Bile Acid Sequestrant / Ion Exchange Resin Pregnancy: Compatible — not systemically absorbed; however, fat-soluble vitamin deficiency may occur — supplement

Colestyramine (Cholestyramine)

Brand names: Questran

Adult dose

Dose: 4–8 g (1–2 sachets) TDS–QDS before meals. Initial: 4 g OD–BD, titrate over several weeks.

Route: Oral (powder mixed in liquid)

Frequency: TDS–QDS with meals

Max: 36 g/day

For pruritus of cholestasis, diarrhoea associated with bile acid malabsorption (post-terminal ileum resection), and hypercholesterolaemia. Always separate other drugs by 1 hour before or 4–6 hours after colestyramine.

Paediatric dose

Route: Oral

Frequency: TDS

Max: 8 g/day

Concentration: 4 g/sachet g/ml

Children 6–12 years: 4 g OD–BD, titrate to response. Mix in fruit juice or squash to improve palatability.

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required — used specifically for hepatic cholestasis

Clinical pearls

For cholestatic pruritus: first-line agent (NICE recommends colestyramine or rifampicin)
Bile acid malabsorption diarrhoea (SeHCAT <10%): highly effective treatment
Fat-soluble vitamin supplements (A, D, E, K) required with long-term use
Questran sachets can be mixed in orange juice, squash, or soup — improve compliance by finding preferred vehicle

Contraindications

Complete biliary obstruction
Hyperchloraemic acidosis

Side effects

Constipation (dose-limiting)
Flatulence and bloating
Nausea
Fat-soluble vitamin deficiency (vitamins A, D, E, K) with prolonged use
Steatorrhoea at high doses

Interactions

Multiple drugs — binds and reduces absorption of almost all oral drugs. Separate by minimum 1 hour before or 4–6 hours after.
Particularly important: warfarin, thyroxine, digoxin, statins, oral contraceptives, fat-soluble vitamins

Monitoring

Symptom response (pruritus/diarrhoea)
Lipid profile (if for hypercholesterolaemia)
Fat-soluble vitamins (with prolonged use)
INR if on warfarin

Reference: BNFc; BNF; NICE CG149 Jaundice in Adults; SeHCAT Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways