کلستیرامین
Cholestyramine (Questran)
کلستیرامین

نام ژنریک

Cholestyramine

شکل دارویی

اشكال دارويي:


Powder, For Suspension (Sachet) : 4g

موارد مصرف

موارد و مقدار مصرف


چربي خون، هيپركلسترولمي، كاهش خطر بيماري‌هاي آتروسكلروتيك عروق كرونر و سكته قلبي، خارش‌هاي ناشي از انسداد صفراوي، مسموميت با گليكوزيدهاي قلبي.


اين دارو براي چربي خون اوليه، خارش و اسهال هاي صفراوي، به عنوان درمان كمكي براي كاهش كلسترول سرم در بيماران مبتلا به هايپركلسترولمي اوليه و براي كاهش خطرات بيماري شريان كرونر آترو اسكلروتيك و آنفاركتوس ميوكارد تجويز مي‌شود.


بزرگسالان: چهار گرم قبل از غذا و هنگام خواب مصرف مي‌شود. مقدار مصرف نبايد بيشتر از g/day 24 شود. اين دارو را مي‌توان در يك تا شش مقدار منقسم مصرف كرد.


كودكان 6 سال به بالا: مقدار mg/kg 80 يا g/m2 35/2 سه بار در روز مصرف مي‌شود. مقدار مصرف نبايد از 8 گرم در روز بيشتر شود. مقدار مصرف بي‌خطر در كودكان كوچكتر از شش سال مشخص نشده است.


مكانيسم اثر


پايين‌آورنده چربي خون: صفرا به طور معمول به داخل روده دفع مي‌شود تا جذب چربي و ساير مواد چرب را تسهيل كند. كلستيرامين با اسيدهاي صفراوي پيوند مي‌يابد و تشكيل يك تركيب نامحلول مي‌دهد كه از راه مدفوع دفع مي‌شود. با كاهش صفرا در دستگاه گوارش ، چربي و مواد چرب كمتري از غذا جذب و براي ساخت اسيدهاي صفراوي از كلسترول بيشتري استفاده مي‌شود ؛ در نتيجه ، غلظت سرمي كلسترول كاهش مي‌يابد. در انسداد نسبي صفراوي، اسيدهاي صفراوي اضافي در بافت‌هاي پوست تجمع يافته و به خارش منجر مي‌شوند. كلستيرامين با كاهش غلظت اسيدهاي صفراوي پوستي از خارش جلوگيري مي‌كند.


همچنين، كلستيرامين مي‌تواند به عنوان يك ضد اسهال در اسهال بعد از عمل ناشي از اسيدهاي صفراوي در كولون عمل كند.

موارد منع مصرف

تداخل دارويي


كلستيرامين ممكن است جذب ساير داروهاي خوراكي مانند استامينوفن، كورتيكواستروئيدها، مدرهاي تيازيدي، فرآورده‌هاي تيروئيد و گليكوزيدهاي قلبي را كم كند و در نتيجه اثرات درماني آنها را كاهش دهد. همچنين، توانايي بالقوه پيوند اين دارو ممكن است اثرات ضدانعقادي وارفارين را كاهش دهد. تخليه همزمان ويتامين K ممكن است يا اين اثر را خنثي كند يا فعاليت ضد انعقادي را افزايش دهد. پيگيري دقيق زمان پروترومبين لازم است.


مقدار مصرف هر يك از داروهاي خوراكي ممكن است احتياج به تنظيم داشته باشد تا پيوند احتمالي با كلستيرامين را جبران كند. داروهاي ديگر بايد حداقل يك ساعت قبل يا 6-4 ساعت (در صورت امكان بيشتر) بعد از كلستيرامين مصرف شوند. بعد از قطع مصرف كلستيرامين، تنظيم مجدد مقدار مصرف داروها لازم است تا از مسموميت دارويي جلوگيري شود.

موارد قابل توجه

-

تداخل دارویی

اثر بر آزمايشهاي تشخيصي


كلستيرامين غلظت سرمي آلكالينفسفاتاز، آسپارتات آمينوترانسفراز (AST)، كلرور، فسفر، كلسيم و سديم را كاهش مي‌دهد. نارسايي در جذب كلسيم ممكن است به استئوپروز منجر شود. كول هسيستوگرافي با استفاده از اسيديوپانوييك به نتايج غيرمعمول منجر مي‌شود، زيرا اسيد يوپانوييك با كلستيرامين نيز پيوند مي‌يابد و ممكن است منجر به كاهش سطح هموگلوبين و هماتوكريت گردد.

مکانیزم اثر

اثر بر آزمايشهاي تشخيصي


كلستيرامين غلظت سرمي آلكالينفسفاتاز، آسپارتات آمينوترانسفراز (AST)، كلرور، فسفر، كلسيم و سديم را كاهش مي‌دهد. نارسايي در جذب كلسيم ممكن است به استئوپروز منجر شود. كول هسيستوگرافي با استفاده از اسيديوپانوييك به نتايج غيرمعمول منجر مي‌شود، زيرا اسيد يوپانوييك با كلستيرامين نيز پيوند مي‌يابد و ممكن است منجر به كاهش سطح هموگلوبين و هماتوكريت گردد.

فارماكوكینتیك

موارد منع مصرف و احتياط


موارد منع مصرف: انسداد كامل صفراوي و حساسيت مفرط به هر يك از اجزاي آن (كلستيرامين حاوي تارترازين است و اين ماده ممكن است موجب بروز واكنش‌هاي آلرژيك در افراد حساس شود)، انسداد روده.


