Is cholestyramine used for diarrhea?

Questran

What should I discuss with my healthcare provider before taking cholestyramine?

You should not use cholestyramine if you are allergic to it, or if you have:

  • a blockage in your digestive tract (stomach or intestines).

To make sure cholestyramine is safe for you, tell your doctor if you have:

  • chronic constipation;
  • a thyroid disorder;
  • diabetes;
  • kidney disease;
  • liver disease; or
  • coronary artery disease (clogged arteries).

This medicine may contain phenylalanine. Talk to your doctor before using cholestyramine if you have phenylketonuria (PKU).

Taking cholestyramine can make it harder for your body to absorb certain vitamins. Your doctor may recommend you take a vitamin supplement.

You may have an even greater need for vitamin supplements during pregnancy or while you are breast-feeding a baby. Follow your doctor’s instructions about taking vitamin supplements during treatment with cholestyramine.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

How should I take cholestyramine?

Follow all directions on your prescription label. Your doctor may occasionally change your dose. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Although cholestyramine is usually taken once or twice per day, this medicine may be taken up to 6 times per day. Carefully follow your doctor’s dosing instructions.

Mix the cholestyramine powder with at least 2 to 3 ounces of water or other non-carbonated beverage. You may also mix the powder with a brothy soup, crushed pineapple, or applesauce. Measure the powder using the scoop provided with your medication. Do not use any other scoop or measuring cup to measure your cholestyramine dose.

Cholestyramine works best if you take it with meals. However, your dosing schedule may depend on when you need to take any other medications. Cholestyramine should not be taken within 1 hour after or 4 hours before you take other medications.

Use cholestyramine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Cholestyramine can affect the surfaces of your teeth. Sipping the cholestyramine/liquid mixture slowly or holding the liquid in your mouth for too long may result in tooth discoloration, enamel erosion, or tooth decay. Be sure to brush your teeth regularly while you are using this medicine.

Drink extra fluids to prevent constipation while you are taking cholestyramine.

While using cholestyramine, you may need frequent blood tests.

Cholestyramine is only part of a complete program of treatment that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

Store at room temperature away from moisture and heat.

Diarrhea is best described as the too frequent and often urgent passage of loose or watery stools, but there is no perfect definition of the disorder.
There are many causes, and diarrhea may be a mild nuisance or a disabling dysfunction with life-threatening consequences. Therefore, if you have anything more than mild, short-term diarrhea, you should consult a physician to obtain a diagnosis and specific treatment. If you have blood in the stool, signs of dehydration, weight loss, or fever such a consultation is urgent.
Acute diarrhea is usually short lived. In the case of viral infection, it must run its course. Antibiotics may shorten the duration of some parasitic and bacterial infections. Sometimes diagnosis is impossible or delayed, there is persistent diarrhea during or despite specific treatment, or intermittent diarrhea is part of irritable bowel syndrome (IBS).
The symptom of diarrhea can usually be managed until the underlying disease is brought under control. Sometimes, diarrhea persists despite everyone’s best efforts.

Hydration

People often underestimate the dehydrating effect of diarrhea, especially if it results from an acute infection in a hot climate. Dehydration may be less noticed in the elderly who often fail to experience appropriate thirst.

Fluid losses must be replaced. For mild episodes, drinking extra water may suffice. But where fluid losses are great, sodium and potassium may also be lost, so the glucose/saline solution recommended by the World Health Organization may be restorative. Your pharmacy will have a commercial version of this solution known as oral replacement therapy (ORT).

ORT is especially important for young children and the elderly. Severe cases may require fluids administered intravenously. For mild cases, soups and juices may suffice. For some acute diarrheal illnesses, hydration is all that is required.

Signs of Dehydration

General signs of dehydration include:

  • thirst
  • less frequent urination
  • dry skin
  • fatigue
  • light-headedness
  • dark colored urine

Signs of dehydration in children include:

  • dry mouth and tongue
  • no tears when crying
  • no wet diapers for 3 hours or more
  • sunken abdomen, eyes, or cheeks
  • high fever
  • listlessness or irritability
  • skin that does not flatten when pinched and released

Diet

Although you may have undergone investigation that has excluded dietary causes, you should know that several commonly ingested substances tend to loosen stools.

Caffeine is present in coffee, tea and cola drinks. Reduced caffeine intake or decaffeinated drinks may ease your diarrhea. (Beware that sudden cessation of caffeine may cause headaches, so withdraw slowly.)

