Bile-binding resins

PBBs and PBDEs tend to accumulate in lipid-rich tissues and are slowly metabolized and eliminated from the body (see Section 3.4). Several methods to enhance the elimination of PBBs from the body have been examined in animals and are also relevant to PBDEs, including the restriction of caloric intake (to reduce total body fat), and the administration of various agents that interact with bile acids including activated charcoal, mineral oil and bile-binding resins such as cholestyramine (Kimbrough et al. 1980 McConnell et al. 1980 Polin and Leavitt 1984 Polin et al. 1985, 1991 Rozman et al. 1982). It should be mentioned, however, that based on the pharmacokinetic considerations discussed in Section 3.8.1, a rapid breakdown... 

Discuss the mechanism of action of bile-binding resins. 

Bile binding resin - binds bile salts Excretion... 

Actions of bile binding resins in the reduction of total cholesterol. 

Describe the changes in lipid profile seen with bile-binding resin therapy. 

Would bile-binding resins be effective in conjunction with a low fat diet ... 

Describe the effect of bile binding resins on triglyceride levels. 

What are the disadvantages of therapy with bile-binding resins ... 

Discuss drug interactions with bile-binding resins. 

What effect would a high-fiber diet, or the ingestion of bile-binding resins or antacids, have on thyroid hormone replacement therapy ... 

Bile Acid Sequestrants. The bile acid binding resins, colestipol [26658424] and cholestyramine, ate also effective in controlling semm cholesterol levels (150). Cholestyramine, a polymer having mol wt > ICf, is an anion-exchange resin. It is not absorbed in the gastrointestinal tract, is not affected by digestive enzymes, and is taken orally after being suspended in water (151). 

Hyperlipidemia. Bile acid binding resins such as cholestyramine sequester bile acids in the intestine,... 

Cholestyramine, colestipol, and colesevelam are the bile acidbinding resins or sequestrants (BAS) currently available in the United States. Resins are highly charged molecules that bind to bile adds (which are produced from cholesterol) in the gut. The resin-bile acid complex is then excreted in the feces. The loss of bile causes a compensatory conversion of hepatic cholesterol to bile, reducing hepatocellular stores of cholesterol resulting in an up-regulation of LDL receptors to replenish hepatocellular stores which then result in a decrease in serum cholesterol. Resins have been shown to reduce CHD events in patients without CHD.26... 

The answer is c. (Hardman, pp 887, 889.) Bile acid-binding resins bind more than just bile acids, and binding of simvastatin to cholestyramine is the most likely mechanism for decreased Gl absorption. Cholestyramine may also bind to several other drugs, including digoxin, benzothiadiazides (thiazides), warfarin, vancomycin, thyroxine (T4), and aspirin. Medications should be given one hour before or four hours after cholestyramine. 

Concomitant lipid-lowering f/ erapy-Atorvastatin may be used in combination with a bile-acid-binding resin for additive effect. Generally, avoid the combination of HMG-CoA reductase inhibitors and fibrates. 

Concomitant lipid-lowering therapy-The effect of rosuvastatin on LDL-C and total-C may be enhanced when used in combination with a bile acid-binding resin. If rosuvastatin is used in combination with gemfibrozil, limit the dose of rosuvastatin to 10 mg once daily. 

In addition symptomatic treatment with opiates, with bile acid binding resins in those with bile acid malabsorption, with milk free diets in those who are lactose intolerant, and with low fat diets may materially help relevant symptoms. 

Biliary cirrhosis, secondary disease this requires elimination of the obstructive cause. Itching associated with bile acid retention can respond to cholestyramine, a bile acid binding resin. 

Itching associated with retention of bile acids is ameliorated by treatment with the bile acid binding resin cholestyramine. Fat soluble vitamin (A, D and K) deficiency may require administration of supplements. Direct toxic effects of alcohol associated with dietary deficiency may require soluble B vitamin administration. 

The principal precaution with use of the bile acid resins is the possibility of impaired absorption of other drugs given orally at the same time. Cholestyramine and colestipol can bind many other drugs, such as digitoxin, phenobarbital, chlorothiazide, and warfarin, and delay or prevent their absorption. For this reason, other drugs should always be taken at least 1 hour before or 4 to 6 hours after the resin. The resins can also decease absorption of fat-soluble vitamins. 

PO026 Smith, M. A., and A. A. Aso. Comparison of psyllium hydrophilic mucilloid and bile salt binding resin therapy for hypercholesterolemia. Abstr Endocrine Society 144 Annual Meeting June 1992 62. 

FIBRIC ACID DERIVATIVES BILE ACID-BINDING RESINS... 

Colestimide (colestilan)2 Bile acid binding resin improves glycemic control and reduces weight in an obese DM-2 model... 

See also Antacids Bile acid-binding resins. 

Review of the use of HMG-CoA inhibitors and bile acid-binding resins to reduce serum cholesterol. 

Fibric Acid Derivatives Bile Acid-Binding Resins... 

Conjugated bile salts are normally absorbed in the terminal ileum. Disease of the terminal ileum (eg, Crohn s disease) or surgical resection leads to malabsorption of bile salts, which may cause colonic secretory diarrhea. The bile salt binding resins cholestyramine or colestipol may decrease diarrhea caused by excess fecal bile acids (see Chapter 35 Agents Used in Hyperlipidemia). The usual dose is 4-5 g one to three times daily before meals. Side effects include bloating, flatulence, constipation, and fecal impaction. In patients with diminished circulating bile acid pools, further removal of bile acids may lead to an exacerbation of fat malabsorption. These agents bind a number... 

Bile acid-binding Resins may bind with orally... 

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