موارد احتياط: يبوست (خطر تجمع مدفوع وجود دارد)، سوءجذب (كاهش جذب چربي‌ها و ويتامين‌هاي محلول در چربي A، D، E، K ناشي از دارو ممكن است وضعيت را بدتر كند)، بارداري (نارسايي جذب ويتامين‌ها و ساير مواد غذايي در مادر تهديد جدي براي جنين است).

سایر اطلاعات

طبقه‌بندي فارماكولوژيك: رزين تعويض‌كننده آنيون.


طبقه‌بندي درماني: پايين‌آورنده چربي خون.


طبقه‌بندي مصرف در بارداري: رده C


ملاحظات اختصاصي


براي مخلوط كردن، پودر را بايد بر روي سطح مايع مورد نظر يا غذاي غيرخشك پاشيد، چند دقيقه منتظر ماند و سپس آن را هم زد تا سوسپانسيون يكنواخت به دست آيد. براي جلوگيري از كف كردن زياد دارو مي‌توان از ليوان شيشه‌اي بزرگ استفاده كرد و سوسپانسيون را آهسته هم زد. حداقل 90 ميلي‌ليتر آب يا مايعات ديگر (در صورت استفاده از مايع كربنات‌دار، براي جلوگيري از كف كردن زياد، پودر را مي‌توان در ليوان شيشه‌اي بزرگ ريخت و هم زد)، سوپ، شير و يا آب ميوه لازم است. بيمار بعد از مصرف دارو، بايد در ليوان خالي آن آب ريخته و ميل كند تا از مصرف تمام دارو اطمينان حاصل گردد.


كلستيرامين براي درمان مصرف بيش از حد گليكوزيد قلبي استفاده مي‌شود، زيرا با اين داروها پيوند يافته و از گردش مجدد روده‌اي - كبدي آنها جلوگيري مي‌كند. در صورت مصرف همزمان ، غلظت گليكوزيدهاي قلبي و ساير داروها بايد پيگيري شود تا از مقدار مصرف صحيح طي و بعد از درمان با كلستيرامين اطمينان حاصل شود.


غلظت سرمي كلسترول بايد طي اولين ماه‌هاي درمان و بعد از آن به طور مرتب پيگيري گردد.


عملكرد روده بايد پيگيري شود. يبوست بايد بلافاصله با كاهش مقدار مصرف و اضافه كردن يك نرم‌كننده مدفوع، درمان و در صورت لزوم، مصرف دارو قطع شود.


علائم كمبود ويتامين A، D يا K پيگيري شود.


نكات قابل توصيه به بيمار


رژيم غذايي را رعايت كرده و به طور مرتب آزمون خون به عمل آوريد. اگر چه مصرف دارو بيماري را درمان نمي‌كند ولي به كنترل غلظت سرمي كلسترول كمك مي‌كند.


عوامل خطر قلبي را در نظر داشته باشيد، بايد وزن خود را كنترل و كشيدن سيگار را قطع كنيد.


دارو را نبايد به صورت پودر خشك استفاده كنيد. طرز صحيح مصرف دارو را از پزشك بپرسيد.


سوسپانسيون دارو را در دهان نگه نداريد، چرا كه مي‌تواند منجر به تغييراتي در سطح دهان همچون تغيير رنگ، خوردگي مينا يا پوسيدگي گردد.


مصرف در سالمندان: بيماران 60 ساله و بزرگتر در معرض عوارض جانبي گوارشي و اثرات جانبي تغذيه‌اي دارو قرار دارند.


مصرف در كودكان: كودكان طي مصرف كلستيرامين ممكن است در معرض خطر بيشتر اسيدوز هيپركلرميك قرار داشته باشند.


دوز بي‌خطر در كودكان زير 6 سال مشخص نشده است.


مصرف در شيردهي: بي‌ضرري مصرف دارو در دوران شيردهي ثابت نشده است.


مصرف در بارداري: با وجود اينكه انتظار نمي‌رود دارو براي جنين ضرري داشته باشد، ولي ممكن است از طريق تداخل با جذب ويتامين‌هاي محلول در چربي منجر به آسيب به جنين گردد.


عوارض جانبي


اعصاب مرکزي : اضطراب، گيجي، خستگي، سردرد، بي‌خوابي، سرگيجه، سنكوپ.


گوش - حلق - بيني: وزوز گوش.


ادراري ـ تناسلي: هماچوري، ديزوري.


خون: آنمي، خونريزي.


متابوليک: اسيدوز هايپرکلرميک با آنيون گپ بالا که با استفاده طولاني مدت يا دوزها ي بالا اتفاق مي‌ افتد.


عضلاني- اسکلتي: کمردرد، درد عضلات و مفاصل، استئوپروز.


پوست: بثورات پوستي، اکيموز، تحريك پوست، زبان و نواحي اطراف مقعد و بيني، راش.


دستگاه گوارش: يبوست، متراكم شدن مدفوع، تشديد هموروئيد، ناراحتي شكم، نفخ، تهوع، استفراغ، استئاتوره، خونريزي گوارشي.


ساير عوارض: كمبود ويتامين A، D، K ناشي از كاهش جذب.


توجه: در صورت ادامه يبوست حتي بعد از كاهش مقدار مصرف دارو، افزايش ناگهاني در غلظت سرمي كلسترول و يا پاسخ نامناسب بعد از سه ماه درمان، بايد مصرف دارو قطع شود.


مسموميت و درمان


تظاهرات باليني: خطر عمده، انسداد روده است.


درمان: به محل و ميزان انسداد و ميزان حركت روده بستگي دارد.

