Cholestyramine Powder (can) 378gm

Cholestyramine resin is an anion-exchange resin that binds bile acids in the intestine to form an insoluble complex, which is then excreted in the feces. This interruption of the enterohepatic circulation of bile acids increases the fecal loss of bile acids, leading to an upregulation of hepatic LDL receptors and increased synthesis of bile acids from cholesterol, thereby lowering plasma LDL-C levels. It also reduces bile acid accumulation in the skin, alleviating pruritus.

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 symptoms that bother you or do not go away, contact your doctor:

Constipation: Drinking more liquids, exercising, 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, contact your doctor for medical advice. 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 allergic reaction you experienced, including any symptoms that occurred.
If you have a blockage in your biliary tract.

This medication may interact with other medications or health conditions. Therefore, it is crucial to provide your doctor and pharmacist with a comprehensive list of:

All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
* Your existing health problems

Before starting, stopping, or changing the dose of any medication, including this one, you must consult with your doctor to ensure your safety. It is your responsibility to verify that it is safe to take this medication with all your other medications and health conditions.

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 contain phenylalanine.

Regular blood work and laboratory tests should be conducted as directed by your doctor to monitor your condition. When taking other medications, administer them at least 1 hour before or 4 hours after taking this drug to avoid potential interactions.

Adhere to the diet and exercise plan recommended by your doctor to maximize the benefits of this medication. To minimize the risk of tooth discoloration, avoid sipping this drug 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 by practicing regular dental care and scheduling frequent dental check-ups. This is particularly important to prevent tooth changes, such as discoloration, associated with this medication.

If you are 60 years or older, use this medication with caution, as you may be more susceptible to side effects. In rare cases, bowel obstruction has occurred in children taking this drug, and in some instances, it has been fatal. If you have questions or concerns, consult with your doctor.

Before taking this medication, inform your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. Your doctor will discuss the potential benefits and risks of this medication to you and your baby, allowing you to make an informed decision.

• Complete biliary obstruction (cholestyramine requires bile in the intestine to work)

• Warfarin (decreased absorption, monitor INR closely)
• Thyroid hormones (e.g., levothyroxine, decreased absorption)
• Fat-soluble vitamins (A, D, E, K; decreased absorption, may require supplementation)
• Digoxin (decreased absorption)
• Thiazide diuretics (e.g., hydrochlorothiazide, decreased absorption)
• Beta-blockers (e.g., propranolol, decreased absorption)
• Statins (e.g., pravastatin, fluvastatin; decreased absorption)
• Oral contraceptives (potential for decreased absorption, though clinical significance varies)
• Phenobarbital (decreased absorption)
• Tetracyclines (decreased absorption)
• NSAIDs (e.g., ibuprofen, naproxen; decreased absorption)

• Many acidic drugs and drugs with a high molecular weight or that are highly protein-bound (e.g., methotrexate, furosemide, glipizide, sulfonylureas, spironolactone, clofibrate, penicillin G, phosphate supplements, iron salts). Separate administration times.

• Constipation (most common side effect)
• Abdominal pain, bloating, gas, nausea, vomiting
• Symptoms of fat-soluble vitamin deficiency (e.g., easy bruising/bleeding for Vitamin K, night blindness for Vitamin A, bone pain for Vitamin D, neurological symptoms for Vitamin E)
• Unusual bleeding or bruising (due to Vitamin K deficiency)
• Dark urine, yellowing of skin/eyes (if used for pruritus, monitor for worsening liver function)

Category C. While not systemically absorbed, cholestyramine can interfere with the absorption of fat-soluble vitamins (A, D, E, K) and folic acid, which are essential for fetal development. Supplementation of these vitamins may be necessary during pregnancy if cholestyramine is used.

L3 (Moderately Safe). Cholestyramine is not absorbed systemically by the mother, so it is not excreted into breast milk. However, it can reduce the absorption of fat-soluble vitamins in the mother, potentially affecting the nutritional content of breast milk. Monitor the infant for signs of vitamin deficiency if the mother is on high doses or long-term therapy.

Used in children for familial hypercholesterolemia. Dosing is weight-based and individualized. Close monitoring of growth, development, and fat-soluble vitamin levels is crucial due to the potential for malabsorption. Constipation is a common concern.

Use with caution due to increased susceptibility to constipation and potential for fecal impaction. Start with lower doses and titrate slowly. Monitor for fat-soluble vitamin deficiencies and ensure adequate fluid intake.

• Always mix cholestyramine powder thoroughly with liquid (water, juice, applesauce, etc.) before ingestion. Never take the powder dry, as it can cause esophageal irritation or choking.
• To minimize gastrointestinal side effects (e.g., constipation, bloating), start with a low dose and gradually increase it. Ensure adequate fluid intake.
• Space administration of other medications (especially those with narrow therapeutic windows or that are highly protein-bound) at least 1 hour before or 4-6 hours after cholestyramine to prevent drug interactions due to binding.
• Long-term use may lead to deficiencies of fat-soluble vitamins (A, D, E, K) and folic acid. Supplementation may be necessary.
• Cholestyramine can sometimes cause an increase in triglyceride levels, especially in patients with pre-existing hypertriglyceridemia. Monitor triglyceride levels closely.
• While not systemically absorbed, rare cases of hyperchloremic acidosis have been reported, particularly with high doses or in patients with renal impairment.

• Statins (HMG-CoA reductase inhibitors) for hyperlipidemia (e.g., atorvastatin, simvastatin)
• Ezetimibe (cholesterol absorption inhibitor) for hyperlipidemia
• PCSK9 inhibitors (e.g., evolocumab, alirocumab) for severe hyperlipidemia
• Fibrates (e.g., gemfibrozil, fenofibrate) for hypertriglyceridemia
• Niacin (nicotinic acid) for dyslipidemia
• Rifampin, ursodiol, naltrexone for pruritus associated with cholestasis

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 your 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 emergency medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.