Side effect of cholestyramine

Questran

SIDE EFFECTS

The most common adverse reaction is constipation. When used as a cholesterol-lowering agent predisposing factors for most complaints of constipation are high dose and increased age (more than 60 years old). Most instances of constipation are mild, transient, and controlled with conventional therapy. Some patients require a temporary decrease in dosage or discontinuation of therapy.

Less Frequent Adverse Reactions: Abdominal discomfort and/or pain, flatulence, nausea, vomiting, diarrhea, eructation, anorexia, and steatorrhea, bleeding tendencies due to hypoprothrombinemia (Vitamin K deficiency) as well as Vitamin A (one case of night blindness reported) and D deficiencies, hyperchloremic acidosis in children, osteoporosis, rash and irritation of the skin, tongue and perianal area. Rare reports of intestinal obstruction, including two deaths, have been reported in pediatric patients.

Occasional calcified material has been observed in the biliary tree, including calcification of the gallbladder, in patients to whom QUESTRAN has been given. However, this may be a manifestation of the liver disease and not drug related.

One patient experienced biliary colic on each of three occasions on which he took QUESTRAN. One patient diagnosed as acute abdominal symptom complex was found to have a “pasty mass” in the transverse colon on x-ray.

Other events (not necessarily drug related) reported in patients taking QUESTRAN include:

Gastrointestinal – GI-rectal bleeding, black stools, hemorrhoidal bleeding, bleeding from known duodenal ulcer, dysphagia, hiccups, ulcer attack, sour taste, pancreatitis, rectal pain, diverticulitis.

Laboratory test changes – Liver function abnormalities.

Hematologic – Prolonged prothrombin time, ecchymosis, anemia

Hypersensitivity – Urticaria, asthma, wheezing, shortness of breath.

Musculoskeletal – Backache, muscle and joint pains, arthritis.

Neurologic – Headache, anxiety, vertigo, dizziness, fatigue, tinnitus, syncope, drowsiness, femoral nerve pain, paresthesia.

Eye – Uveitis.

Renal – Hematuria, dysuria, burnt odor to urine, diuresis.

Miscellaneous – Weight loss, weight gain, increased libido, swollen glands, edema, dental bleeding, dental caries, erosion of tooth enamel, tooth discoloration.

Read the entire FDA prescribing information for Questran (Cholestyramine)

Cholestyramine Side Effects

Medically reviewed by Drugs.com. Last updated on Nov 12, 2018.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Interactions
  • More

In Summary

More frequently reported side effects include: constipation, dyspepsia, heartburn, nausea, stomach pain, and vomiting. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to cholestyramine: oral powder for suspension

In some animal studies, cholestyramine was found to cause tumors. It is not known whether cholestyramine causes tumors in humans.

Along with its needed effects, cholestyramine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking cholestyramine:

Rare

  • Black, tarry stools
  • stomach pain (severe) with nausea and vomiting

Check with your doctor as soon as possible if any of the following side effects occur while taking cholestyramine:

More common

  • Constipation

Rare

  • Loss of weight (sudden)

Some side effects of cholestyramine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Heartburn or indigestion
  • nausea or vomiting
  • stomach pain

Less common

  • Belching
  • bloating
  • diarrhea
  • dizziness
  • headache

For Healthcare Professionals

Applies to cholestyramine: compounding powder, oral powder for reconstitution

General

The most frequently reported side effect is constipation.

Gastrointestinal

Intestinal obstruction occurred rarely and 2 deaths in pediatric patients were reported.

Very common (10% or more): Constipation

Rare (less than 0.1%): Intestinal obstruction

Frequency not reported: Rectal bleeding, black stools, hemorrhoidal bleeding, bleeding from known duodenal ulcer, dysphagia, hiccoughs, ulcer attack, sour taste, pancreatitis, rectal pain, diverticulitis, eructation, dental bleeding, dental caries, calcification of gallbladder, tooth discoloration, erosion of tooth enamel

Cardiovascular

Frequency not reported: Claudication, angina, arteritis, thrombophlebitis, myocardial infarction, myocardial ischemia, postprandial angina increased

Musculoskeletal

Common (1% to 10%): Osteoporosis

Frequency not reported: Backache, arthritis, muscle/joint pain

Hematologic

Uncommon (0.1% to 1%): Bleeding

Frequency not reported: Prothrombin time increased, prothrombin time decreased, anemia, hypoprothrombinemia