Cholestyramine (Questran)

QUESTRAN®
(cholestyramine) for Oral Suspension USP

DRUG DESCRIPTION

QUESTRAN® (Cholestyramine for Oral Suspension USP), the chloride salt of a basic anion exchange resin, a cholesterol lowering agent, is intended for oral administration. Cholestyramine resin is quite hydrophilic, but insoluble in water. The cholestyramine resin in QUESTRAN (cholestyramine) is not absorbed from the digestive tract. Four grams of anhydrous cholestyra-mine resin is contained in 9 grams of QUESTRAN powder. Four grams of anhydrous cholestyramine resin is contained in 5 grams of QUESTRAN (cholestyramine) LIGHT. It is represented by the following structural formula:

QUESTRAN®  (Cholestyramine for Oral Suspension USP)   Structural Formula Illustration

QUESTRAN (cholestyramine) powder contains the following inactive ingredients:acacia, citric acid, D&C Yellow No. 10, FD&C Yellow No.6, flavor (natural and artificial Orange), polysorbate 80, propylene glycol alginate and sucrose. QUESTRAN (cholestyramine) LIGHT contains the following inactive ingredients: aspartame, citric acid, colloidal silicon dioxide, D&C Yellow No. 10, FD&C Red No.40, flavor (natural and artificial Orange), maltodextrin, propylene glycol alginate and xanthan gum.

What are the possible side effects of cholestyramine (Cholestyramine Light, Prevalite, Questran, Questran Light)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

  • blood in your urine;
  • severe stomach pain;
  • ongoing constipation;
  • feeling short of breath;
  • black, bloody, or tarry stools; or
  • easy bruising or bleeding.

Less serious side effects may include:

  • mild constipation,...

Read All Potential Side Effects and See Pictures of Questran »

What are the precautions when taking cholestyramine (Questran)?

Before taking cholestyramine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: constipation, hemorrhoids, kidney disease.

Some products may contain sugar or aspartame. Caution is advised if you have diabetes, phenylketonuria (PKU), or any other condition that requires you to limit/avoid these substances in your diet. Ask your doctor or pharmacist about using this product safely.

Because this drug can interfere with the absorption of certain nutrients (such as folic acid, fat-soluble...

Read All Potential Precautions of Questran »

Last reviewed on RxList: 6/2/2008
This monograph has been modified to include the generic and brand name in many instances.

INDICATIONS

1) QUESTRAN (Cholestyramine for Oral Suspension USP), is indicated as adjunctive therapy to diet for the reduction of elevated serum cholesterol in patients with primary hypercholes-terolemia (elevated low density lipoprotein [LDL] cholesterol) who do not respond adequately to diet. QUESTRAN (cholestyramine) may be useful to lower LDL cholesterol in patients who also have hyper-triglyceridemia, but it is not indicated where hypertriglyceridemia is the abnormality of most concern.

Therapy with lipid-altering agents should be a component of multiple risk factor intervention in those individuals at significantly increased risk for atherosclerotic vascular disease due to hypercholesterolemia. Treatment should begin and continue with dietary therapy specific for the type of hyperlipoproteinemia determined prior to initiation of drug therapy. Excess body weight may be an important factor and caloric restriction for weight normalization should be addressed prior to drug therapy in the overweight.

Prior to initiating therapy with QUESTRAN (cholestyramine) secondary causes of hypercholesterolemia (e.g., poorly controlled diabetes mellitus, hypothyroidism, nephrotic syndrome, dysproteinemias, obstructive liver disease, other drug therapy, alcoholism), should be excluded, and a lipid profile performed to assess Total cholesterol, HDL-C, and triglycerides (TG). For individuals with TG less than 400 mg/dL ( < 4.5 mmol/L), LDL-C can be estimated using the following equation:-

LDL-C=Total cholesterol - [(TG/5) + HDL-C]

For TG levels > 400 mg/dL, this equation is less accurate and LDL-C concentrations should be determined by ultracentrifugation. In hypertriglyceridemic patients, LDL-C may be low or normal despite elevated Total-C. In such cases QUESTRAN (cholestyramine) may not be indicated.

Serum cholesterol and triglyceride levels should be determined periodically based on NCEP guidelines to confirm initial and adequate long-term response. A favorable trend in cholesterol reduction should occur during the first month of QUESTRAN (cholestyramine) therapy. The therapy should be continued to sustain cholesterol reduction. If adequate cholesterol reduction is not attained, increasing the dosage of QUESTRAN (cholestyramine) or adding other lipid-lowering agents in combination with QUESTRAN (cholestyramine) should be considered.

Since the goal of treatment is to lower LDL-C, the NCEP4 recommends that LDL-C levels be used to initiate and assess treatment response. If LDL-C levels are not available then Total-C alone may be used to monitor long-term therapy. A lipoprotein analysis (including LDL-C determination) should be carried out once a year. The NCEP treatment guidelines are summarized below.

LDL-Cholesterol mg/dL (mmol/L)

Definite Atherosclerotic Disease* Two or More Other Risk Factors** Initiation Level Goal
NO NO ≥ 190 < 160
( ≥ 4.9) ( < 4.1)
NO YES ≥ 160 < 130
( ≥ 4.1) ( < 3.4)
YES YES or NO ≥ 130 ≤ 100
( ≥ 3.4) ( ≤ 2.6)
*Coronary heart disease or peripheral vascular disease (including symptomatic carotid artery disease).
**Other risk factors for coronary heart disease (CHD) include:age (males ≥ 45 years; females ≥ 55 years or premature menopause without estrogen replacement therapy); family history of premature CHD; current cigarette smoking; hypertension; confirmed HDL-C < 35 mg/dL ( < 0.91 mmol/L); and diabetes mellitus. Subtract one risk factor if HDL-C is ≥ 60 mg/dL ( ≥ 1.6 mmol/L).

QUESTRAN (cholestyramine) monotherapy has been demonstrated to retard the rate of progression2, 3 and increase the rate of regression3 of coronary atherosclerosis.

