Colestid

Action

Binds bile acids in GI tract and forms insoluble complex, impeding bile acid reabsorption and promoting its excretion. As a result, cholesterol and low-density lipoprotein levels decrease.

Availability

Granules for suspension: 5 g/packet or scoop

Tablets: 1 g

Indications and dosages

➣ Primary hypercholesterolemia

Adults: Granules-5 g P.O. once or twice daily; may increase q 1 to 2 months up to 30 g/day P.O. given in one or two divided doses. Tablets-2 g P.O. once or twice daily; may increase q 1 to 2 months up to 16 g/day P.O. given in one or two divided doses.

Off-label uses

• Digoxin toxicity

Contraindications

• Hypersensitivity to drug

Precautions

Use cautiously in:

• history of constipation

• breastfeeding patients

• children (safety and efficacy not established).

Administration

• Mix granules with at least 90 ml of liquid, and stir until completely mixed.

• Give tablets with large amount of water.

• Administer other drugs 1 hour before or 4 hours after colestipol.

Adverse reactions

CNS: dizziness, headache, vertigo, anxiety, syncope, fatigue

CV: chest pain

GI: nausea, vomiting, constipation, abdominal discomfort, fecal impaction, flatulence, fatty stools, hemorrhoids, perianal irritation, tongue irritation

Metabolic: deficiency of vitamins A, D, E, and K and folic acid, hyperchloremic acidosis

Musculoskeletal: osteoporosis, backache, muscle and joint pain, arthritis

Skin: irritation, rashes

Interactions

Drug-drug. Amiodarone, corticosteroids, digoxin, diuretics, fat-soluble vitamins (A, D, E, K), folic acid, gemfibrozil, imipramine, methotrexate, mycophenolate, nonsteroidal anti-inflammatory drugs, penicillin G, phosphates, propranolol, tetracyclines, thyroid preparations, ursodiol: decreased absorption of these drugs (when given orally)

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, phosphorus: increased levels

Prothrombin time: prolonged

Patient monitoring

• Monitor lipid levels frequently during first few months of therapy and periodically thereafter.

• Evaluate patient for signs and symptoms of abnormal bleeding.

• Be aware that prolonged use may increase bleeding tendency (from hypoprothrombinemia resulting from vitamin K deficiency). As prescribed and needed, give oral or parenteral vitamin K to reverse this effect.

Patient teaching

• Instruct patient to take granules with 3 to 4 oz of water, fruit juice, soup with high fluid content, cereal, or pulpy fruits (crushed).

• Tell patient to swallow tablets whole, one at a time, and not to crush, cut, or chew them.

• Inform patient that drug may interfere with absorption of many other drugs. Advise him to take other drugs

1 hour before or 4 hours after colestipol.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.