Metabolic

Uncommon (0.1% to 1%): Anorexia, hyperchloremic acidosis, Vitamin A deficiency, Vitamin K deficiency

Dermatologic

Uncommon (0.1% to 1%): Rash, skin irritation

Frequency not reported: Ecchymosis, xanthoma of hands/fingers, urticaria

Hepatic

Frequency not reported: Liver function test abnormal

Nervous system

Frequency not reported: Headache, paresthesia, syncope, dizziness, drowsiness, femoral nerve pain

Other

Frequency not reported: Vertigo, weight loss, weight gain, glands swollen, edema, chest pain, tinnitus

Ocular

Frequency not reported: Arcus juvenilis, uveitis, night blindness

Genitourinary

Frequency not reported: Hematuria, dysuria, burnt odor to urine, diuresis

Respiratory

Frequency not reported: Asthma, wheezing, shortness of breath

Psychiatric

Frequency not reported: Libido increased

1. Cerner Multum, Inc. “UK Summary of Product Characteristics.” O 0

2. Cerner Multum, Inc. “Australian Product Information.” O 0

3. “Product Information. Questran (cholestyramine).” Par Pharmaceutical Inc, Chestnut Ridge, NY.

4. “Product Information. Cholestyramine Light (cholestyramine).” Sandoz Laboratories, Eon Division, Lake Success, NY.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

Medical Disclaimer

More about cholestyramine

  • During Pregnancy or Breastfeeding
  • Dosage Information
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  • Compare Alternatives
  • Support Group
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  • En Español
  • 137 Reviews
  • Drug class: bile acid sequestrants

Consumer resources

  • Cholestyramine
  • Cholestyramine Resin
  • Cholestyramine (Advanced Reading)

Other brands: Questran, Prevalite, Cholestyramine Light, Questran Light

Professional resources

  • Cholestyramine Resin (AHFS Monograph)
  • … +2 more

Related treatment guides

  • Crohn’s Disease
  • Dumping Syndrome
  • Hyperlipoproteinemia
  • Hyperlipoproteinemia Type IIa, Elevated LDL
  • … +4 more

How to Lower Cholesterol

What is cholesterol?

Your body needs some cholesterol to work properly. But if you have too much in your blood, it can stick to the walls of your arteries and narrow or even block them. This puts you at risk for coronary artery disease and other heart diseases.

Cholesterol travels through the blood on proteins called lipoproteins. One type, LDL, is sometimes called the “bad” cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries. Another type, HDL, is sometimes called the “good” cholesterol. It carries cholesterol from other parts of your body back to your liver. Then your liver removes the cholesterol from your body.

There are steps that you can take to lower your LDL (bad) cholesterol and raise your HDL (good) cholesterol. By keeping your cholesterol levels in range, you can lower your risk of heart diseases.

What are the treatments for high cholesterol?

The main treatments for high cholesterol are lifestyle changes and medicines.

Lifestyle changes to lower cholesterol

Heart-healthy lifestyle changes that can help you lower or control your cholesterol include

  • Heart-healthy eating. A heart-healthy eating plan limits the amount of saturated and trans fats that you eat. It recommends that you eat and drink only enough calories to stay at a healthy weight and avoid weight gain. It encourages you to choose a variety of nutritious foods, including fruits, vegetables, whole grains, and lean meats. Examples of eating plans that can lower your cholesterol include the Therapeutic Lifestyle Changes diet and the DASH eating plan.
  • Weight Management. If you are overweight, losing weight can help lower your LDL (bad) cholesterol. This is especially important for people with metabolic syndrome. Metabolic syndrome is a group of risk factors that includes high triglyceride levels, low HDL (good) cholesterol levels, and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).
  • Physical Activity. Everyone should get regular physical activity (30 minutes on most, if not all, days).
  • Managing stress. Research has shown that chronic stress can sometimes raise your LDL cholesterol and lower your HDL cholesterol.
  • Quitting smoking. Quitting smoking can raise your HDL cholesterol. Since HDL helps to remove LDL cholesterol from your arteries, having more HDL can help to lower your LDL cholesterol.

Medicines to lower cholesterol

For some people, making lifestyle changes alone does not their lower cholesterol enough. They may also need to take medicines. There are several types of cholesterol-lowering drugs available. They work in different ways and can have different side effects. Talk to your health care provider about which medicine is right for you.

Even if you take medicines to lower your cholesterol, you still need to continue with lifestyle changes.