2) QUESTRAN (cholestyramine) is indicated for the relief of pruritus associated with partial biliary obstruction. QUESTRAN (cholestyramine) has been shown to have a variable effect on serum cholesterol in these patients. Patients with primary biliary cirrhosis may exhibit an elevated cholesterol as part of their disease.

DOSAGE AND ADMINISTRATION

The recommended starting adult dose for all QUESTRAN (cholestyramine) powdered products (QUESTRAN (cholestyramine) Powder and QUESTRAN (cholestyramine) LIGHT) is one packet or one level scoopful once or twice a day. The recommended maintenance dose for all QUESTRAN (cholestyramine) powdered products is 2 to 4 packets or scoopfuls daily (8-16 grams anhydrous cholestyramine resin) divided into two doses. Four grams of anhydrous cholestyramine resin is contained in each measured dose of QUESTRAN (cholestyramine) as follows:

QUESTRAN Powder 9 grams
QUESTRAN LIGHT 5 grams

It is recommended that increases in dose be gradual with periodic assessment of lipid/lipoprotein levels at intervals of not less than 4 weeks. The maximum recommended daily dose is six packets or scoopfuls of QUESTRAN (24 grams of anhydrous cholestyramine resin). The suggested time of administration is at mealtime but may be modified to avoid interference with absorption of other medications. Although the recommended dosing schedule is twice daily, QUESTRAN (cholestyramine) may be administered in 1-6 doses per day.

QUESTRAN (cholestyramine) should not be taken in its dry form. Always mix QUESTRAN (cholestyramine) with water or other fluids before ingesting. See Preparation Instructions.

Concomitant Therapy

Preliminary evidence suggests that the lipid-lowering effects of QUESTRAN (cholestyramine) on total and LDL-cholesterol are enhanced when combined with a HMG-CoA reductase inhibitor, e.g., pravastatin, lovastatin, simvastatin, and fluvastatin. Additive effects on LDL-cholesterol are also seen with combined nicotinic acid /QUESTRAN therapy. See the DRUG INTERACTIONS subsection of the PRECAUTIONS section for recommendations on administering concomitant therapy.

Preparation

The color of QUESTRAN (cholestyramine) may vary somewhat from batch to batch but this variation does not affect the performance of the product. Place the contents of one single-dose packet or one level scoopful of QUESTRAN (cholestyramine) in a glass or cup. Add an amount of water or other non-carbonated beverage of your choice depending on the product being used:

Product Formula Amount of Water or other Non-Carbonated Liquid
QUESTRAN Powder 2-6 ounces per dose
QUESTRAN LIGHT 2-6 ounces per dose

Stir to a uniform consistency and drink.

QUESTRAN (cholestyramine) may also be mixed with highly fluid soups or pulpy fruits with a high moisture content such as applesauce or crushed pineapple.

HOW SUPPLIED

QUESTRAN® Powder (Cholestyramine for Oral Suspension USP) is available in cans containing 378 grams and in cartons of sixty 9 gram packets. Four grams of anhydrous cholestyra-mine resin are contained in 9 grams of QUESTRAN (cholestyramine) Powder. The 378 g can includes a 15 cc scoop. The scoop is not interchangeable with scoops from other products.

NDC-49884-936-66 Can, 378 g
NDC-49884-936-65 Carton of 60, 9 g packets

QUESTRAN® LIGHT (Cholestyramine for Oral Suspension USP) is available in cans containing 210 grams and in cartons of sixty 5 gram packets.Four grams of anhydrous cholestyramine resin are contained in 5 grams of QUESTRAN (cholestyramine) LIGHT. The 210 g can includes a 9 cc scoop. The scoop is not interchangeable with scoops from other products.

NDC-49884-937-67 Can, 210 g
NDC-49884-937-65 Carton of 60, 5 g packets

Storage

Store between 20°-25°C (68°-77°F).[See USP Controlled Room Temperature].Excursions permitted to 15°-30°C (59°-86°F).

REFERENCES

2. Brensike JF, Levy RI, Kelsey SF, et al.Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: results of the NHLBI type II coronary intervention study. Circulation 1984;69:313-24.

3. Watts, GF, Lewis B, Brunt JNH Lewis ES, et al.Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine. In the St. Thomas Atherosclerosis Regression Study (STARS). Lancet 1992;339:563-69.

4.National Cholesterol Education Program. Second Report of the Expert Panel Detection. Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Circulation 1994 Mar; 89(3):1333-445.

® Registered trademark of Par Pharmaceutical, Inc., Distributed by: PAR PHARMACEUTICAL COMPANIES, INC., Spring Valley, NY 10977. Revised:05/06. FDA revision date: 8/22/1997

Last reviewed on RxList: 6/2/2008
This monograph has been modified to include the generic and brand name in many instances.

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 (cholestyramine) 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 QUES-TRAN. 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 (cholestyramine) 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 Questran (cholestyramine) Side Effects Center for a complete guide to possible side effects »

DRUG INTERACTIONS

QUESTRAN (Cholestyramine for Oral Suspension USP) may delay or reduce the absorption of concomitant oral medication such as phenylbutazone, warfarin, thiazide diuretics (acidic), or propranolol (basic), as well as tetracycline, penicillin G, phenobarbital, thyroid and thyroxine preparations, estrogens and progestins, and digitalis. Interference with the absorption of oral phosphate supplements has been observed with another positively-charged bile acid sequestran (cholestyramine) t. QUESTRAN (cholestyramine) may interfere with the pharmacokinetics of drugs that undergo enterohepatic circulation. The discontinuance of QUESTRAN (cholestyramine) could pose a hazard to health if a potentially toxic drug such as digitalis has been titrated to a maintenance level while the patient was taking QUESTRAN.

