Colestyramine NSAIDs

ANION EXCHANGE RESINS NSAIDs Colestyramine i absorption of NSAIDs Colestyramine binds NSAIDs in the intestine, reducing their absorption it also binds those NSAIDs with a significant entero-hepatic recirculation (meloxicam, piroxicam, sulindac, tenoxicam) Give the NSAID 1 hour before or 4-6 hours after colestyramine however, meloxicam, piroxicam, sulindac and tenoxicam should not be given with colestyramine... 

Colestyramine Naproxen and probably other NSAIDs The anion exchange resin binds NSAIDs in gut, reducing the rate ( and extent) of absorption Separate dosing times by 4 hours may need higher than expected dosages of NSAIDs... 

Simultaneous colestyramine marked reduced the absorption of diclofenac and sulindac, modestly reduced the absorption of ibu-profen, but only delayed and did not reduce the extent of absorption of naproxen. Administration of colestyramine three or more hours after oral sulindac, piroxicam, or tenoxicam still markedly reduced their plasma levels. Markedly reduced NSAID levels have also been found when colestyramine is given after intravenous meloxicam or tenoxicam. 

The studies of simultaneous oral use suggest that the anion exchange resin colestyramine, and to a lesser extent colestipol, bind anionic NSAIDs (e.g. diclofenac) in the gut, so reducing their absorption. The studies showing reduced plasma levels when colestyramine was given after intravenous oxicams or separated by at least 3 hours from some oral NSAIDs, suggest that colestyramine can reduce the enterohepatic recirculahon of these drugs. 

Established interactions. Colestyramine markedly reduces the initial absorption of some NSAIDs (shown for diclofenac), and if these NSAIDs also undergo enterohepatic recirculation, their clearance will also be increased (shown for meloxicam, piroxicam, sulindac, and tenoxicam). This latter interaction cannot be avoided by separating the doses, and it may be best not to use colestyramine with these NSAIDs. Colestyramine can be used to speed the removal of piroxicam and tenoxicam following overdosage. Diclofenac has been formulated with colestyramine in an attempt to reduce gastric mucosal damage by reducing direct mucosal contact 140 mg of diclofenac-colestyramine is considered equivalent to 70 mg of diclofenac. ... 

The reduction in absorption of ibuprofen with colestyramine is probably not clinically important, and naproxen is not affected. Nevertheless, colestyramine delayed the absorption of both ibuprofen and naproxen, which may be relevant if they are being taken for the management of acute pain. Information on many other NSAIDs appears to be lacking. Animal studies suggest that mefenamic acid, flufenamic acid and phenylbutazone will also be affected by colestyramine." " Note that it is usually recommended that other drugs are given 1 hour before or 4 to 6 hours after colestyramine. 

The serum levels of the active metabolite of leflunomide are reduced by activated charcoal, and colestyramine. The manufacturers advise against the concurrent use of alcohol because of the potential for hepatotoxicity. Methotrexate may also increase leflunomide hepatotoxicity, so in general the combination is not recommended. A case of fatal fulminant hepatic failure has been reported in a patient taking leflunomide and itraconazole. A case of peripheral neuropathy has been reported in a patient taking leflunomide and tegafiir/uraciL The manufacturers predict interactions between leflunomide and phenytoin or tolbutamide, and advise caution with rifampicin as it may increase leflunomide metabolite levels. No clinically relevant interaction occurs with cime-tidine, corticosteroids or NSAIDs. 

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