Cholestyramine, Oral Suspension

• Complete biliary obstruction: You shouldn’t take this drug if you have a full blockage of your bile ducts that doesn’t allow bile to be released into your intestine.
• Low vitamin levels: This drug may stop your body from absorbing vitamin K and folate (a form of vitamin B). Low levels of these vitamins can be harmful and make you more likely to bleed or bruise if you get hurt. Your doctor will let you know if you need to take extra vitamins.
• High acid levels: This drug can increase the acid levels in your body. Tell your doctor if you have low energy, headaches, nausea, or vomiting when you take this medication.

Cholestyramine is a prescription drug. It’s available as a powder for oral suspension.

Cholestyramine is available as the brand-name drug Prevalite. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version.

This drug may be used as part of a combination therapy. This means you may need to take it with other medications.

Why it’s used

Cholestyramine is used to reduce high cholesterol levels. It’s given to people with high cholesterol who haven’t been able to lower their cholesterol enough with diet changes.

This drug is also used to treat itching due to partial bile obstruction.

How it works

Cholestyramine belongs to a class of drugs called bile acid sequestrants. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

For high cholesterol: This drug combines with bile acids in your intestine, which stops them from being taken up into your body. When less bile acids are taken up into your body, cholesterol is broken down into acids. Breaking down cholesterol helps to lower your body’s cholesterol levels.

For itching due to partial bile obstruction: High levels of bile acids in your skin can cause itching. This drug can decrease this itching by stopping bile acids from being taken up into your body.

Cholestyramine oral suspension doesn’t cause drowsiness, but it can cause other side effects.

More common side effects

The more common side effects of cholestyramine can include:

• constipation
• upset stomach or stomach pain
• diarrhea or loose stools
• nausea
• vomiting
• belching
• loss of appetite
• skin irritation

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Low vitamin K levels. Symptoms can include:
• bleeding or bruising more easily
• Low vitamin B. This can cause changes to the red blood cells in your body and cause anemia. Symptoms can include:
• shortness of breath
• weakness
• tiredness
• High acid levels. Symptoms can include:
• nausea
• vomiting
• confusion
• headache
• breathing faster than normal

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Cholestyramine oral suspension can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with cholestyramine are listed below.

Other medications taken by mouth

Cholestyramine can delay or slow other oral medications from being absorbed by your body. This can lower the amount of the medication in your body. This means that it won’t work as well to treat your condition.

You should take other oral drugs at least 1 hour before you take cholestyramine, or 4 to 6 hours after you take it. Examples of these drugs include:

• phenylbutazone
• warfarin
• thiazide diuretics, such as:
• hydrochlorothiazide
• indapamide
• metolazone
• propranolol
• tetracycline
• penicillin G
• phenobarbital
• thyroid drugs
• estrogens/progestins, such as oral birth control pills
• digoxin
• phosphate supplements, such as:
• K-Phos
• Phospho-soda
• Visicol

Certain vitamins

Cholestyramine interferes with fat digestion and may stop certain vitamins from getting into your body. Examples of these drugs include:

• vitamin A
• vitamin D
• vitamin E
• vitamin K

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

This drug comes with several warnings.

Allergy warning

This drug can cause a severe allergic reaction. Symptoms can include:

• itching
• trouble breathing
• wheezing

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Warnings for people with certain health conditions

For people with constipation: This drug can cause or worsen constipation. If you have constipation, your doctor may change your dosage or dosing schedule. If your constipation gets worse, your doctor may take you off of this drug and give you a different drug, especially if you have heart disease or hemorrhoids.

For people with phenylketonuria (PKU): The light form of cholestyramine contains 22.4 mg of phenylalanine per 5.7-gram dose. It may be better if you take regular cholestyramine, which doesn’t contain phenylalanine.

Warnings for other groups

For pregnant women: This drug is a category C pregnancy drug. That means two things:

1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Cholestyramine stays in your digestive tract and does not reach the bloodstream. However, this drug may reduce your body’s absorption of vitamins it needs during pregnancy.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should be used only if the potential benefit justifies the potential risk to the fetus.

For women who are breastfeeding: This drug doesn’t pass into breast milk. However, this drug may reduce the amount of vitamins absorbed by the mother’s body. As a result, babies who are breastfed may not get the vitamins they need.

Talk to your doctor if you breastfeed your baby. You may need to decide whether to stop breastfeeding or stop taking this medication.

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

• your age
• the condition being treated
• how severe your condition is
• other medical conditions you have
• how you react to the first dose

Forms and strengths

Generic: Cholestyramine

• Form: powder for oral suspension
• Strengths: cartons of 60 pouches (4 grams each) or cans (168 grams or 42 doses)

Generic: Cholestyramine (light)

• Form: powder for oral suspension (light)
• Strengths: cartons of 60 pouches (4 grams each) or cans (239.4 grams each)

Brand: Prevalite

• Form: powder for oral suspension
• Strengths: cartons of 42 or 60 pouches (4 grams each) or cans (231 grams or 42 doses)

Dosage for high cholesterol (hyperlipidemia)

Adult dosage (ages 18 years and older)

• Cholestyramine: The starting dose is 1 pouch (4 grams) or 1 level scoopful (4 grams) taken by mouth once or twice per day. After one month, your doctor may increase your dosage based on your cholesterol levels. You may take up to 2 to 4 pouches or level scoopfuls per day, divided into 2 doses. You can take individual doses 1 to 6 times per day. You shouldn’t take more than 6 pouches or level scoopfuls per day.
• Cholestyramine light: The starting dose is 1 pouch (4 grams) or 1 level scoopful (4 grams) taken by mouth once or twice per day. After one month, your doctor may increase your dosage based on your cholesterol levels. You may take up to 2 to 4 pouches or level scoopfuls per day, divided into 2 doses. You can take individual doses 1 to 6 times per day. You shouldn’t take more than 6 pouches or level scoopfuls per day.