Because cholestyramine binds bile acids, QUESTRAN (cholestyramine) may interfere with normal fat digestion and absorption and thus may prevent absorption of fat-soluble vitamins such as A, D, E and K. When QUESTRAN (cholestyramine) is given for long periods of time, concomitant supplementation with water-miscible (or parenteral) forms of fat-soluble vitamins should be considered.

SINCE QUESTRAN (cholestyramine) MAY BIND OTHER DRUGS GIVEN CONCURRENTLY, IT IS RECOMMENDED THAT PATIENTS TAKE OTHER DRUGS AT LEAST ONE HOUR BEFORE OR 4 TO 6 HOURS AFTER QUESTRAN (cholestyramine) (OR AT AS GREAT AN INTERVAL AS POSSIBLE) TO AVOID IMPEDING THEIR ABSORPTION.

Last reviewed on RxList: 6/2/2008
This monograph has been modified to include the generic and brand name in many instances.

WARNINGS

PHENYLKETONURICS: QUESTRAN (cholestyramine) LIGHT CONTAINS 14.0 MG PHENYLALANINE PER 5 GRAM DOSE.

PRECAUTIONS

General

Chronic use of QUESTRAN (cholestyramine) may be associated with increased bleeding tendency due to hypoprothrombinemia associated with Vitamin K deficiency. This will usually respond promptly to parenteral Vitamin K1 and recurrences can be prevented by oral administration of Vitamin K1. Reduction of serum or red cell folate has been reported over long term admin-istration of QUESTRAN (cholestyramine) . Supplementation with folic acid should be considered in these cases.

There is a possibility that prolonged use of QUESTRAN (cholestyramine) , since it is a chloride form of anion exchange resin, may produce hyperchloremic acidosis. This would especially be true in younger and smaller patients where the relative dosage may be higher. Caution should also be exercised in patients with renal insufficiency or volume depletion, and in patients receiving concomitant spironolactone.

QUESTRAN (cholestyramine) may produce or worsen pre-existing constipation. The dosage should be increased gradually in patients to minimize the risk of developing fecal impaction. In patients with pre-existing constipation, the starting dose should be 1 packet or 1 scoop once daily for 5-7 days, increasing to twice daily with monitoring of constipation and of serum lipoproteins, at least twice, 4-6 weeks apart. Increased fluid intake and fiber intake should be encouraged to alleviate constipation and a stool softener may occasionally be indicated. If the initial dose is well tolerated, the dose may be increased as needed by one dose/day (at monthly intervals) with periodic monitoring of serum lipoproteins.

If constipation worsens or the desired therapeutic response is not achieved at one to six doses/day, combination therapy or alternate therapy should be considered. Particular effort should be made to avoid constipation in patients with symptomatic coronary artery disease. Constipation associated with QUESTRAN (cholestyramine) may aggravate hemorrhoids.

Laboratory Tests

Serum cholesterol levels should be determined frequently during the first few months of therapy and periodically thereafter. Serum triglyceride levels should be measured periodically to detect whether significant changes have occurred.

The LRC-CPPT showed a dose-related increase in serum triglycerides of 10.7%-17.1% in the cholestyramine-treated group, compared with an increase of 7.9%-11.7% in the placebo group. Based on the mean values and adjusting for the placebo group, the cholestyramine-treated group showed an increase of 5% over pre-entry levels the first year of the study and an increase of 4.3% the seventh year.

Carcinogenesis, Mutagenesis, Impairment of Fertility

In studies conducted in rats in which cholestyramine resin was used as a tool to investigate the role of various intestinal factors, such as fat, bile salts and microbial flora, in the development of intestinal tumors induced by potent carcinogens, the incidence of such tumors was observed to be greater in cholestyramine resin-treated rats than in control rats.

The relevance of this laboratory observation from studies in rats to the clinical use of QUES-TRAN is not known. In the LRC-CPPT study referred to above, the total incidence of fatal and nonfatal neoplasms was similar in both treatment groups. When the many different categories of tumors are examined, various alimentary system cancers were somewhat more prevalent in the cholestyramine group. The small numbers and the multiple categories prevent conclusions from being drawn. However, in view of the fact that cholestyramine resin is confined to the GI tract and not absorbed, and in light of the animal experiments referred to above, a six-year post-trial follow-up of the LRC-CPPT5 patient population has been completed (a total of 13.4 years of in-trial plus post-trial follow-up) and revealed no significant difference in the incidence of cause-specific mortality or cancer morbidity between cholestyramine and placebo treated patients.

Pregnancy

Pregnancy Category C

There are no adequate and well controlled studies in pregnant women. The use of QUES-TRAN in pregnancy or lactation or by women of childbearing age requires that the potential benefits of drug therapy be weighed against the possible hazards to the mother and child. QUESTRAN (cholestyramine) is not absorbed systemically, however, it is known to interfere with absorption of fat-soluble vitamins; accordingly, regular prenatal supplementation may not be adequate (see PRECAUTIONS: DRUG INTERACTIONS).

Nursing Mothers

Caution should be exercised when QUESTRAN (cholestyramine) is administered to a nursing mother. The possible lack of proper vitamin absorption described in the “Pregnancy” section may have an effect on nursing infants.

Pediatric Use

Although an optimal dosage schedule has not been established, standard texts(6, 7) list a usual pediatric dose of 240 mg/kg/day of anhydrous cholestyramine resin in two to three divided doses, normally not to exceed 8 gm/day with dose titration based on response and tolerance.