Lipoprotein apheresis to lower cholesterol

Familial hypercholesterolemia (FH) is an inherited form of high cholesterol. Some people who have FH may get a treatment called lipoprotein apheresis. This treatment uses a filtering machine to remove LDL cholesterol from the blood. Then the machine returns the rest of the blood back to the person.

Supplements to lower cholesterol

Some companies sell supplements that they say can lower cholesterol. Researchers have studied many of these supplements, including red yeast rice, flaxseed, and garlic. At this time, there isn’t conclusive evidence that any of them are effective in lowering cholesterol levels. Also, supplements may cause side effects and interactions with medicines. Always check with your health care provider before you take any supplements.

Postcholecystectomy diarrhea: What relieves it?

EVIDENCE-BASED ANSWER

A TRIAL OF A BILE ACID BINDER such as cholestyramine or colestipol may benefit patients with postcholecystectomy diarrhea (strength of recommendation : C, case series).

Although postcholecystectomy diarrhea is uncommon and rarely severe, it can be debilitating (SOR: B, prospective case-control study).

Evidence summary

A prospective study compared the bowel function of 106 adults (85 women) who underwent laparoscopic cholecystectomy with bowel function of 37 women who had laparoscopic sterilization (and served as controls).1 The investigators gave bowel function questionnaires to both groups before surgery and 2 to 6 months afterward. They found no significant differences in bowel function between the groups.

Of the 6 women in the cholecystectomy group who reported diarrhea, only one had new-onset diarrhea, and it was “mild.” No men reported bowel function changes.1

Case studies suggest benefit from bile acid binders
When postcholecystectomy diarrhea does occur, the best treatment is unclear in the absence of randomized controlled trials. Case reports and case series support using bile acid binders based on the hypothesis that bile acid malabsorption causes the diarrhea.

The largest case series followed 26 postcholecystectomy patients with chronic diarrhea, defined as more than 3 liquid stools in 24 hours for an average of 3.9 years (range, 3 months to 13 years). Twenty-five of the 26 (96%) had severe bile acid malabsorption.

Cholestyramine, in doses of 2 to 12 g/d “normalized bowel movements” in 23 of the 25 patients with malabsorption (92%). When treatment was suspended, diarrhea recurred in 9 of the 23 (39%); bowel habits remained regular in 14 (61%).2

A smaller case series studied 8 patients who had postcholecystectomy diarrhea, defined as more than 4 loose stools in a 24-hour period for 1 to 20 years. Six of the 8 had elevated stool bile acids and stool weight greater than 200 g/24 hours. All 6 had less frequent bowel movements within 72 hours of starting oral cholestyramine at 4 to 16 g/d (adjusting the dose to maintain 1 bowel movement daily). Diarrhea recurred in all of the patients after they stopped cholestyramine.3

A single case report of a 71-year-old man who had 4 to 6 loose stools a day for 4 years after cholecystectomy noted improvement to 2 to 3 stools daily when he was treated with either colestipol or psyllium hydrophilic mucilloid.4

Recommendations

We found no consensus statements regarding treatment of postcholecystectomy diarrhea. A gastroenterology textbook notes that diarrhea occurs in as many as 20% of patients.5 The authors recommend nightly bile acid binders and, in refractory cases, opiate antidiarrheals.

An internal medicine textbook states that postcholecystectomy diarrhea—defined as 3 or more watery bowel movements per day—occurs in 5% to 10% of patients.6 The authors recommend treatment with cholestyramine or colestipol.

A week after my gall bladder operation I suddenly developed bright yellow diarrhoea. I have no nausea or bloating, just some occasional belching. I have been eating a varied diet and have maintained a good appetite. My energy levels are high and my sleeping pattern remains normal. Can you offer any advice as to what may have caused this attack of diarrhoea? – Lainie

What you’re describing probably represents bile salt diarrhoea, an uncommon complication of gall bladder surgery. The gall bladder is a little bag attached to the liver that holds bile, a thick, yellow, salty liquid that helps us digest fats. The liver makes it, and the gall bladder stores it, squeezing it out when our intestines sense a fatty meal. The bile salts are then reabsorbed further down the intestine and recycled by the body. Without a gall bladder the body loses bile salts in the stool, and must make more.

