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 in Fredrickson's Type II
  • Initially 4g daily, increase by 4g at weekly intervals to 12–24g daily in 1–4 divided doses, adjusted according to response; maximum 36g daily
• Diarrhoea associated with Crohn’s disease
  • Initially 4g daily, increased by 4g at weekly intervals to 12–24g daily in 1–4 divided doses, then adjusted as required; maximum 36g daily
• Pruritus associated with partial biliary obstruction and primary biliary cirrhosis
  • 4–8g daily

Notes

1. 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.
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 (£68.57 = 180 pack)

Indications

• Colesevelam is included for the treatment of bile salt diarrhoea (off-label use) only in patients unable to tolerate colestyramine.

Notes

1. Colesevelam has not been approved locally for the treatment of hypercholesterolaemia.
2. 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.