In calculating pediatric dosages, 44.4 mg of anhydrous cholestyramine resin are contained in 100 mg of QUESTRAN powder and 80 mg of anhydrous cholestyramine resin are contained in 100 mg of QUESTRAN (cholestyramine) LIGHT.

The effects of long-term administration, as well as its effect in maintaining lowered cholesterol levels in pediatric patients, are unknown. (Also see ADVERSE REACTIONS.)

REFERENCES

5. The Lipid Research Clinics Investigators. The Lipid Research Clinics Coronary Primary Prevention Trial:Results of 6 Years of Post-Trial Follow-up. Arch Intern Med 1992;152:1399-1410.

6. Behrman RE et al (eds): Nelson, Textbook of Pediatrics, ed 15. Philadelphia, PA WB Saunders Company, 1996.

7. Takemoto CK et al (eds): Pediatric Dosage Handbook, ed 3. Cleveland/Akron, OH, Lexi-Comp, Inc., 1996-1997.

Last reviewed on RxList: 6/2/2008
This monograph has been modified to include the generic and brand name in many instances.

OVERDOSE

Overdosage with QUESTRAN (cholestyramine) has been reported in a patient taking 150% of the maximum recommended daily dosage for a period of several weeks. No ill effects were reported. Should an overdosage occur, the chief potential harm would be obstruction of the gastrointestinal tract. The location of such potential obstruction, the degree of obstruction, and the presence or absence of normal gut motility would determine treatment.

CONTRAINDICATIONS

QUESTRAN (cholestyramine) is contraindicated in patients with complete biliary obstruction where bile is not secreted into the intestine and in those individuals who have shown hypersensitivity to any of its components.

Last reviewed on RxList: 12/8/2004
This monograph has been modified to include the generic and brand name in many instances.

CLINICAL PHARMACOLOGY

Actions

Cholesterol is probably the sole precursor of bile acids. During normal digestion, bile acids are secreted into the intestines. A major portion of the bile acids is absorbed from the intestinal tract and returned to the liver via the enterohepatic circulation. Only very small amounts of bile acids are found in normal serum.

QUESTRAN (cholestyramine) resin adsorbs and combines with the bile acids in the intestine to form an insoluble complex which is excreted in the feces. This results in a partial removal of bile acids from the enterohepatic circulation by preventing their absorption.

The increased fecal loss of bile acids due to QUESTRAN (cholestyramine) administration leads to an increased oxidation of cholesterol to bile acids, a decrease in beta lipoprotein or low density lipoprotein plasma levels and a decrease in serum cholesterol levels. Although in man, QUESTRAN (cholestyramine) produces an increase in hepatic synthesis of cholesterol, plasma cholesterol levels fall. In patients with partial biliary obstruction, the reduction of serum bile acid levels by QUES-TRAN reduces excess bile acids deposited in the dermal tissue with resultant decrease in pruritus.

Clinical Studies

In a large, placebo-controlled, multi-clinic study, LRC-CPPT1, hypercholesterolemic subjects treated with QUESTRAN (cholestyramine) had mean reductions in total and low-density lipoprotein cholesterol (LDL-C) which exceeded those for diet and placebo treatment by 7.2% and 10.4%, respec-tively. Over the seven-year study period the QUESTRAN (cholestyramine) group experienced a 19% reduction (relative to the incidence in the placebo group) in the combined rate of coronary heart disease death plus non-fatal myocardial infarction (cumulative incidences of 7% QUESTRAN (cholestyramine) and 8.6% placebo). The subjects included in the study were men aged 35-59 with serum cholesterol levels above 265 mg/dL and no previous history of heart disease. It is not clear to what extent these findings can be extrapolated to females and other segments of the hypercholesterolemic population. (See also PRECAUTIONS: Carcinogenesis, Mutagenesis, Impairment of Fertility.)

Two controlled clinical trials have examined the effects of QUESTRAN (cholestyramine) monotherapy upon coronary atherosclerotic lesions using coronary arteriography. In the NHLBI Type II Coronary Intervention Trial2, 116 patients (80% male) with coronary artery disease (CAD) documented by arteriography were randomized to QUESTRAN (cholestyramine) or placebo for five years of treatment. Final study arteriography revealed progression of coronary artery disease in 49% of placebo patients compared to 32% of the QUESTRAN (cholestyramine) group (p < 0.05).

In the St.Thomas Atherosclerosis Regression Study (STARS)3, 90 hypercholesterolemic men with CAD were randomized to three blinded treatments: usual care, lipid-lowering diet, and lipid-lowering diet plus QUESTRAN (cholestyramine) . After 36 months, follow-up coronary arteriography revealed progression of disease in 46% of usual care patients, 15% of patients on lipid-lowering diet and 12% of those receiving diet plus QUESTRAN (cholestyramine) (p < 0.02). The mean absolute width of coronary segments decreased in the usual care group, increased slightly (0.003mm) in the diet group and increased by 0.103mm in the diet plus QUESTRAN (cholestyramine) group (p < 0.05). Thus in these randomized controlled clinical trials using coronary arteriography, QUESTRAN (cholestyramine) monotherapy has been demonstrated to slow progression2, 3 and promote regression3 of atherosclerotic lesions in the coronary arteries of patients with coronary artery disease.

The effect of intensive lipid-lowering therapy on coronary atherosclerosis has been assessed by arteriography in hyperlipidemic patients. In these randomized, controlled clinical trials, patients were treated for two to four years by either conventional measures (diet, placebo, or in some cases low dose resin), or intensive combination therapy using diet plus colestipol (an anion exchange resin with a mechanism of action and an effect on serum lipids similar to that of QUESTRAN (cholestyramine) and QUESTRAN (cholestyramine) LIGHT) plus either nicotinic acid or lovastatin. When compared to conventional measures, intensive lipid-lowering combination therapy significantly reduced the frequency of progression and increased the frequency of regression of coronary atherosclerotic lesions in patients with or at risk for coronary artery disease.

