colestipol

[ko-les´tĭ-pol] an resin" >anion exchange resin used as adjunctive therapy to diet for the reduction of elevated serum cholesterol in patients with primary hypercholesterolemia.

colestipol

(koe-les-ti-pole) colestipol,

Colestid

(trade name)

Classification

Therapeutic: lipid lowering agents
Pharmacologic: bile acid sequestrants
Pregnancy Category: UK

Indications

Management of primary hypercholesterolemia.Pruritus associated with elevated levels of bile acids.Diarrhea associated with excess bile acids.

Action

Binds bile acids in the GI tract, forming an insoluble complex. Result is increased clearance of cholesterol.

Therapeutic effects

Decreased plasma cholesterol and LDL.Decreased pruritus.

Pharmacokinetics

Absorption: Action takes place in the GI tract. No absorption occurs.Distribution: No distribution.Metabolism and Excretion: After binding bile acids, insoluble complex is eliminated in the feces.Half-life: Unknown.

Time/action profile (hypocholesterolemic effects)

ROUTE	ONSET	PEAK	DURATION
PO	24–48 hr	1 mo	1 mo

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Complete biliary obstruction;Some products contain aspartame and should be avoided in patients with phenylketonuria.Use Cautiously in: History of constipation.Exercise Extreme Caution in: Pediatric: May cause potentially fatal intestinal obstruction in children.

Adverse Reactions/Side Effects

Ear, Eye, Nose, Throat

irritation of the tongue

Gastrointestinal

abdominal discomfort (most frequent)
constipation (most frequent)
nausea (most frequent)
fecal impaction
flatulence
hemorrhoids
perianal irritation
steatorrhea
vomiting

Dermatologic

irritation
rashes

Fluid and Electrolyte

hyperchloremic acidosis

Metabolic

vitamin A, D, and K deficiency

Interactions

Drug-Drug interaction

May decrease absorption/effects of orally administered acetaminophen, amiodarone, clindamycin, clofibrate, digoxin, diuretics, gemfibrozil, glipizide, corticosteroids, imipramine, mycophenolate, methotrexate, methyldopa, niacin, NSAIDs, penicillin, phenytoin, phosphates, propranolol, tetracyclines, tolbutamide, thyroid preparations, ursodiol, warfarin, and fat-soluble vitamins (A, D, E, and K).May decrease absorption of other orally administered medications.

Route/Dosage

Oral (Adults) Granules—5 g 1–2 times daily, may be increased q 1–2 mo up to 30 g/day in 1–2 doses. Tablets—2 g 1–2 times daily, may be increased q 1–2 mo up to 16 g/day in 1–2 doses.

Availability

Granules for suspensionunflavored: 5 g/packet or scoop Flavored granules for suspension with aspartameorange flavor: 5 g/packet or scoop Tablets: 1 g

Nursing implications

Nursing assessment

Hypercholesterolemia: Obtain a diet history, especially in regard to fat consumption.
Pruritus: Assess severity of itching and skin integrity. Dose may be decreased when relief of pruritus occurs.
Diarrhea: Assess frequency, amount, and consistency of stools.
Lab Test Considerations: Serum cholesterol and triglyceride levels should be evaluated before initiating, frequently during first few months and periodically throughout therapy. Discontinue medication if paradoxical increase in cholesterol level occurs.
- May cause an increase in AST, ALT, phosphorus, chloride, and alkaline phosphatase and a decrease in serum calcium, sodium, and potassium levels.
- May also cause prolonged PT.

Potential Nursing Diagnoses

Constipation (Side Effects)
Noncompliance (Patient/Family Teaching)

Implementation

Parenteral or water-miscible forms of fat-soluble vitamins (A, D, K) and folic acid may be ordered for patients on chronic therapy.
Oral: Administer before meals.
- Scoops for powdered preparations may not be exchangable between products.
- Administer other medications 1 hr before or 4–6 hr after the administration of this medication.
- Colestipol tablets should be swallowed whole; do not crush, break, or chew.

Patient/Family Teaching

Instruct patient to take medication exactly as directed; do not skip doses or double up on missed doses.
Instruct patient to take medication before meals. Colestipol can be mixed with water, juice, or carbonated beverages. Slowly stir in a large glass. Rinse glass with small amount of additional beverage to ensure all medication is taken. May also mix with highly fluid soups, cereals, or pulpy fruits (applesauce, crushed pineapple). Allow powder to sit on fluid and hydrate for 1–2 min before mixing. Do not take dry.
Advise patient that this medication should be used in conjunction with diet restrictions (fat, cholesterol, carbohydrates, alcohol), exercise, and cessation of smoking.
Explain that constipation may occur. Increase in fluids and bulk in diet, exercise, stool softeners, and laxatives may be required to minimize the constipating effects. Instruct patient to notify health care professional if constipation, nausea, flatulence, and heartburn persist or if stools become frothy and foul smelling.
Advise patient to notify health care professional if unusual bleeding or bruising; petechiae; or black, tarry stools occur. Treatment with vitamin K may be necessary.

Evaluation/Desired Outcomes

Decrease in serum LDL cholesterol levels. Therapy is usually discontinued if the clinical response remains poor after 3 mo of therapy.
Decrease in severity of pruritus. Relief usually occurs 1–3 wk after therapy is initiated.
Decrease in frequency and severity of diarrhea.

colestipol

A BILE ACID SEQUESTRANT drug used to treat abnormally high levels of lipoproteins. A brand name is Colestid.