Colesevelam hydrochloride

How it works

It binds bile acids in the intestine to prevent their reabsorption, increasing hepatic conversion of cholesterol to bile acids and upregulating LDL-receptor activity to lower LDL-cholesterol.

Prescribing in practice

• Because it can bind other drugs in the gut and reduce their absorption, separate the administration of interacting medicines, such as some thyroid hormones and certain anticoagulants, as advised in the SPC.
• It may raise serum triglycerides, so use with caution in patients with hypertriglyceridaemia.
• Gastrointestinal effects such as constipation are common and it can reduce absorption of fat-soluble vitamins with prolonged use.

Monitoring

Monitor the lipid profile including triglycerides to confirm response and detect any rise in triglycerides.

Counselling the patient

• Take other medicines at a separate time from this one, as advised.
• Take it with a meal and plenty of fluid.
• Report troublesome constipation so it can be managed.

Evidence & guidelines

Bile-acid sequestrants lower LDL-cholesterol and are positioned by NICE as add-on therapy when statins are insufficient or not tolerated.