REFERENCES

1. The Lipid Research Clinics Coronary Primary Prevention Trials Results: (l) Reduction in Incidence of Coronary Heart Disease; (ll) The Relationship of Reduction in Incidence of Coronary Heart Disease to Cholesterol Lowering. JAMA 1984; 251:351-374.

2. Brensike JF, Levy RI, Kelsey SF, et al.Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: results of the NHLBI type II coronary intervention study. Circulation 1984;69:313-24.

3. Watts, GF, Lewis B, Brunt JNH Lewis ES, et al.Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine. In the St. Thomas Atherosclerosis Regression Study (STARS). Lancet 1992;339:563-69.

Last reviewed on RxList: 6/2/2008
This monograph has been modified to include the generic and brand name in many instances.

PATIENT INFORMATION

Inform your physician if you are pregnant or plan to become pregnant or are breastfeeding. Drink plenty of fluids and mix each 9 gram dose of QUESTRAN (cholestyramine) Powder in at least 2 to 6 ounces of fluid.Mix each 5 gram dose of QUESTRAN (cholestyramine) LIGHT in at least 2 to 6 ounces of fluid before taking.Sipping or holding the resin suspension in the mouth for prolonged periods may lead to changes in the surface of the teeth resulting in discoloration, erosion of enamel or decay; good oral hygiene should be maintained.

Last reviewed on RxList: 6/2/2008
This monograph has been modified to include the generic and brand name in many instances.

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PATIENT INFORMATION

Inform your physician if you are pregnant or plan to become pregnant or are breastfeeding. Drink plenty of fluids and mix each 9 gram dose of QUESTRAN (cholestyramine) Powder in at least 2 to 6 ounces of fluid.Mix each 5 gram dose of QUESTRAN (cholestyramine) LIGHT in at least 2 to 6 ounces of fluid before taking.Sipping or holding the resin suspension in the mouth for prolonged periods may lead to changes in the surface of the teeth resulting in discoloration, erosion of enamel or decay; good oral hygiene should be maintained.

Last reviewed on RxList: 6/2/2008
This monograph has been modified to include the generic and brand name in many instances.

Disclaimer

Questran Consumer

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

CHOLESTYRAMINE - ORAL

(KOE-le-STYE-ra-meen)

COMMON BRAND NAME(S): Prevalite, Questran

USES: Cholestyramine is used along with a proper diet to lower cholesterol in the blood. Lowering cholesterol helps decrease the risk for strokes and heart attacks.

In addition to a proper diet (such as a low-cholesterol/low-fat diet), other lifestyle changes that may help this medication work better include exercising, losing weight if overweight, and stopping smoking. Consult your doctor for more details.

Cholestyramine may also be used to treat itching in people with too much bile acid caused by a certain type of liver/bile duct disease (partial biliary obstruction).

This medication is known as a bile acid-binding resin. It works by removing bile acid from the body. In people with high cholesterol, this causes the liver to make more bile acid by using cholesterol in the blood. This helps to lower the cholesterol levels.

HOW TO USE: Take this medication by mouth as directed by your doctor, usually 1 to 2 times a day. This medication comes as a powder with doses measured by the scoopful (using the provided scoop) or in individual dose packets. Do not take your dose in the dry powder form. Mix the medication in at least 2 to 6 ounces (60 to 180 milliliters) of liquid (such as water, milk, fruit juice), stir completely, and drink immediately. Rinse your glass with more liquid and drink the rinse liquid to be sure that you have taken the entire dose. You may also mix this medication with watery soups, applesauce, or a pulpy fruit which has a lot of juice (such as crushed pineapple, peaches).

Do not hold the mixture in your mouth for long since doing so can damage your teeth. Practice good dental habits (such as brushing and flossing your teeth regularly).

The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. It may take several weeks before you get the full benefit of this drug.

Cholestyramine may decrease your absorption of other medications. Take your other medications at least 1 hour before or 4 to 6 hours after cholestyramine. Ask your doctor or pharmacist for more information or if you have any questions.

Take this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) each day. It is important to continue taking this medication even if you feel well. Most people with high cholesterol do not feel sick.

Disclaimer

Questran Consumer (continued)

SIDE EFFECTS: Constipation, stomach/abdominal pain, gas, nausea, and vomiting may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

To prevent constipation, eat a diet adequate in fiber, drink plenty of water, and exercise. If you become constipated while using this drug, consult your pharmacist for help in selecting a stool softener and/or a laxative.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor immediately if any of these rare but serious side effects occur: severe stomach/abdominal pain, unusual bleeding/bruising, rapid breathing, confusion.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Read the Questran (cholestyramine) Side Effects Center for a complete guide to possible side effects »

PRECAUTIONS: Before taking cholestyramine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: constipation, hemorrhoids, kidney disease.

Some products may contain sugar or aspartame. Caution is advised if you have diabetes, phenylketonuria (PKU), or any other condition that requires you to limit/avoid these substances in your diet. Ask your doctor or pharmacist about using this product safely.

Because this drug can interfere with the absorption of certain nutrients (such as folic acid, fat-soluble vitamins including A, D, E, K), your doctor may direct you to take a multivitamin supplement. Consult your doctor for more information.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the side effects of this drug, especially constipation.

During pregnancy, this medication should be used only when clearly needed. It may affect the absorption of certain nutrients. Discuss the risks and benefits with your doctor.

This medication is unlikely to pass into breast milk. However, it may affect the absorption of certain nutrients. Consult your doctor before breast-feeding.

Disclaimer

Questran Consumer (continued)

DRUG INTERACTIONS: See also How to Use section.

