Colestyramine (Questran, Questran Light, LoCholest, Colestid, Prevalite)

Colestyramine is a drug that works by binding bile acids in the bowel. It can be used particularly to treat diarrhoea caused by bile acids, to reduce the itching seen in some liver and bile duct diseases, and to lower high cholesterol in certain patients.

It usually comes as a powder that is mixed with water or a suitable drink. It is not a steroid (cortisone) or an antibiotic. It is not addictive.

How does colestyramine work?

Bile, made in the liver, helps digest fats. Most of the bile acids are absorbed again from the last part of the small bowel and return to the liver.

In some diseases the bile acids are not absorbed back well enough, and more of them than normal reach the large bowel. This increases water secretion in the bowel and can cause watery stools and a sudden need to go to the toilet.

Colestyramine binds the bile acids in the bowel and lets them be passed out in the stool. In this way the diarrhoea caused by bile acids can lessen.

The drug is not absorbed from the bowel into the blood to any meaningful degree; it works mostly inside the bowel.

What is it used for?

Diarrhoea caused by bile acids

This is one of colestyramine’s important uses in gastroenterology.

Diarrhoea caused by bile acids can bring frequent, watery stools, a sudden need to go to the toilet and sometimes leakage of stool.

In suitable patients, colestyramine can help reduce these complaints.

Diarrhoea after gallbladder surgery

After the gallbladder has been removed, the way bile acids reach the bowel can change in some patients. This can lead to watery diarrhoea.

Not every patient who has gallbladder surgery develops diarrhoea. But if the cause of diarrhoea continuing after the operation is bile acids, colestyramine can be helpful.

Crohn’s disease and small bowel surgery

The last part of the small bowel (the ileum), where bile acids are absorbed back, can be affected by Crohn’s disease or may have been removed in an operation.

Some of these patients develop diarrhoea because the bile acids cannot be absorbed.

Colestyramine can be helpful in selected patients. However, in patients who have had a large part of the small bowel removed, or who have severe malabsorption, it should be used with care, because it can make fat absorption even worse.

Itching in liver and bile duct diseases

Severe itching can occur in some liver diseases, particularly those in which the flow of bile is impaired.

In suitable patients, colestyramine can be used to reduce itching linked to impaired bile flow.

However, it should not be used when the bile ducts are completely blocked.

High cholesterol

Colestyramine can help lower LDL cholesterol in the blood in some patients.

Although other drugs are used more often for cholesterol today, colestyramine can be an option in certain patients.

How is colestyramine taken?

Colestyramine usually comes as a powder and is mixed with water or a suitable liquid before use.

• The powder should not be swallowed dry.
• It should be mixed well with the amount of liquid your doctor recommends.
• The dose and how often it is taken each day vary with the disease.
• Treatment may start at a low dose and be increased step by step if needed.
• Take care not to take the drug at the same time as other medicines.

The dose of colestyramine, when it is taken and how long the treatment lasts should be decided by the doctor.

Can it be taken with other medicines?

One of colestyramine’s most important features is that it can also bind some medicines in the bowel and reduce their absorption.

Interactions can occur particularly with thyroid medicines, some heart medicines, blood thinners, water tablets (diuretics) and contraceptive pills.

In general, other medicines taken by mouth are recommended to be taken at least 1 hour before or 4–6 hours after colestyramine.

However, some medicines may need different arrangements. Patients who take medicines regularly should tell their doctor before starting colestyramine.

What are the side effects?

The most common side effects of colestyramine involve the digestive system.

Common side effects

• Constipation
• Bloating and wind
• Abdominal discomfort
• Nausea
• Indigestion

Constipation may be more marked at high doses or in patients prone to constipation.

Less common but important problems

With long-term use, the absorption of vitamins A, D, E and K can fall. In some patients triglyceride levels can rise.

If severe constipation, marked abdominal pain, severe swelling of the abdomen or unusual bleeding develops, medical assessment is needed.

Who should take it with care?

Colestyramine should be used carefully and under a doctor’s supervision in the following situations:

• Chronic constipation
• Suspected or previous bowel obstruction
• High triglyceride levels
• Fat malabsorption
• Kidney disease
• Long-term use of many medicines

Colestyramine should not be used in patients whose bile ducts are completely blocked.

During pregnancy and breastfeeding, the decision to use it should be made by the doctor, also taking into account the possible effect on vitamin absorption.

Frequently asked questions

Does colestyramine help every kind of diarrhoea?

No. Colestyramine works particularly in diarrhoea caused by bile acids. In diarrhoea due to infection, coeliac disease or other causes, the right treatment may be different.

Should everyone who has had their gallbladder removed take colestyramine?

No. Most patients who have gallbladder surgery do not need this drug. It can be used in some patients who develop bile acid diarrhoea after the operation.

Is colestyramine addictive?

No. It is not addictive. However, if the disease it is being used for continues, the complaints may come back when treatment is stopped.

How long should colestyramine be taken?

The length of treatment depends on the cause of the disease and the response to treatment. Some patients need it for a short time, others for a long time.

Does colestyramine cause vitamin deficiency?

With long-term use it can reduce the absorption of the fat-soluble vitamins A, D, E and K in particular. Where needed, the doctor can plan monitoring and vitamin supplements.

Important: This page has been prepared to give general health information. Colestyramine is not suitable for every type of diarrhoea. Decisions to start treatment, change the dose or stop the drug should be made after assessment by a doctor.