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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:

Reduction of Elevated Serum Cholesterol in Patients with Primary Hypercholesterolemia:

• 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. QUESTRAN 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 Associated with Partial Biliary Obstruction:

• The relief of pruritus associated with partial biliary obstruction. QUESTRAN has been shown to have a variable effect on serum cholesterol in these patients. Patients with primary biliary cirrhosis may exhibit an elevated cholesterol as part of their disease.

QUESTRAN 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.

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

There is a possibility that prolonged use of QUESTRAN, 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.

QUESTRAN may produce or worsen pre-existing constipation. The dosage should be increased gradually in patients to minimize the risk of developing fecal impaction.

QUESTRAN 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.

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

QUESTRAN 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. Interference with the absorption of oral phosphate supplements has been observed with another positively-charged bile acid sequestrant. QUESTRAN may interfere with the pharmacokinetics of drugs that undergo enterohepatic circulation. The discontinuance of QUESTRAN 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 QUESTRAN.

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

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

Caution should be exercised when QUESTRAN is administered to a nursing mother due to possible lack of proper vitamin absorption.

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Off-label Uses

• Use in patients under the age of 18. GoToSource

• Bile acid malabsorption. GoToSource

• Alagille syndrome. GoToSource 

• Improvement of glycemic control with type 2 diabetes. GoToSource

• Chronic watery diarrhea. GoToSource

• Erythropoietic protoporphyria. GoToSource

• Use with diclofenac, uridine, cytidine and vitamin B12 for acute, non-traumatic pain. GoToSource

• Hyperthyroidism. GoToSource

Adverse Events

Vitamins A and E deficiencies. GoToSource

Bloating, vomiting, heartburn, loss of appetite, indigestion, edema (swelling), syncope (temporary loss of consciousness), drowsiness, skin rashes, exacerbation of peptic ulcer disease and hemorrhoids, shortness of breath, paresthesia (abnormal sensation), biliary colic, dental discoloration, asthma, steatorrhea (excess fat in stools) and anemia (low number of red blood cells). GoToSource

Hypoprothrombinemia (deficiency of the blood-clotting substance prothrombin) and hemorrhage. GoToSource

Osteomalacia (softening of the bones). GoToSource

Platelet gigantism. GoToSource

Coagulopathy (blood’s ability to clot is impaired) and vitamin K deficiency. GoToSource

Hyperchloremic metabolic acidosis. GoToSource

Constipation, intestinal obstruction and increased plasma triglyceride levels. 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 29, 2024