Cholestyramine adverse effects

WARNING May T risk of CV events GI bleeding Uses Osteoarthritis, RA, JRA Action NSAID w/ T COX-2 activity Dose Adults. 7.5-15 mg/d PO Feds (>2 y). 0.125 mg/kg/d, max 7.5 mg 4- in renal insuff take w/ food Caution [C, D (3rd tri) /-] Peptic ulcer, NSAID, or ASA sensitivity Disp Tabs, susp SE HA, dizziness, GI upset, GI bleeding, edema Interactions T Effects OF ASA, anticoagulants, corticosteroids, Li, EtOH, tobacco effects W/ cholestyramine 4-effects OF antihypertensives EMS T Effects of anticoagulants concurrent EtOH/tobacco use can T adverse GI effects (bleeding, D) T risk of photosensitivity Rxns OD May cause NA and lethargy activated charcoal may be effective... 

Adverse effects The most common of these are headache, diarrhea, and nausea. Other untoward effects are weight loss, allergic reactions including a flu-like syndrome, skin rash, alopecia, and hypokalemia. Leflunomide is teratogenic in experimental animals, and is therefore contraindicated in pregnancy, and in women of childbearing potential. It should be used with caution in patients with liver disease, because it is cleared by both biliary and renal excretion. Cholestyramine increases the clearance of leflunomide. 

Food delays the absorption and decreases MPA C ax by 25% but has no effect on MPA At/C. As a result, prescribing information indicates that MMF should be taken on an empty stomach however, MMF is often given with food in chnical practice to minimize GI adverse effects. Administration with aluminum- and magnesium-containing antacids or cholestyramine, significantly decreases the At/C of MPA and should be avoided. It has been suggested that administration of iron may produce similar results, but this has not been tested. 

Cholestyramine and colestipol are bile acid sequestranls that enhance cholesterol loss into the feces, thereby stimulating new bile salt synthesis, which lowers liver cholesterol levels and consequently plasma LDL levels. Their adverse effects are also listed. 

The bile acid sequestrants, cholestyramine and colestipol, reduce LDL-cholesterol by up to 30% and their use is supported by RCTs [69]. However, they are not well-tolerated chiefly because of gastro intestinal adverse effects. In patients already on multiple drug therapies timing of administration of resins is difficult as they can interfere with the absorption of other drugs. They need to be given at least 1 h before or at least 4 h after other medications. 

Hypercholesterolemia is associated with abnormal vascular reactivity (Vita et al, 1990 Seiler et al., 1993), and there is some evidence that lipid lowering with HMG-CoA reductase inhibitors (Treasure et al., 1995 O Driscoll et al., 1997 Simons et al., 1998) and cholestyramine (Leung et al., 1993) can partially reverse this effect within a few months. Improvement in endothelial-dependent vasodilation has also been observed within 24 hours after LDL apheresis in patients with familial hypercholesterolemia this supports the view that high plasma concentrations of LDL adversely affect endothelial function and impair vasodilation (Tamai et al, 1997). However, the Coronary Artery Reactivity After Treatment with Simvastatin (CARATS) study, a large, well-controlled study, provided no evidence for an effect, despite a mean 40% reduction in LDL cholesterol with simvastatin 40 mg daily (Hodgson et al, 1996 Vita et al, 2000). Furthermore, a link between vascular reactivity and coronary events has yet to be established. 

Vancomycin has adverse reactions when used with some medications. You must wait several hours before giving vancomycin to a patient who has received oral cholestyramine (Questran) or colestipol (Colestid) because these medications lower the therapeutic effect of vancomycin. 

With advance in our knowledge of the physical chemistry of bile acids and lipids, it may be possible to synthesize resins with still greater selectivity in vivo than cholestyramine, should this method prove to be an effective longterm therapeutic measure. The administration of cholestyramine to guinea pigs induces cholelithiasis (62) and isolated incidents of adverse affects have been reported in the clinical literature following long-term treatment with the resin (63). 

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