Colestyramine (Cholestyramine) — NZ Medication Guide
📋 Reviewed by a Registered Pharmacist NZ — This information is for general educational purposes only and does not replace professional medical advice. Always consult your doctor or pharmacist before starting, stopping, or changing any medication.
What is Colestyramine (Cholestyramine)?
Colestyramine is a bile acid sequestrant (ion exchange resin) used to lower LDL cholesterol and for the relief of pruritus associated with bile acid accumulation. This medication is funded by Pharmac for hypercholesterolaemia and cholestatic pruritus.
What is Colestyramine (Cholestyramine) Used For?
Colestyramine is used as an adjunct in primary hypercholesterolaemia (type IIa) to reduce LDL cholesterol, and for the relief of pruritus caused by partial biliary obstruction (bile acids accumulate in the skin). Also used to accelerate leflunomide washout.
How Does Colestyramine (Cholestyramine) Work?
Colestyramine binds bile acids in the gut — preventing their reabsorption in the ileum and increasing their excretion in the stool. The liver compensates by increasing cholesterol conversion to bile acids, upregulating LDL receptors and thus reducing plasma LDL cholesterol. In cholestasis, removing bile acids from circulation reduces pruritus.
How to Take Colestyramine (Cholestyramine)
Taken orally as a powder mixed with water, juice, or food. Typical dose: 4–8 g daily in 1–3 divided doses, taken with meals. Start at a low dose and increase gradually. Always take other medicines at least 1 hour before or 4–6 hours after colestyramine to prevent binding and absorption impairment.
Common Side Effects of Colestyramine (Cholestyramine)
- Constipation (very common — dose-related)
- Bloating and flatulence
- Nausea
- Abdominal discomfort
- Heartburn
Serious Side Effects — Seek Medical Attention
Contact your doctor or call 111 immediately if you experience any of the following:
- Fat-soluble vitamin deficiencies (A, D, E, K) with prolonged use — supplement may be required
- Hypertriglyceridaemia (colestyramine can raise triglycerides — avoid if triglycerides are high)
- Hyperchloraemic acidosis (rare — with prolonged high-dose use in children)
Drug Interactions
Colestyramine (Cholestyramine) may interact with other medicines. Always inform your doctor and pharmacist of all medications you are taking. Key interactions include:
- Binds many medicines in the gut — reduces absorption of warfarin, digoxin, levothyroxine, thiazide diuretics, NSAIDs, beta-blockers, statins, fat-soluble vitamins — take ALL other medicines at least 1 hour before or 4–6 hours after colestyramine
New Zealand Prescribing Information
Colestyramine (Questran® 4 g sachets) is funded by Pharmac. Because of its many drug binding interactions and poor palatability, colestyramine is now mainly used as an add-on to statin therapy in patients with high LDL cholesterol, or for cholestatic pruritus. It is also the standard agent for the leflunomide washout procedure (36 g/day for 11 days) before pregnancy.
Frequently Asked Questions
Does colestyramine interact with my other medicines?
Yes — colestyramine can bind many medicines in the gut and prevent their absorption. This is one of its most significant limitations. Always take all other medicines at least 1 hour BEFORE, or 4–6 hours AFTER colestyramine. Inform your pharmacist of all medicines you take.
How do I make colestyramine more palatable?
Colestyramine powder has a gritty texture and is unpleasant for many patients. Mix it in orange juice, a smoothie, or applesauce. Taking it with meals helps. Start with a low dose and gradually increase over 1–2 weeks to improve tolerance.
⚠️ Disclaimer: This page is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or a qualified health provider. In New Zealand, medication availability and funding may vary — check with Pharmac or your pharmacist for current information.
Reviewed by a Registered Pharmacist NZ
References & Further Information
The following New Zealand and international resources were used to inform this page: