Colesevelam | Side Effects, Dosage, Uses & More
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Generic Name:

colesevelam, Oral tablet

All Brands

  • WelChol
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Highlights for colesevelam

Oral tablet
1

Colesevelam is used to treat high cholesterol. It’s also used to control blood sugar in people with type 2 diabetes.

2

This drug comes in the form of a tablet you take by mouth. It also comes as an oral suspension that you take by mouth. For the oral suspension, you mix a packet of granules with a liquid.

3

Colesevelam is available as a brand-name drug called Welchol. It’s not available as a generic drug.

4

Common side effects include constipation, upset stomach, and nausea in adults. In children, it can cause headache, tiredness, the common cold, upper respiratory tract infection, the flu, and nausea.

5

In some cases, colesevelam can cause serious side effects. This includes inflammation of the pancreas (pancreatitis).

IMPORTANT INFORMATION

Triglyceride-induced pancreatitis warning

This drug can raise your risk of inflammation of the pancreas (pancreatitis) if you have very high triglyceride levels, or if you’ve had pancreatitis due to high triglycerides. You shouldn’t take colesevelam if you have these conditions.

Stomach problems warning

This drug may not be safe for you if you have problems with slow digestion or swallowing or if you’ve had major gastrointestinal tract surgery. These things can increase your risk of developing a blockage in your intestines or esophagus. This may require hospitalization.

Vitamin deficiency warning

Colesevelam blocks the absorption of fat-soluble vitamins A, D, E, and K. You may not be able to take this drug if you have problems with low levels of these vitamins or if you take drugs that depend on these vitamins to work correctly, such as warfarin. If you take vitamin supplements, take them at least 4 hours before taking colesevelam.

Drug features

Colesevelam is a prescription drug. It’s available in these forms: oral tablet and granules for oral suspension.

Colesevelam isn’t available as a generic drug.

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

Why it's used

Colesevelam is used to lower cholesterol in people with high low-density lipoprotein (LDL) or “bad” cholesterol. High LDL cholesterol is a major cause of heart disease and stroke.

More Details

How it works

Colesevelam 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.

More Details

Why it's used

Colesevelam is used to lower cholesterol in people with high low-density lipoprotein (LDL) or “bad” cholesterol. High LDL cholesterol is a major cause of heart disease and stroke. 

This drug is also used to control high blood sugar levels in people with type 2 diabetes.

How it works

Colesevelam 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.

Colesevelam binds to bile acids in your intestine, which triggers your body to make more bile acid. Your body uses cholesterol to make more bile acid, so the amount of cholesterol gets used up during this process. This lowers your cholesterol levels.

It isn’t known how colesevelam works to lower blood sugar levels.

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colesevelam Side Effects

Oral tablet

Most Common Side Effects

The adult side effects for this drug are slightly different from the side effects for children.

  • Adult side effects can include:

    • constipation
    • upset stomach
    • nausea
  • Children’s side effects can include:

    • headache
    • tiredness
    • the common cold
    • upper respiratory tract infection
    • the flu
    • nausea

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 9-1-1 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:

  • inflammation of the pancreas (pancreatitis). Symptoms can include:

    • sharp stomach pain
    • nausea and vomiting
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Colesevelam doesn’t cause drowsiness.

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.
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colesevelam May Interact with Other Medications

Oral tablet

Colesevelam 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.

Medications that might interact with this drug

Birth control pills

Colesevelam decreases the effectiveness of certain birth control pills. This can increase your chance of getting pregnant. 

These drugs include:

  • ethinyl estradiol with norethindrone

Blood thinners

Certain blood thinners won’t work as well when taken at the same time as colesevelam. This can increase your risk for blood clots. Take your blood thinner at least 4 hours before you take colesevelam to avoid this interaction.

These drugs include:

  • warfarin

Diabetes medicines

Colesevelam increases the amount of certain diabetes medicines in your body. This can cause side effects, including low blood sugar (hypoglycemia). 

These drugs include:

  • metformin extended release

This drug can decrease the amount of other diabetes medicines. This can increase your risk of high blood sugar (hyperglycemia). 

These drugs include:

  • glimepiride
  • glipizide
  • glyburide

Heart medicines

Colesevelam decreases the amount of certain heart medicines in your body. This can cause poor control of your blood pressure or other heart problems. 

These drugs include:

  • olmesartan

Rheumatoid arthritis/organ transplant medicines

Colesevelam decreases the amount of certain rheumatoid arthritis or solid organ transplant medicines in your body. This means that these drugs won’t work as well. Take these medicines at least 4 hours before you take colesevelam. Your doctor will monitor the levels of your rheumatoid arthritis/organ transplant medicines more carefully while you take this drug.

These drugs include:

  • cyclosporine

Seizure medicines

Colesevelam decreases the effectiveness of certain seizure medicines. This can cause increased seizures. Take your seizure medicine at least 4 hours before you take colesevelam to avoid this interaction.

These drugs include:

  • phenytoin

Thyroid medicines

Colesevelam decreases the amount of certain thyroid medicines. This can cause effects, such as fatigue, from not having enough thyroid hormone in your body. Take your thyroid medicine at least 4 hours before you take colesevelam to avoid this interaction.

These drugs include:

  • levothyroxine

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.
Colesevelam warnings
pancreatitis or high triglycerides
People with a history of pancreatitis or high triglycerides

This drug can raise your risk of inflammation of the pancreas (pancreatitis) if you have very high triglyceride levels, or if you’ve had pancreatitis due to high triglycerides. You shouldn’t take colesevelam if you have these conditions.

stomach problems
People with stomach problems

This drug may not be safe for you if you have problems with slow digestion or swallowing or if you’ve had major gastrointestinal tract surgery. These things can increase your risk of developing a blockage in your intestines or esophagus. This may require hospitalization.

low vitamin levels
People with low vitamin levels

Colesevelam blocks the absorption of fat-soluble vitamins A, D, E, and K. You may not be able to take this drug if you have problems with low levels of these vitamins or if you take drugs that depend on these vitamins to work correctly, such as warfarin. If you take vitamin supplements, take them at least 4 hours before taking colesevelam.

pregnant women
Pregnant women

Colesevelam is a category B pregnancy drug. That means two things:

  1. Studies of the drug in pregnant animals haven’t shown a risk to the fetus.
  2. There aren’t enough studies done in pregnant women to show if the drug poses a risk to the fetus.

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.

breastfeeding
Women who are breast-feeding

Colesevelam isn’t expected to pass into breast milk. Colesevelam is acceptable for use with breastfeeding.

for children
For children

This medication hasn’t been studied in children younger than 10 years of age or in girls who haven’t started menstruation. It shouldn’t be used in people younger than 10 years of age for high cholesterol. This drug shouldn’t be used in people younger than 18 years of age for diabetes.

call doctor
When to call the doctor

Call your doctor if you have symptoms of a heart attack or stroke.

Symptoms of heart attack include:

  • crushing pain in your chest
  • pain in your arms, back, shoulders, neck, jaw, or upper stomach
  • shortness of breath
  • nausea or vomiting

Symptoms of a stroke include:

  • face drooping or numbness on one side
  • weakness of one arm
  • slurred speech and being unable to talk
  • sudden loss of vision or consciousness
allergies
Allergies

Colesevelam can cause a severe allergic reaction. Symptoms can include:

  • body rash
  • blisters in your mouth

Call 9-1-1 or go to the nearest emergency room if you develop these symptoms.

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

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How to Take colesevelam (Dosage)

Oral tablet

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

What are you taking this medication for?

High cholesterol

Brand: Welchol

Form: Oral tablet
Strengths: 625 mg
Form: Oral suspension
Strengths: 1.875 g packet, 3.75 g packet
Adult dosage (ages 18–64 years)

You can take 6 tablets by mouth once per day or 3 tablets by mouth two times per day.

If you can’t swallow the tablets, you can take one 3.75-g packet for oral suspension once per day or one 1.875-g packet two times per day. Empty each packet into a cup. Add ½–1 cup (4–8 ounces) of water, fruit juice, or diet soft drink to the cup. Stir it well and drink all of the liquid.

Child dosage (ages 10–17 years)

You can take one 3.75-g packet for oral suspension once per day or one 1.875-g packet two times per day. Each packet should be emptied into a cup or glass. Add ½–1 cup (4–8 ounces) of water, fruit juice, or diet soft drink to the cup. Stir it well and drink all of the liquid.

Child dosage (ages 0-9 years)

This medication hasn’t been studied in children younger than 10 years of age or in girls who haven’t started menstruation. It shouldn’t be used in people younger than 10 years of age.

Special considerations

People with phenylketonuria (PKU): Colesevelam oral suspension packets have 27 mg of phenylalanine in them. If you have this condition, ask your doctor if colesevelam oral suspension is safe for you to take.

Warnings

You should never take the oral suspension packet without first mixing it in liquid. This can harm your esophagus.

Doses higher than 4.5 g per day haven’t been tested. Taking more than the recommended dose may cause severe constipation.

Type 2 diabetes

Brand: Welchol

Form: Oral tablet
Strengths: 625 mg
Form: Oral suspension
Strengths: 1.875 g packet, 3.75 g packet
Adult dosage (ages 18–64 years)

You can take 6 tablets by mouth once per day or 3 tablets by mouth two times per day.

If you can’t swallow the tablets, you can take one 3.75-g packet for oral suspension once per day or one 1.875-g packet two times per day. Empty each packet into a cup. Add ½–1 cup (4–8 ounces) of water, fruit juice, or diet soft drink to the cup. Stir it well and drink all of the liquid.

Child dosage (ages 10–17 years)

You can take one 3.75-g packet for oral suspension once per day or one 1.875-g packet two times per day. Each packet should be emptied into a cup or glass. Add ½–1 cup (4–8 ounces) of water, fruit juice, or diet soft drink to the cup. Stir it well and drink all of the liquid.

Child dosage (ages 0-9 years)

This medication hasn’t been studied in children younger than 10 years of age or in girls who haven’t started menstruation. It shouldn’t be used in people younger than 10 years of age.

Special considerations

People with phenylketonuria (PKU): Colesevelam oral suspension packets have 27 mg of phenylalanine in them. If you have this condition, ask your doctor if colesevelam oral suspension is safe for you to take.

Warnings

You should never take the oral suspension packet without first mixing it in liquid. This can harm your esophagus.

Doses higher than 4.5 g per day haven’t been tested. Taking more than the recommended dose may cause severe constipation.

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 to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

Colesevelam 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’re taking this drug for high cholesterol, your low-density lipoprotein (LDL) cholesterol level may rise. This can lead to narrowing of your arteries, which may cause a heart attack and stroke.

If you’re taking this drug for diabetes, your blood sugar may stay high. This can lead to complications from diabetes, such as heart, kidney, or nerve problems.

If You Miss Doses or Don’t Take the Drug on Schedule

Your medication may not work as well.

If You Take Too Much

If you take too much, you’re more likely to have stomach problems, like constipation. If you think you’ve taken too much of the drug, act right away. Call your doctor or local Poison Control Center, or go to the nearest emergency room.

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 dangerous side effects.

How to Tell If the Drug Is Working

You can’t feel if the drug is working. Your doctor will check your cholesterol levels and tell you if this drug is working for you. If you’re taking colesevelam for diabetes, you may be able to tell it’s working if your blood sugar is lower.

Colesevelam is a long-term drug treatment.

Important considerations for taking colesevelam
take with meals
Take the tablets with a meal and a liquid. Take the oral suspension with meals.
can crush or cut
You can cut or crush the tablet
storage
Store it at room temperature
See Details
refillable
Prescription is refillable
travel
Travel
See Details
self-management
Self-management
See Details
clinical monitoring
Clinical monitoring
See Details
diet considerations
Your diet
See Details
hidden costs
Hidden costs
See Details
prior authorization
Insurance
See Details

Store it at room temperature

Keep colesevelam tablets and oral suspension packets at 77°F (25°C). If necessary, you can keep it from 59–86°F (15–30°C).

Don’t store this medication in moist or damp areas, such as bathrooms.

Travel

When traveling with your medication:

  • Always carry it with you, such as 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

If you have diabetes, your doctor may show you how to check your blood sugar level at home. You would do this with a home blood glucose monitor.

If you’re taking the colesevelam oral suspension, you’ll need fruit juice, diet soft drinks, or water, and a cup to mix it in, to prepare it.

If you’re taking colesevelam for type 2 diabetes, you may need to use a home blood glucose monitor.

Clinical monitoring

You’ll need to have your cholesterol levels monitored while you take colesevelam for high cholesterol. This will help make sure your level is within the range your doctor feels is best for you.  It will also tell if your medication is working.

This monitoring may be done using this test:

  • Fasting lipid panel. For this test, you’ll have to avoid eating for a certain number of hours before having your blood drawn. This is done to get an accurate reading of cholesterol levels in the blood.

You’ll need to have your blood sugar level monitored while you take colesevelam for type 2 diabetes. This will help make sure your level is within the range your doctor feels is best for you. It will also tell if your medication is working.

This monitoring may be done using two tests:

  • Blood sugar level. Your doctor may tell you to test your blood sugar levels regularly at home.  Your doctor will tell you where to get this device and how to use it.
  • Hemoglobin A1C test (HgbA1C). Your doctor will do this blood test about four times each year. This tells what your average blood sugar level has been over the past three months.

You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These issues include:

  • Inflammation of your pancreas (pancreatitis). This drug can increase your triglyceride levels. This can cause pancreatitis in some people. You should watch for symptoms of pancreatitis such as severe stomach pain, sometimes with nausea and vomiting. If this happens, stop taking this drug and go to the emergency room.

Your diet

You should follow a cholesterol-lowering diet while taking colesevelam for high cholesterol.

If you’re taking this drug for type 2 diabetes, you should follow the diet program recommended by your doctor.

Hidden costs

If your doctor tells you to monitor your blood sugar level at home, you’ll need to purchase the following:

  • sterile alcohol wipes
  • lancing device and lancets (pricking needles used to draw a drop of blood for blood sugar testing)
  • blood glucose monitor
  • blood glucose test strips
  • a container for safe disposal of used lancets

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

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.

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How Much Does colesevelam Cost?

Oral tablet

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Lowest price for colesevelam

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These prices represent the lowest priced national pharmacies for colesevelam on GoodRx. They may be lower than your insurance.

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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on August 25, 2015

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.
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