These increased amounts of bile salts reaching the colon irritate it, creating a watery diarrhoea that is often yellow. In most patients who’ve had gall bladder removal, the body adjusts to its new circumstances post-surgery after a few weeks, and the bile salt diarrhoea goes away. In perhaps 5 per cent, it becomes chronic. If it lasts longer than a few months, chances are that it will be a long-term issue.

Luckily there are effective treatments for this, in the form of powders or pills like cholestyramine – agents that trap the bile salts and make them insoluble in water, and thus unable to cause diarrhoea.

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There are of course other possible causes of yellow diarrhoea, such as various medications, liver and intestinal disorders. Yellow stools can even be caused by a lack of bile salts.

If your symptoms persist, your surgeon will want to know about them, to confirm the correct diagnosis and start you on the appropriate treatment.

Gary Payinda MD, is an emergency medicine consultant in Whangarei.
If you have a science or health topic question you’d like addressed, email [email protected]
(This column provides general information and is not a substitute for the advice of your doctor.)

Gallbladder surgery

Published: January, 2006

Most people who have their gallbladders removed are glad to see them go, but for a small percentage, the operation seems to cause bowel problems.

Like your appendix and spleen, the gallbladder is something you can do without. Each year, about a million Americans have their gallbladders surgically removed because the organ has become inflamed (cholecystitis) or contains gallstones. If the gallstones become lodged in a duct, the result can be excruciating pain. Serious infection and inflammation are risks, too. Most people are more than happy to bid their gallbladders adieu if that’s what it takes to make the pain or threat of complications go away.

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How Biotherapy Alternative Medicine Clinic can help people with diarrhea after gallbladder removal

If you had your gallbladder removed and you suffer from diarrhea, you are not alone. 700.000 gallbladders’ are removed annually in the USA. Statistically, almost one in three persons will develop a chronic diarrhea after the gallbladder surgery. For some it is infrequent episodes, for others it is an annoying situation with frequent accidents and constant search for the nearest so bathroom.
However, it is just a symptom. Unfortunately, people without gallbladder experience some problems with digestion and pain, have much more chances for colon cancer. If conventional medicine cannot help, you can seek the non-drug approach of the alternative medicine. You lost you gallbladder mainly because of stones or inflammation.

Explanation of the development of the diarrhea after gallbladder removal

The simple and often explanation why the diarrhea after gallbladder removal occurs is irritation of the colon by the bile acids. The bile acids diarrhea is a side effect of gallbladder removal.

Using the powerful ion exchange resin (Cholestyramine) that can bind bile in the gastrointestinal tract and can reduce this kind of diarrhea.

To realize the holistic approach for diarrhea after gallbladder removal, we have to ask very important question: what is the reasons for bile acids diarrhea, why gallbladder removal can create it? There are a few things that can help to understand that. Bile acids are component of bile. They have strong detergent actions, which help to reduce the size of the fats’ particles so pancreatic lipase can split them to fatty acids and glycerol. Bile acids can exist in soluble and insoluble (precipitated) forms in human GI tract. Bile acids in soluble form help to digest fatty foods and fat-soluble vitamins such as A, D, E, K. Contrary, precipitated bile acids are highly aggressive, irritated substances, which can corrode ducts, sphincter of Oddi, duodenum and even colon causing irritation, inflammation, pain, reflux and diarrhea. By medical research, bile acids can be also substantial reason for increasing numbers of the colon cancers in the persons after gallbladder removal.

Normally, bile with bile acids in it, releases from the gallbladder through special muscle valve (sphincter of Oddi) into duodenum mainly when foods are there. Normally, gallbladder contracts, sphincter of Oddi opens. What happens when gallbladder is removed? Sphincter of Oddi is closed, so liver bile collected in the bile duct, pressure inside the bile duct increases causing pain and indigestion. On the other hand, sphincter of Oddi opens in inappropriate time when duodenum is empty, without foods, Therefore, bile drips, irritates empty gut’s walls, causing pain and indigestion.

You remember, we talk about soluble and precipitated bile salts before. One, very serious thing can make bile acids precipitate is acidic pH. By the way, you lost your gallbladder because of its inflammation or gallbladder stones that were caused by acidic bile. Gallbladder removal did not change the pH of your liver bile. Acidic bile and acidic changes in the pancreatic juice are culprits of pain, indigestion, bile reflux, gas, bloating and, certainly, diarrhea after gallbladder removal.