Sorbitol, a common artificial sweetener in certain preserves, gum, and candy, has laxative effects and should also be avoided.

Since the ability to absorb lactose (milk sugar) may be impaired, you should avoid milk products until the diarrhea improves.

While reducing food intake may be wise in acute diarrhea, it is important to maintain nutrition if the attack lasts more than a few days.

For severe diarrhea, it may be necessary to avoid solid foods for a time, maintaining nutrition with clear fluids, that is, fluids with sugars and proteins through which light passes such as juices, consommé, and jellies. Some soft drinks and sweet juices may contain sugars that are difficult to absorb and therefore may aggravate the diarrhea. After acute infections, lactose and complex carbohydrates may be ill absorbed and should be avoided for a few days.

Bulking Agent

Psyllium (Metamucil, Fybogel, generics) – One teaspoonful of psyllium twice daily is often recommended for constipation, so why use it for diarrhea? The answer is that it has a water-holding effect in the intestines that may help bulk up watery stool. Some doctors recommend it for the variable bowel habit of IBS. It also has the ability to bind some toxins that may be the cause of acute diarrhea. Obviously, psyllium products combined with laxatives should be avoided.

Before taking any medication, whether over the counter or prescription, talk to your healthcare provider or pharmacist about dosage, other medicines you are taking, or any other questions you might have about the treatment. Otherwise, carefully follow the directions on the drug package or on your prescription label.

Over the Counter (OTC) Drugs

Bismuth (Pepto-Bismol, generics) – This preparation is sometimes recommended for traveler’s diarrhea and chronic microscopic colitis. It has many disadvantages. The dose is 30ml of the pink liquid every 30 minutes up to 8 times a day. It turns the stool black and may interfere with the absorption of other drugs such as diphenoxylate (See below) and tetracycline. Chronic, excessive use may cause neurological complications and the salicylate component of the drug may cause salicylate toxicity.
Codeine – Codeine 15 mg. combined with acetaminophen (Tylenol, generic) is available by prescription or over the counter (OTC) in some jurisdictions. If nothing else is handy when stricken with acute diarrhea, two such tablets may help control your acute diarrhea until a regular antidiarrheal drug can be obtained. Beware that overuse use of an OTC codeine combination could include toxic doses of acetaminophen.
Loperamide (Imodium) – The safest of the opioid drugs, loperamide is available OTC in 1 and 2mg doses. Depending on age, the recommended dose is 2 mg after each loose bowel movement to a maximum of 16 mg/day. It has an opioid’s ability to slow gut transit and improve absorption of water from the intestines. Some evidence suggests it also improves anal sphincter tone. Although it has the lowest addiction potential of all opioids, it may cause sedation, nausea, and cramps. It is the best emergency treatment for mild attacks of diarrhea, and when taken preventively it may even help you avoid urgent exits during meetings or other events.

Prescription Drugs

Codeine phosphate (generic) – The usual therapeutic dose of Codeine is 30 to 60 mg up to every four hours as necessary to control diarrhea. For this, a prescription is required in most jurisdictions. Codeine is potentially addicting, and unsuitable for chronic diarrhea. It is sedating, and causes nausea, making it a second choice after loperamide.

Diphenoxylate (Lomotil) – Because it is an opiate with some addictive potential, diphenoxylate is available only by prescription. It is combined with atropine so that excessive use will cause dry mouth and other undesirable side effects. It is useful if other drugs fail.
Cholestyramine (Questran) – Cholestyramine is a powdered resin with a plastic taste that binds bile salts and has a water-holding effect. When other treatments fail, it may relieve some cases of diarrhea. Rarely, chronic diarrhea occurs after removal of the gall bladder or the lower small intestine (ileum), and cholestyramine has a beneficial effect. Usually prescribed for patients with high cholesterol blood levels, it is available in 4mg packets and is taken with water. Occasionally, a very small dose will improve diarrhea, but for most cases, loperamide is preferable. In addition to its bad taste, cholestyramine may interfere with the absorption of some drugs and vitamins, and may cause hypersensitivity reactions. It should only be used for special cases with a doctor’s advice.

How to Use the Drugs

No medicine is risk free. Ask a pharmacist or your healthcare professional if you are not sure how much medicine to take, how often to take it, or whether an interaction may occur with any other medicine you are taking. Always tell your health care professionals about all the medicines you are taking, including OTC and prescription medicines.

