cholestyramine (Questran)
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Introduction
Tradename: Questran.
Indications
- hypercholesterolemia* (increased LDL)
- pruritus associated with elevated levels of bile acids
- diarrhea associated with excess fecal bile acids
- binding of toxic agents
- pseudomembranous colitis
- adjunctive treatment of digitalis toxicity
- treatment of enteric hyperoxaluria[6]
* Especially useful when inflammatory liver disorder coexists with hyperlipidemia, making use of niacin & HMG CoA reductase inhibitors (statins) problematic.
Dosage
Tabs: 1g
Powder: 4 g/9 g of powder (378 g) 4 g/5 g of powder (378 g) with aspartame (Questran Light)
Pharmacokinetics
- not abdorbed from the GI tract
- peak effects within 21 days
elimination via feces
Adverse effects
- constipation (1-10%)
- abdominal pain
- abdominal distension
- flatulence
- nausea/vomiting
- diarrhea
- increased levels of triglycerides
- rash
- irritation of perianal area, skin or tongue
- hyperchloremic acidosis
- malabsorption of fat-soluble vitamins
- increased urinary Ca+2 excretion*
- may increase homocysteine levels
- may increase serum transaminase levels[6]
* but decreases hyperoxaluria[6]
Drug interactions
- interferes with absorption of many medications
Mechanism of action
- depletes bile acid pool
- removes plasma LDL
- upregulates hepatic LDL receptors
- binds oxalate when excessive free fatty acids bind calcium[6]
More general terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 354
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Prescriber's Letter 7(2):7, Feb. 2000
- ↑ Geriatric Dosage Handbook, 6th edition, Selma et al eds, Lexi-Comp, Cleveland, 2001
- ↑ 6.0 6.1 6.2 6.3 6.4 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018
- ↑ Department of Veterans Affairs, VA National Formulary
non formulary drug request