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Prevalite/Questran

Generic Name: Cholestyramine
Drug Category: Bile Acid Sequestrant
Litigation Alert Level: Low
This drug has been approved for use by males and females over the age of 18 years old for a maximum duration of 7 years.

Approved Uses

Indicated for:

Primary Hypercholesterolemia:

• As adjunctive therapy to diet for the reduction of elevated serum cholesterol in patients with primary hypercholesterolemia (elevated low-density lipoprotein [LDL] cholesterol) who do not respond adequately to diet.

Hypertriglyceridemia:

• Prevalite may be useful to lower LDL cholesterol in patients who also have hypertriglyceridemia, but it is  not indicated where hypertriglyceridemia is the abnormality of most concern.

Pruritus:

• For the relief of pruritus associated with partial biliary obstruction. Cholestyramine resin has been shown to have a variable effect on serum cholesterol in these patients.

Prevalite 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. Primary biliary cirrhosis may exhibit an elevated cholesterol as part of their disease.

Chronic use of cholestyramine resin may be associated with increased bleeding tendency due to hypoprothrombinemia associated with Vitamin K deficiency.

Reduction of serum or red cell folate has been reported over long term administration of cholestyramine resin. Supplementation with folic acid should be considered in these cases.

Cholestyramine resin may produce or worsen pre-existing constipation. The dosage should be increased gradually in patients to minimize the risk of developing fecal impaction. Particular effort should be made to avoid constipation in patients with symptomatic coronary artery disease. Constipation associated with cholestyramine resin may aggravate hemorrhoids.

There is a possibility that prolonged use of cholestyramine resin, 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.

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.

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.

Cholestyramine resin 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.

The discontinuance of cholestyramine resin 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 cholestyramine resin.

Because cholestyramine binds bile acids, cholestyramine resin 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 cholestyramine resin is given for long periods of time, concomitant supplementation with water-miscible (or parenteral) forms of fat-soluble vitamins should be considered.

Since cholestyramine resin may bind other drugs given concurrently, it is recommended that patients take other drugs at least 1 hour before or 4 to 6 hours after cholestyramine resin (or at as great an interval as possible) to avoid impeding their absorption.

There are no adequate and well controlled studies in pregnant women. Animal studies: development of intestinal tumors.

Caution should be exercised when cholestyramine resin is administered to a nursing mother. The possible lack of proper vitamin absorption may have an effect on nursing infants.

GoToSource

Off-label Uses

• Use in patients under the age of 18. GoToSource

• Microscopic colitis. GoToSource

• Management and prevention of recurrent clostridium difficile infection after total joint arthroplasty. GoToSource

• Cholesteryl ester storage disease. GoToSource 

• Post cholecystectomy diarrhea. GoToSource

• Biotoxin-associated illness from exposure to water-damaged buildings. GoToSource 

• Bile acid malabsorption. GoToSource 

• Fecal incontinence. GoToSource 

• Babesia microti and borrelia burgdorferi. GoToSource 

• Digoxin intoxication. GoToSource

Adverse Events

Hyperchloremic metabolic acidosis. GoToSource

Intestinal obstruction after pancreatic surgery. GoToSource

Vitamin K deficiency and bleeding. GoToSource

Osteomalacia (softening of the bones). GoToSource

Constipation. GoToSource

Impairment of vitamin D. GoToSource

Litigation

No major injury lawsuits reported.

The material contained in GoToPills is for informational purposes only and not intended to replace the judgment, evaluation and treatment of physicians, pharmacists and other healthcare providers. GoToPills does not provide medical advice, diagnoses or treatment. Always seek the advice of your physician or other qualified health provider regarding a medical condition or treatment.

 

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Site Last Updated March 28, 2024