For mild or acute, short-lived diarrhea, most adults may treat themselves with:

  • Hydration
  • Diet adjustments
  • OTC drugs

However, if your diarrhea is severe, prolonged, or accompanied with blood, high (101°F, 39°C) fever, or 10 lb (5kg) weight loss, you should consult a doctor. Special vigilance is required at the extremes of life.
You should use drugs only as necessary, and stop them when the diarrhea stops. In the case of loperamide, you should take the drug after each loose bowel movement. If your social life or business affairs are hampered by unpredictable diarrhea, loperamide may be taken before an event to prevent embarrassing trips to the toilet. Sedation, severe abdominal cramps, or other unexplained symptoms are indications to stop the drug and seek an explanation from your doctor.
Antidiarrheal drugs should be used cautiously and with a doctor’s supervision if the diarrhea is severe. Because they delay colon evacuation, opiates may prolong an intestinal infection (colitis), and in severe colitis, they may precipitate a paralysis of the colon with dire consequences.
Conclusion
For anything more than mild, short-lived diarrhea, a diagnosis is necessary in order to properly treat the underlying cause.
In every case, adequate hydration must be assured. For a short time, clear fluids may suffice, and ORT is available at any pharmacy for more prolonged or severe cases.
Severe watery diarrhea, bloody stools, fever, and weight loss are warning signs requiring a doctor’s assessment and perhaps intravenous fluids and salts.
Sometimes a bulking agent such as psyllium will help, but for moderately severe acute diarrhea, food must be forgone until the diarrhea subsides, or a doctor can make recommendations.
Used as directed, loperamide after loose bowel movements is the safest OTC medication for managing diarrhea. The maximum approved daily dose for adults is 8 mg per day for OTC use and 16 mg per day for prescription use. Never take more than recommended doses. A doctor should be consulted if they fail.

Severe diarrhea can be life-threatening, so caution is important, especially in the very young and very old.
Source:
Adapted from IFFGD publication #201 by W. Grant Thompson, MD, FRCPC, Emeritus Professor of Medicine, University of Ottawa, Ontario, Canada

  • Functional Diarrhea
  • Common Causes of Chronic Diarrhea
  • Managing Diarrhea
  • Nutrition Strategies for Managing Diarrhea

questran light

Review by Tony

I had my gallbladder removed more than a year ago and I was very happy because I was saved from the horrible pain that the gallstones caused. After the surgery, my surgeon told me that I was cured and that I was not going to miss my gallbladder. Well, to tell you the truth I now miss my gallbladder very much.

The reason for this is that after the surgery I developed nasty diarrhea, and I had a horrible time. I couldn’t think of anything else but my bowel. I couldn’t go anywhere without going to the bathroom seven or eight times and draining my bowel. I started to become isolated and afraid to get out of the house, because of the fear of this crazy diarrhea.

It was the worst time of my life and I wanted answers. I talked to a gastroenterologist and he recommended Questran Light. Man, I was saved. I am taking two packets a day, one in the morning, one at night, and I feel so much better. I know that there are people out there just like me with the same symptoms and I hope that everybody gets well because we are the ones who know how embarrassing and devastating IBS can be. So for sure I will recommend Questran, but make sure to talk to your doctor first, because not everybody can use this drug.

Do you suffer from IBS? Have you tried Questran Light? Please contact Sophie to send in your review.

QUESTRAN® LITE

colestyramine resin

Consumer Medicine Information

What is in this leaflet

This leaflet answers some common questions about QUESTRAN LITE. It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you taking QUESTRAN LITE against the benefits they expect it will have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet. You may need to read it again.

What QUESTRAN LITE is used for

QUESTRAN LITE is used to reduce high levels of cholesterol in the blood & the prevention of coronary heart disease. The relief of pruritis (itching) associated with the flow of bile being partially blocked. The relief of diarrhoea caused by surgery or disease of the small bowel.

QUESTRAN LITE contains colestyramine (KOL-es-TIE-rameen) which belongs to a group of medicines called resins. It reduces the level of cholesterol in the blood by combining with bile in the small intestine to form an insoluble complex, which is then excreted in faeces.

The reduction of blood cholesterol levels help to prevent blockages in the blood vessels to the heart which reduces the likelihood of angina (chest pain with heart disease) & heart attacks

QUESTRAN LITE may be used alone or in combination with other medicines. Your doctor will inform you if this is necessary.

Your doctor may have prescribed this medicine for another reason.