The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.

To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.

Some products that may interact with this drug include: "blood thinners" (such as warfarin).

This document does not contain all possible drug interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.

OVERDOSE: If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call the US National Poison Hotline at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe stomach/abdominal pain.

NOTES: Do not share this medication with others.

Laboratory and/or medical tests (such as blood cholesterol/triglyceride levels, vitamin levels) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature away from light and moisture. See packaging for the exact temperature range. The color of the medication may sometimes vary. This is normal and will not affect how the drug works. If you have any questions about storage, ask your pharmacist. Do not store the medication in the bathroom. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Information last revised May 2010. Copyright(c) 2010 First Databank, Inc.

Questran Patient Information Including Side Effects

Brand Names: Cholestyramine Light, Prevalite, Questran, Questran Light

Generic Name: cholestyramine (Pronunciation: koe le STYE ra meen)

What is cholestyramine (Questran)?

Cholestyramine helps reduce cholesterol (fatty acids) in the blood. High cholesterol is associated with an increased risk of heart disease and atherosclerosis (clogged arteries).

Cholestyramine is used to lower high levels of cholesterol in the blood, especially low-density lipoprotein (LDL) ("bad" cholesterol).

Cholestyramine powder is also used to treat itching caused by a blockage in the bile ducts of the gallbladder.

Cholestyramine may also be used for other purposes not listed in this medication guide.

What are the possible side effects of cholestyramine (Questran)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

  • blood in your urine;
  • severe stomach pain;
  • ongoing constipation;
  • feeling short of breath;
  • black, bloody, or tarry stools; or
  • easy bruising or bleeding.

Less serious side effects may include:

  • mild constipation, diarrhea;
  • stomach pain, nausea, loss of appetite, weight changes;
  • bloating or gas;
  • hiccups or a sour taste in your mouth;
  • skin rash or itching;
  • irritation of your tongue;
  • itching or irritation around your rectal area;
  • muscle or joint pain; or
  • dizziness, spinning sensation; ringing in your ears.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Read the Questran (cholestyramine) Side Effects Center for a complete guide to possible side effects »

What is the most important information I should know about cholestyramine (Questran)?

You should not take this medication if you are allergic to cholestyramine, or if you have a blockage in your stomach or intestines.

Before taking cholestyramine, tell your doctor if you have a thyroid disorder, diabetes, kidney or liver disease, or chronic constipation.

Avoid taking other medications at the same time you take cholestyramine. Wait at least 4 to 6 hours after taking cholestyramine before you take any other medications.

Side Effects Centers

Questran Patient Information including How Should I Take

What should I discuss with my healthcare provider before taking cholestyramine (Questran)?

You should not take this medication if you are allergic to cholestyramine, or if you have a blockage in your stomach or intestines.

Before taking this medication, tell your doctor if you are allergic to any drugs, or if you have:

  • a thyroid disorder;
  • diabetes,
  • kidney disease,
  • liver disease, or
  • chronic constipation.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take cholestyramine.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Taking cholestyramine can make it harder for your body to absorb certain vitamins your body needs while you are nursing a baby. Do not take cholestyramine without telling your doctor if you are breast-feeding.

This medication may contain phenylalanine. Talk to your doctor before using cholestyramine if you have phenylketonuria (PKU).

How should I take cholestyramine (Questran)?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts or for longer than recommended by your doctor. Follow the directions on your prescription label.

Cholestyramine is sometimes taken up to 6 times per day. Follow your doctor's instructions.

Take cholestyramine with meals unless your doctor tells you otherwise.

Mix the cholestyramine powder with 2 to 6 ounces of water or other non-carbonated beverage. You may also mix the powder with a brothy soup, crushed pineapple, or applesauce. Measure the powder using the scoop provided with your medication. Do not use any other scoop or measuring cup to measure your cholestyramine dose.

Drink extra fluids to prevent constipation while you are taking cholestyramine.

It is important to take cholestyramine regularly to get the most benefit.

Cholestyramine is only part of a complete program of treatment that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

To be sure this medication is helping your condition, your blood may need to be tested on a regular basis. Do not miss any scheduled appointments.

Store cholestyramine at room temperature away from moisture and heat.

Side Effects Centers

Questran Patient Information including If I Miss a Dose

What happens if I miss a dose (Questran)?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose (Questran)?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include severe stomach pain or constipation.

What should I avoid while taking cholestyramine (Questran)?

Avoid taking other medications at the same time you take cholestyramine. Wait at least 4 to 6 hours after taking cholestyramine before you take any other medications.

What other drugs will affect cholestyramine (Questran)?

Cholestyramine can make it harder for your body to absorb other medications, such as:

  • a blood thinner such as warfarin (Coumadin);
  • digoxin (digitalis, Lanoxin);
  • propranolol (Inderal);
  • a diuretic (water pill);
  • thyroid hormones such as levothyroxine (Synthroid, Levoxyl, Levothroid);
  • birth control pills or hormone replacement;
  • seizure medicines such as phenytoin (Dilantin) and phenobarbital (Luminal, Solfoton); or
  • an antibiotic such as amoxicillin (Amoxil, Trimox, others), doxycycline (Adoxa, Doryx, Oracea, Vibramycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), penicillin (BeePen-VK, Pen-Vee K, Veetids, others), tetracycline (Brodspec, Panmycin, Sumycin, Tetracap).

This list is not complete and there may be other drugs that can interact with cholestyramine. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about cholestyramine.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 4.08. Revision date: 12/15/2010.

Your use of the content provided in this service indicates that you have read,understood and agree to the End-User License Agreement,which can be accessed by clicking on this link.

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Side Effects Centers

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