Child dosage (ages 0–17 years)

• Cholestyramine: The usual dosage in children is 240 mg/kg of body weight per day of anhydrous cholestyramine resin taken in 2 to 3 divided doses. Most children won’t need more than 8 grams per day.
• Cholestyramine light: The usual dose in children is 240 mg/kg of body weight per day of anhydrous cholestyramine resin taken in 2 to 3 divided doses. Most children won’t need more than 8 grams per day.

Special considerations

• Constipation: If you have constipation, you should start taking cholestyramine once per day for 5 to 7 days. Then, increase your dosage to twice per day if you’re able to. Your doctor may increase your dosage slowly (over several months) to make sure that your constipation doesn’t get worse.

Dosage for itching due to partial bile obstruction

Adult dosage (ages 18 years and older)

• Cholestyramine: The starting dose is 1 pouch (4 grams) or 1 level scoopful (4 grams) taken by mouth once or twice per day. After one month, your doctor may increase your dosage based on your cholesterol levels. You may take up to 2 to 4 pouches or level scoopfuls per day, divided into 2 doses. You can take individual doses 1 to 6 times per day. You shouldn’t take more than 6 pouches or level scoopfuls per day.
• Cholestyramine light: The starting dose is 1 pouch (4 grams) or 1 level scoopful (4 grams) taken by mouth, once or twice per day. After one month, your doctor may increase your dosage based on your cholesterol levels. You may take up to 2 to 4 pouches or level scoopfuls per day, divided into 2 doses. You can take individual doses 1 to 6 times per day. You shouldn’t take more than 6 pouches or level scoopfuls per day.

Child dosage (ages 0–17 years)

• Cholestyramine: The usual dosage in children is 240 mg/kg of body weight per day of anhydrous cholestyramine resin, taken in 2 to 3 divided doses. Most children won’t need more than 8 grams per day.
• Cholestyramine light: The usual dosage in children is 240 mg/kg of body weight per day of anhydrous cholestyramine resin, taken in 2 to 3 divided doses. Most children won’t need more than 8 grams per day.

Special considerations

• Constipation: If your child has constipation, they should start taking cholestyramine once per day for 5 to 7 days. Then, increase their dose to twice per day if they’re able to take that. Your doctor may increase their dose slowly (over several months) to make sure that their constipation doesn’t get worse.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Cholestyramine is used for long-term treatment. It comes with risks if you don’t take it as prescribed.

If you stop taking the drug or don’t take it at all: If you don’t take this drug, your cholesterol may not improve. This could increase your risk of heart attack or stroke. If you take this drug for itching due to partial bile obstruction, your itching may not get better.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. If this drug doesn’t work as well, your cholesterol or itching may not improve.

If you take too much: This drug doesn’t get taken up into your body, so taking too much likely won’t cause major problems. Taking too much may cause worse constipation or your digestive tract may become blocked. Call your doctor right away if you think you’ve taken too much of this drug.

What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in increased constipation.

How to tell if the drug is working: You’ll be able to tell this drug is working if your cholesterol level decreases or your itching improves.

Keep these considerations in mind if your doctor prescribes cholestyramine for you.

General

• Take this drug with food.
• You should take this drug with meals unless a different time of day would be better to help you avoid interactions with other medications.
• Always mix this drug with water, juice, other non-carbonated drinks, applesauce, pulpy fruits (such as crushed pineapple), or thin soups.

Storage

• Store the dry powder at room temperature between 68°F and 77°F (20°C and 25°C).
• Keep it away from high temperatures.
• You can mix your dose with the liquid a day before taking it and store it in the refrigerator overnight.
• Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t hurt your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

• You should drink plenty of fluids with this drug. Mix each dose in at least 2 ounces of non-carbonated fluid. (If you mix the drug with a carbonated drink, it will foam up and may be hard to drink). Before taking it, stir the mixture until the powder is dissolved. This drug can also be mixed with liquid soups or pulpy fruits that contain lots of water, such as applesauce or crushed pineapple.
• You can mix your dose with the liquid a day before taking it and store it in the refrigerator overnight. This may make it easier to drink.
• Drink the mixture like you would drink a glass of water. Don’t sip it slowly or keep it in your mouth too long. If you do, it can discolor your teeth or cause tooth decay.

Clinical monitoring

You may need to have your cholesterol monitored while you take this drug. This will tell if your medication is working.

This monitoring may be done using this test:

• Cholesterol levels, including triglycerides. Your doctor will do this blood test often during your first few months of treatment. You’ll have your cholesterol checked less often after you’ve been taking this drug for a while.

Your diet

This drug may stop vitamin K and folate (a form of vitamin B) from being absorbed by your body. Low levels of these vitamins can be harmful. Your doctor will let you know if you need to take extra vitamins.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure they carry it.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.