Colestyramine (Cholestyramine)

Source: eMC SPC for Colestyramine 4 g Powder for Oral Suspension (sachet = 4 g colestyramine). INTRODUCTION SCHEDULE (sachets per day, weeks 1-4) — to a final dose of 3: 1, 2, 3, 3; to a final dose of 4: 1, 2, 3, 4; to a final dose of 6: 1, 2, 3, 6. Occasional slight gastrointestinal upsets, e.g. constipation, may occur when starting; these usually pass with continued use and are minimised by starting therapy gradually. OTHER INDICATIONS: to relieve pruritus — one or two sachets daily are usually sufficient; to relieve diarrhoea — as for reduction of cholesterol, but it may be possible to reduce this dosage, and in all patients presenting with diarrhoea induced by bile acid malabsorption, if a response is not seen within 3 days then alternative therapy should be initiated. Colestyramine should NOT be used in patients with exudative or bloody diarrhoea. COMBINATION THERAPY: the cholesterol-lowering effect on total and LDL-cholesterol is enhanced when combined with an HMG-CoA reductase inhibitor (e.g. pravastatin, simvastatin, lovastatin); enhanced LDL lowering is also seen with combined nicotinic acid/colestyramine therapy, and there is evidence to support adding colestyramine to gemfibrozil in patients with high LDL-cholesterol and triglycerides and low HDL-cholesterol. ELDERLY: no dosage adjustment is necessary. ADMINISTRATION TIMING (precautionary): where concurrent drug therapy exists, such drugs should be administered at least one hour before or 4-6 hours after colestyramine. MONITORING: serum cholesterol should be determined frequently during the first few months and periodically thereafter; serum triglycerides measured periodically; the diet may require supplementation with vitamins A, D and K during prolonged high-dose administration, and folic acid supplementation should be considered in children with familial hypercholesterolaemia. Reduce the dose in patients with constipation, since colestyramine may produce impaction. EXCIPIENTS: contains 3.79 g sucrose per sachet (relevant in diabetes mellitus; not for patients with hereditary fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency) and 97.5 mg propylene glycol-related excipient (text truncated). PAEDIATRIC: the SPC states 'Children 6 - 12 years: The initial dose is determined by the following formula:' — THE FORMULA ITSELF WAS NOT CAPTURED in the fetched text (it is rendered as an equation/image on the eMC page), so no paediatric dose has been recorded; clinician to source it. Subsequent dosage adjustment may be necessary where clinically indicated; to minimise potential gastrointestinal side effects it is desirable to begin all therapy in children with one dose daily, increasing gradually every five to seven days to the desired level for effective control. Colestyramine should NOT be used in children under 6 years — there are no data to support its use. Verify against a children's formulary. §4.4 is marked truncated at the source-fetch limit and eMC §4.5 was not included in this bundle.