1.9.2 Bile acid sequestrants

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.

NICE Clinical Guideline CG181; Cardiovascular disease: risk assessment and reduction, including lipid modification states "do not offer a bile acid sequestrant (anion exchange resin) for the prevention of CVD to any of the following:

  • people who are being treated for primary prevention or secondary prevention
  • people with CKD
  • people with type 1 diabetes or type 2 diabetes"
Colestyramine
  • Sachets 4g (£10.76 = 50 sachets)
  • Sachets 4g (sugar-free) (£16.15 = 50 sachets)

Indications and Dose

  • Reduction of plasma cholesterol in hypercholesterolaemia, such as in Fredrickson's Type II and primary prevention of coronary heart disease in men aged 35–59 years with primary hypercholesterolaemia who have not responded to diet and other appropriate measures
    • 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 (unlicensed 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. Colestyramine is a potent cholesterol lowering agent; it is recommended only for people who cannot tolerate other agents.
  3. Doses of more than 24g a day of colestyramine resin may interfere with normal fat absorption.
  4. 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 (£115.32 = 180 tablets)

Indication and dose

  • Diarrhoea associated with bile acid malabsorption in patients unable to tolerate colestyramine (unlicensed)
    • 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.

 

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