Normally, there are no many bacteria in duodenum. Mather Nature does not wish for invaders eat our foods and produce toxins in the small intestine. Acidity of bile and pancreatic juice decreases antibacterial, antifungal activity in the small intestine. Intestinal dysbiosis such as Small Intestine Bacterial Overgrowth (SIBO) and Candida-yeast overgrowth often goes with the postcholecystectomy syndrome; the side effect of the gallbladder removal. Overgrowth of bacteria and yeasts in the small intestine promote precipitation of the bile acids.

Unfortunately, SIBO and Candida-yeast overgrowth lead to more acidity that cause vicious circle.

Scientific medical support about that can be found in our EBook Healthy Pancreas, Healthy You written by Peter Melamed PhD and Felix Melamed, LAc, MSTCM, CHt

Therefore, the vital actions in the postcholecystectomy syndrome are normalize natural acid-alkaline balance in the body, restore the friendly intestinal flora, enhance pancreatic function, decrease inflammation and bile reflux, flush out bile acids, regulate sphincter of Oddi contractions, replace deficiencies of the essential nutrients, etc. This time-consumption, natural process cannot get passively overnight. It requires active participation of the patient and some non-drug methods of the alternative medicine.

Long history of the popular treatment of the postcholecystectomy syndrome in the European mineral spa, Karlovy Vary and healing action of the mineral water prepared from genuine Karlovy Vary thermal spring salt proves that. Healing mineral water alkalizes the body, enhances pancreatic function, improves digestion, flushes out toxins and helps with diarrhea after gallbladder removal. It is safe and effective holistic approach.

Mineral water prepared from genuine Karlovy Vary thermal spring salt alkalizes body better with mineral supplement such as cellular magnesium-potassium. In the chronic diarrhea, person usually is depleted from water and minerals that make people prone to acidity and flabby sphincters.

Food after gallbladder removal can heal or literally kill the proper digestion. Every one is unique. Hard copy of the eating plan for everyone that suffers from diarrhea after gallbladder removal, is absurd. Why? Many people now suffer from food sensitivity and food intolerance; some have comorbidities, parasites, heavy metal toxicity, national and personal preferences. To simplify, person with diarrhea after gallbladder removal have to eat alkaline foods with natural digestive enzymes, mechanically blended, non-allergenic (without gluten, milk). Separate, elimination, anti Candida diet may be suitable for that. The best idea is to work with knowledgeable medical practitioner.

Just taking probiotics and eating yogurt are not enough for restoration intestinal flora. You cannot grow plants and have an abundant harvest in the field with emaciated soil, jam-packed with the weeds, bugs and toxins. European whole body cleansing with colon hydrotherapy, using super quality of probiotics and prebiotics is the first step to healthy microbial balance in the small and large intestines.

Diarrhea is not a new thing. People have suffered from the chronic diarrhea for the centuries. Therefore, they used herbal remedies and teas to survive. For now, the scientific research and the clinical base evidences support the effectiveness of herbs in digestive disorders especially in chronic diarrhea. Herbs can promote releasing of the liver bile, make bile liquid and less acidic.

Problems with digestion, lost of fluid, minerals, trace elements, vitamins and essential fatty acids can cause many symptoms, which are very far from the colon. These problems may involve cognitive, immune, skin, adrenal, thyroid, heart, and vessels functions, create additional symptoms and other treatments. Concerning about bathrooms, water-resistant pads, and diapers are not a solution for diarrhea after gallbladder removal. Look for help, knock all the doors, educate yourself, and be involved in the healing process.

At the Biotherapy Alternative Medicine Clinic, we use a safe, effective, non-drug, and holistic approach to focus on the root of the problems. Many parts of this unique program have been widely used in other countries for hundreds or even thousands of years. Some of them are

1. European Whole Body Cleansing
2. Herbal Medicine
3. Nutritional Supplementation
4. Healing Foods Consultations
5. Karlovy Vary Healing Mineral Water
6. Acupuncture

More than 250 years, Karlovy Vary Healing Mineral Water (KVHMW), has been the most popular in Europe, natural approach to the digestive disorders, especially to chronic diarrhea.* KVHMW provides the body with essential minerals, bicarbonate and trace elements, which alkalize the body, support the pancreatic function, decrease inflammation and deficiencies, promote friendly intestinal flora to grow. Acidic bile is getting aggressive and irritates, corrodes bile ducts, sphincter of Oddi, duodenum and eventually colon causing jerky contractions leading to diarrhea. Drinking Karlovy Vary Healing Mineral Water prepared from genuine Karlovy Vary spring salt can make liver bile alkaline, decreases the amount of aggressive bile acids in bile.

