Bile acid sequestrants interfere with the absorption of fat-soluble vitamins; supplements of vitamins A, D, K, and folic acid may be required when treatment is prolonged.

Colestyramine

• Oral powder sachets sugar free 4g (£74.21 = 12g daily)

Indications and Dose

• Reduction of plasma cholesterol in hypercholesterolaemia, such as Frederickson's Type II:
  • Initially 4g daily, increasing by 4g at weekly intervals to 12–24g daily in 1–4 divided doses, adjusted according to response; maximum 36g daily
• Diarrhoea associated with bile acid malabsorption
  • Local specialists recommend 4g daily; increase by 4g every 3 days as single or divided doses. If no response to 12g is seen after 3 days, consider alternative therapy (off-label dose regimen)

Notes

1. In the management of bile acid malabsorption, the first prescription should be initiated by a gastroenterologist. Following dose titration and once the patient is stabilised on treatment, ongoing prescriptions may be issued in primary care. Dose should be titrated according to response and tolerance. Due to the mode of action it may be possible to reduce the dosage once symptoms are controlled.
2. For use in familial hypercholesterolaemia, see NICE guidance (CG71) Familial hypercholesterolaemia. NICE guidance CG181 states that a bile acid sequestrant should not be offered for the prevention of CVD to people being treated for primary or secondary prevention, people with CKD or type 1 diabetes or type 2 diabetes.
3. Colestyramine is a potent cholesterol lowering agent; it is recommended only for people who cannot tolerate other agents.
4. Doses of more than 24g a day of colestyramine resin may interfere with normal fat absorption.
5. Manufacturer advises take other drugs at least 1 hour before, or 4–6 hours after, colestyramine due to the potential for interaction. Refer to the individual Summary of Product Characteristics for further details.

Colesevelam

• Tablets 625mg (£68.57 = 180 pack)

Indication and dose

• Diarrhoea associated with bile acid malabsorption in patients unable to tolerate colestyramine (off-label)
  • 2-6 tablets per day in single or divided doses; dose should be titrated according to response and tolerance

Notes

1. In the management of bile acid malabsorption, the first prescription should be initiated by a gastroenterologist. Following dose titration and once the patient is stabilised on treatment, ongoing prescriptions may be issued in primary care. Due to the mode of action it may be possible to reduce the dosage once symptoms are controlled.
2. Colesevelam has not been approved locally for the treatment of hypercholesterolaemia
3. Manufacturer advises take 4 hours before, or after, other drugs due to the potential for interaction. Refer to the individual Summary of Product Characteristics for further details.