Ask your doctor if you have any questions about why QUESTRAN LITE was prescribed for you.

There is no evidence that it is addictive.

This medicine is only available with a doctor’s prescription.

The safety & effectiveness of using QUESTRAN LITE in infants & children has not been established.

Before you use it

When you must not use it

Do not use QUESTRAN LITE if you have an allergy to colestyramine or any of the ingredients listed at the end of this leaflet, unless you have discussed it with your doctor.

Symptoms of an allergic reaction may include:

  • chills/fever
  • fast heart beat
  • difficulty in breathing, shortness of breath
  • dizziness or lightheadedness

Do not use QUESTRAN LITE if you have been diagnosed with complete biliary obstruction, where no bile is secreted into the intestine.

Do not use QUESTRAN LITE after the expiry date printed on the pack. If you take this medicine after the expiry date has passed, it may not work as well.

Do not use it if the packaging is torn or shows signs of tampering.

If you are not sure whether you should have QUESTRAN LITE, talk to your doctor.

Tell your doctor if you have allergies to:

  • any other medicines
  • any other substances, such as foods, preservatives or dyes

Tell your doctor if you have or have had any medical conditions, especially the following:

  • liver problems
  • jaundice – yellowing of the skin & eyes
  • phenylketonuria (PKU)
  • blood problems – blood clotting associated with vitamin K deficiency
  • hyperchloraemic acidosis – too much chloride in the blood
  • constipation

Tell your doctor if you are pregnant or intend to become pregnant. Like most medicines QUESTRAN LITE is not recommended for use during pregnancy, unless you & your doctor have discussed the risks & benefits involved.

Tell your doctor if you are breast-feeding or plan to breastfeed. There is the possibility that the breast-fed baby may be affected.

If you have not told your doctor about any of the above, tell them before you start having QUESTRAN LITE.

Taking other medicines

Tell your doctor if you are taking any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food shop.

Some medicines and QUESTRAN LITE may interfere with each other. These include:

  • phenylbutazone
  • thyroid & thyroxine preparations
  • warfarin
  • chlorothiazide
  • tetracycline
  • phenobarbitone
  • digitalis
  • aldosterone antagonists
  • inorganic iron

Do not stop taking QUESTRAN LITE if you have been taking a medicine with toxic side effect such as digitalis while you are using QUESTRAN LITE as this could be hazardous to your health.

These medicines may be affected by QUESTRAN LITE, or affect how well it works. You may need different amounts of your medicine, or you may need to have different medicines. Your doctor will advise you.

Your doctor may have more information on medicines to be careful with or avoid, when using QUESTRAN LITE.

How to take it

How much to take

Your doctor will decide what dose you will receive. Your dose of QUESTRAN LITE is worked out based on your condition & whether you are taking other medicines. The dose worked out for you may be different to the dose for another patient.

The recommended dose:

  • Adults – maintenance or on-going therapy 12 to 16 g of colestyramine resin equivalent to 14.1 to 18.8g of QUESTRAN LITE per day.
  • Children & Infants – No dosage regimen has been established for children. Your doctor will start therapy in a child with small doses and adjust the dose, depending on the child’s response to initial therapy.

Ask your doctor if you want to know more about the dose of QUESTRAN LITE you receive.

QUESTRAN LITE should not be taken in its dry form; it must always be mixed with water or other fluids before taking.

  1. Add the contents of the 4g sachet to 100-150ml of water or fruit juice.
  2. Mix immediately by stirring vigorously.
  3. Continue to stir until the mixture is even (the powder will not dissolve).
  4. Drink the entire mixture immediately, rinse the container & drink the rinse to ensure that you have taken the full dose.

Make sure you use the full amount of water and ensure that it is well mixed before you drink it.

You can mix QUESTRAN LITE with thin soups, pulpy fruits with a high water content e.g. pureed apple or crushed pineapple. If care is taken you can mix it with carbonated drinks.

When to take it

Take QUESTRAN LITE at about the same time each day. Taking your sachet(s) at the same time each day will have the best effect. It will also help you remember when to take your sachet(s).

If you are taking other medicines, you must take them one hour before taking your QUESTRAN LITE or four to six hours after taking your QUESTRAN LITE

If you forget to take it

If it is almost time for next dose, skip the dose that you missed & take your next dose when you are meant to. Otherwise, take your dose as soon as you remember it, and then go back to taking it as you would normally.

Do not take a double dose to make up for the dose that you missed; this may increase the chance of getting an unwanted side effect.

