holdings Ltd. Revised January 2014.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 12 July 2022
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