Cholestyramine Light Powder (can)

Cholestyramine resin is an anion-exchange resin that binds bile acids in the intestinal lumen, forming an insoluble complex. This complex is then excreted in the feces, preventing the enterohepatic reabsorption of bile acids. The depletion of the bile acid pool stimulates the hepatic synthesis of bile acids from cholesterol, leading to an upregulation of hepatic LDL receptors. This increases the clearance of LDL-cholesterol from the plasma, thereby lowering serum LDL-C levels.

Urgent Side Effects: Seek Medical Help Right Away

While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Severe constipation or stomach pain, which may indicate a severe bowel problem
Unexplained bruising or bleeding

Other Possible Side Effects

Like all medications, this drug can cause side effects. Although many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms that bother you or persist, contact your doctor for guidance:

Constipation: Increasing fluid intake, exercising regularly, or adding fiber to your diet may help alleviate this symptom. Your doctor may also recommend a stool softener or laxative.

Reporting Side Effects

This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
If you have a blockage in your biliary tract.

This list is not exhaustive, and it is crucial to discuss all your medications (including prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist. They will help determine if it is safe to take this medication in conjunction with your other medications and health issues.

Remember, do not start, stop, or modify the dosage of any medication without first consulting your doctor to ensure your safety.

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. If you have phenylketonuria (PKU), consult with your doctor, as some formulations of this drug may contain phenylalanine.

Regular blood tests and other laboratory assessments should be performed as directed by your doctor to monitor your condition. When taking other medications, allow at least 1 hour before or 4 hours after taking this drug to minimize potential interactions.

Adhere to the diet and exercise plan recommended by your doctor to ensure optimal management of your condition. To avoid dental discoloration or other tooth changes, avoid sipping this medication after mixing or holding it in your mouth for an extended period. If you have concerns, discuss them with your doctor.

Maintain good oral hygiene and schedule regular dental check-ups to prevent potential dental issues. If you are 60 years or older, use this medication with caution, as you may be more susceptible to side effects.

Although rare, bowel obstruction has occurred in children taking this medication, and in some cases, it has been fatal. If you have questions or concerns, consult with your doctor. Additionally, if you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor to discuss the potential benefits and risks to you and your baby.

• Warfarin (increased risk of bleeding due to vitamin K malabsorption)
• Thyroid hormones (e.g., Levothyroxine - reduced absorption)
• Digoxin (reduced absorption)
• Fat-soluble vitamins (A, D, E, K - reduced absorption, especially with long-term use)

• Thiazide diuretics (e.g., Hydrochlorothiazide - reduced absorption)
• Beta-blockers (e.g., Propranolol - reduced absorption)
• Oral contraceptives (reduced absorption of estrogen/progestin components)
• Phenobarbital (reduced absorption)
• Ursodiol (reduced absorption)
• Mycophenolate mofetil (reduced absorption)
• Methotrexate (reduced absorption)
• Statins (e.g., Atorvastatin - reduced absorption, though often used together with careful timing)
• Fibrates (e.g., Gemfibrozil - reduced absorption)

• Nonsteroidal anti-inflammatory drugs (NSAIDs - potential for reduced absorption of some)

• Constipation (most common)
• Abdominal pain or discomfort
• Bloating
• Flatulence
• Nausea
• Steatorrhea (fatty stools)
• Unusual bleeding or bruising (signs of vitamin K deficiency)
• Muscle weakness or bone pain (signs of vitamin D deficiency)
• Night blindness (signs of vitamin A deficiency)

Category C. Cholestyramine is not absorbed systemically, so direct fetal exposure is unlikely. However, it can interfere with the absorption of fat-soluble vitamins (A, D, E, K) and folic acid, which are crucial for fetal development. If used during pregnancy, vitamin supplementation may be necessary. Use only if the potential benefit justifies the potential risk to the fetus.

L3 (Moderately Safe). Cholestyramine is not absorbed systemically by the mother, so it is not excreted into breast milk. However, it can interfere with the absorption of fat-soluble vitamins in the mother, potentially affecting the nutritional content of breast milk. Monitor maternal vitamin status and consider supplementation if needed.

Used in children for familial hypercholesterolemia, but dosing must be carefully individualized based on age, weight, and lipid levels. Long-term use requires monitoring for fat-soluble vitamin deficiencies and growth. Constipation is a common concern.

No specific dose adjustment needed based on age. However, elderly patients may be more susceptible to constipation and its complications (e.g., fecal impaction). Ensure adequate fluid and fiber intake. Monitor for vitamin deficiencies and drug interactions, as polypharmacy is common.

• Always mix the powder thoroughly with at least 2-6 ounces of water or other non-carbonated liquid (e.g., fruit juice, milk, applesauce) before ingestion. Do not take the powder dry, as it can cause choking or esophageal irritation.
• To minimize gastrointestinal side effects (especially constipation), start with a low dose and gradually titrate upwards. Encourage increased fluid and fiber intake.
• Timing of administration is crucial for drug interactions: administer other medications at least 1 hour before or 4-6 hours after cholestyramine.
• Cholestyramine can increase triglyceride levels in some patients. Monitor triglycerides, especially if baseline levels are high.
• Long-term use may necessitate supplementation of fat-soluble vitamins (A, D, E, K) and folic acid.
• The 'light' formulation contains aspartame and should be used with caution in patients with phenylketonuria (PKU).

• Other Bile Acid Sequestrants (e.g., Colestipol, Colesevelam)
• Statins (HMG-CoA reductase inhibitors - e.g., Atorvastatin, Rosuvastatin)
• Ezetimibe (Cholesterol absorption inhibitor)
• PCSK9 Inhibitors (e.g., Alirocumab, Evolocumab)
• Fibrates (e.g., Gemfibrozil, Fenofibrate - primarily for triglycerides)
• Niacin (Nicotinic acid - for various lipid abnormalities)

If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication, including the amount taken and the time it happened, to ensure you receive the best possible care.