If you are not sure of what to do, ask your doctor or pharmacist.

How long to take it

QUESTRAN LITE helps to control your condition but it does not cure it.

Therefore you must take QUESTRAN LITE every day.

Continue taking QUESTRAN LITE for as long as your doctor tells you to.

If you take too much (overdose)

Immediately contact your doctor, pharmacist or the poisons information centre, (telephone 131126) if you think that you or anyone else may have taken too much QUESTRAN LITE. Do this even if there are no signs of discomfort or poisoning.

Your doctor or pharmacist has information on how to recognize & treat an overdose.

Ask your doctor or pharmacist if you have any concerns.

While you are using it

Things you must do

Tell any other doctors, dentists and pharmacists who are treating you that you are having QUESTRAN LITE.

If you are about to be started on any new medicine, tell your doctor, dentist or pharmacist that you are having QUESTRAN LITE.

If you plan to have surgery that needs a general anaesthetic, tell your doctor or dentist that you are having QUESTRAN LITE.

If you become pregnant while having QUESTRAN LITE, tell your doctor.

Have regular blood tests when your doctor says to ensure that QUESTRAN LITE is working.

Things you must not do

Do not give your medicine to anyone else, even if they have the same condition as you.

Do not take QUESTRAN LITE to treat any other complaints unless your doctor tells you to.

Do not stop taking it, or lower the dose, without checking with your doctor.

Do not take QUESTRAN LITE in its dry form. Always mix it with water or other fluids before you take it.

Things to be careful of

Be careful driving or operating machinery until you know how QUESTRAN LITE affects you. As with other medicines QUESTRAN LITE may cause dizziness, light-headedness, drowsiness or tiredness in some people.

Make sure you know how you react to it before you drive a car, operate machinery, or do anything else that could be dangerous if you are dizzy or light-headed. If you drink alcohol, your dizziness or light-headedness may be worse.

Avoid drinking large quantities of alcohol. Large quantities of alcohol may increase your chance of QUESTRAN LITE causing liver problems.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are having QUESTRAN LITE.

It may have unwanted side effects, some of which may be serious. You may need medical treatment if you get some of the side effects.

Ask your doctor to answer any questions you may have.

Tell your doctor or pharmacist if you notice any of the following and they worry you:

These are the most common side effects of QUESTRAN LITE

  • constipation
  • haemorrhoids

Tell your doctor or pharmacist as soon as possible if you notice any of the following:

These are the less common side effects of QUESTRAN LITE

  • abdominal pain
  • flatulence
  • nausea & vomiting
  • heartburn
  • diarrhoea
  • anorexia – loss of appetite
  • indigestion
  • rash & irritation of the tongue, skin or anal area
  • osteoporosis
  • changes in bowel motions
  • chest pain
  • headache
  • anxiety
  • dizziness
  • drowsiness

If any of the following happen, tell your doctor or pharmacist immediately, or go to Accident and Emergency at your nearest hospital:

These are very serious side effects. You may need urgent medical attention or hospitalisation.

  • sudden life-threatening allergic reactions; sudden signs of allergy such as rash, itching or hives on the skin, swelling of the face, tongue or other parts of the body, shortness of breath, wheezing or trouble breathing

Other side effects not listed above may occur in some patients. Tell your doctor or nurse if you notice anything that is making you feel unwell.

After using it

Storage

QUESTRAN LITE sachets should be stored below 30° C.

QUESTRAN LITE sachets should be kept out of the reach of children. A locked cupboard at least one & a half meters above the ground is a good place to store medicines.

If your doctor tells you to stop taking QUESTRAN LITE, return any that you have not taken to your doctor or pharmacist, so they can be disposed of safely.

Product description

What it looks like

QUESTRAN LITE is an off-white coloured powder, available in sachets containing 4g of powder. They are supplied in boxes of 50 sachets.

Ingredients

Active: The active ingredient in QUESTRAN LITE is colestyramine resin

Each sachet contains the equivalent of 4g of colestyramine resin.

Inactive: Each sachet also contains kelcoloid LVF, xanthan gum, natural & artificial orange juice flavour, aspartame, citric acid & silicon dioxide.

Aspen Pharma Pty Ltd
34-36 Chandos Street
St Leonards NSW 2065
Australia

Australian Registration Numbers:

QUESTRAN LITE Austr 11971

This leaflet was updated in May 2018

Published by MIMS August 2018

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