What else can make our body less acidic? Alkaline-forming foods and mineral supplements such as Biotherapy Cellular Magnesium-Potassium.

Healing Food Consultation is extremely valuable in healing diarrhea after gallbladder removal. Using the “healing power of food”, we can give you a customized diet plan that was developed in European naturopathic clinics. There is no effective healing approach for diarrhea after gallbladder removal without a special diet and proper food combining.

Whole Body Cleansing with restoration of friendly intestinal flora, anti-Candida program helps normalize the function of the entire gastro-intestinal tract by changing the quality and elimination of bile and improve the digestion.

Without gallbladder and concentrated gallbladder bile, you cannot eat everything as before. Your stomach will react quickly on the food that you not get along with. Herbs, acupuncture and some nutritional supplements can help relieve pain, heaviness in the right stomach area, gas, bloating, nausea, heartburn, indigestion, and certainly diarrhea.

For effective healing diarrhea after gallbladder removal, please contact the Biotherapy Clinic through one of the following options:

  • Telephone consultation (415) 409-3939 or (650) 365-3640 after completing Biotherapy questionnaire
  • Office appointment at one of our conveniently located offices, San Francisco and Redwood City

Cholestyramine (CSM) is a bile acid sequestrant used to lower cholesterol and to relieve itching associated with liver disease. Its other uses remain unproven. Read this post to learn about its evidence-based uses and side effects.

Disclaimer: Cholestyramine is available only with your doctor’s prescription. The aim of this post is to outline the scientific findings related to cholestyramine for purely informational purposes. Please discuss your medications with your doctor.

What is Cholestyramine?

Overview

Cholestyramine is an oral medication used as add-on therapy to lower high cholesterol, along with diet and lifestyle changes. It is also used to reduce itching in people with blocked bile ducts (primary biliary obstruction), a type of liver disease.

These are the only proven, safe, and well-researched uses of cholestyramine.

Nonetheless, some doctors prescribe this drug off-label for Chronic Inflammatory Response Syndrome (CIRS) and other “biotoxin-related illness.” This practice is not evidence-based and its safety is unknown.

Additionally, most doctors do not accept that there is any causal connection between mold exposure and any health issue. In light of this, mold illness and CIRS are considered to be highly controversial, pseudo diagnoses. Similarly, what people subjectively describe as CIRS has been linked to psychological disorders .

Mechanism of Action

Cholestyramine (CSM) is a bile acid sequestrant. It binds to bile acids in the intestine, which prevents them from being reabsorbed into the body. Thus, the body eliminates more bile acids, along with cholestyramine, with the stool. To compensate, the liver turns more cholesterol to bile acids, which lowers cholesterol levels in the blood.

Uses of Cholestyramine

Effective for:

The only indications for cholestyramine are as an add-on therapy in people with high cholesterol and for the relief of itching due to certain forms of liver disease (partial biliary obstruction).

Consult your doctor about any medication-related questions you may have as well as to learn more about how to properly use cholestyramine for these indications.

1) Lowering High Blood Cholesterol

Cholestyramine is used as an add-on therapy to lower high cholesterol levels in the blood. Lowering cholesterol helps decrease the risk of strokes and heart attacks.

It should be prescribed in addition to an adequate diet (e.g. low in cholesterol and saturated fats) and lifestyle changes aimed at maintaining healthy cholesterol levels. Some healthy lifestyle changes include exercising, losing weight if overweight, and stopping smoking.

2) Itching due to Liver Disease

People with liver and biliary disease often experience itching. This symptom is thought to be a result of the accumulation of bile acids in the skin due to the inability of the liver or bile ducts to remove bile acids as well as they should .

By binding to bile acids in the intestines, cholestyramine prevents their absorption and lowers their blood levels. This provides symptomatic relief for people with itching due to bile and liver disease.

Additionally, one paper suggested that cholestyramine ointments might reduce diaper rashes in babies, but large-scale trials are lacking to back up its use for this purpose .

3) Chronic Diarrhea due to Bile acid malabsorption

Bile acid malabsorption (BAM) is a relatively common cause of chronic diarrhea. According to some estimates, about one in every 20 people in the general population suffers from BAM .

On the other hand, BAM is much more common in people with Crohn’s disease and diarrhea-predominant irritable bowel syndrome .

Certain stool analyses can help doctors determine a patient’s level of bile acid production and whether they would benefit from cholestyramine. According to some evidence, a trial of cholestyramine is a less time-consuming and expensive practice .

An estimated 70% to 96% of chronic diarrhea patients with BAM respond to short-course cholestyramine .

4) Some Forms of Drug Overdose

Cholestyramine binds some drugs in the intestine, which prevents their absorption and speeds up their elimination. It is sometimes used in cases of drug overdose.

For example, digoxin is a drug used to treat heart failure. Toxic levels of digoxin can cause serious health problems, and cholestyramine will reduce levels and decrease the side effects of digoxin .

Nonetheless, more specific antidotes have been developed for various types of drug overdose.

Possibly Effective for:

Clostridium difficile (C. diff) infections are a major cause of infectious diarrhea in hospitals. The typical treatment for more severe cases involves the antibiotics vancomycin and metronidazole. Unfortunately, one in five patients relapses after the antibiotics are continued. A small number continue relapsing after several antibiotic courses .

One study suggests that adding cholestyramine or Saccharomyces boulardii to longer vancomycin treatment in these multiple-relapse patients may be beneficial. But large trials are needed to confirm the effectiveness of this combination .

Insufficient Evidence for:

The following off-label uses are only supported by limited, low-quality clinical studies. There is insufficient evidence to support the use of cholestyramine for any of the below listed uses.

Post-Surgery Hemorrhoids Pain

In patients post-surgery (for patients with hemorrhoids), cholestyramine ointments helped reduce pain by 15%. The patients also took fewer painkillers. Additional trials are needed to determine the effectiveness and safety of cholestyramine ointment for reducing pain after hemorrhoids surgery .

Colon Inflammation

In one trial, cholestyramine added to mesalazine (an NSAID) treatment reduced symptoms of collagenous colitis, a type of chronic inflammatory disease of the colon. Large-scale trials are needed .

Spur Cell Anemia

According to limited evidence, cholestyramine coupled with flunarizine (a calcium antagonist, not available in the US) and pentoxifylline (a vasodilator and anti-inflammatory) may help treat spur cell anemia, which is a lack of red blood cells due to alcoholism .

This combined treatment helped patients recover from anemia and reduced the number of spur cells in the body in one trial. Further research is needed before we can draw any conclusions about this potential use .

Blocked Gallbladder

Gallbladder stasis or blocked gallbladder is frequent in people who are obese, and it may contribute to their increased risk for gallstones. Some studies suggest that cholestyramine increases emptying of the gallbladder, which might prevent gallstones in overweight people. Additional studies are warranted .

Blood Sugar Control in Diabetes Patients

Cholestyramine reduced blood glucose levels in one trial of patients with type 2 diabetes. Proper large-scale clinical trials are lacking .

Hyperthyroidism

Limited evidence suggests that cholestyramine may reduce some symptoms of hyperthyroidism, but safety and efficacy data are lacking .

Side Effects & Safety of Cholestyramine

Side Effects

This list does not cover all possible side effects. Contact your doctor or pharmacist if you notice any other side effects.

Call your doctor for medical advice about side effects. In the US, you may report side effects to the FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. In Canada, you may report side effects to Health Canada at 1-866-234-2345.

The following side effects of cholestyramine have been reported:

  • Constipation
  • Gastrointestinal pain
  • Gas
  • Nausea
  • Vomiting

Mix each 9 g dose of cholestyramine for oral suspension with 2 to 6 ounces of water. Make sure to drink enough fluids when taking this medication and aim to maintain good oral hygiene.

Limited evidence suggests that cholestyramine may lower the levels of Vitamin D and K. In some cases, patients were Vitamin K deficient after long-term usage of cholestyramine .

In rats, cholestyramine reduced Magnesium, Iron, and Zinc levels. These effects have not been reported in humans .

Consult your doctor if you are concerned about nutrient deficiency and are considering vitamin, mineral, or any other supplements.

In one study on healthy adults, a daily dose of 8 g of cholestyramine slightly increased levels of alanine aminotransferase, a marker of liver damage. However, these elevations were considered to be benign and clinically irrelevant. Additional large-scale safety studies focusing on markers of liver health might be warranted .

Contraindications

Contraindicated for severe hypertriglyceridemia and complete biliary obstruction .

Drug Interactions

Cholestyramine may delay or decrease the absorption of the following drugs :

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