[koh-less-TEER-ah-meen] Alti-Cholestyramine Light M, Lo-Cholest, Novo-Cholaine Light M, PMS-Cholestyramine M, Prevalite, Questran, Questran Light [Rx] Classification: Hypocholesterolemic agent, bile acid sequestrant
Action/Kinetics: Binds sodium cholate (bile salts) in the intestine; thus, the principal precursor of cholesterol is not absorbed due to formation of an insoluble complex, which is excreted in the feces. Decreases cholesterol and LDL and either has no effect or increases triglycerides, VLDL, and HDL. Also, itching is relieved as a result of removing irritating bile salts. The antidiarrheal effect results from the binding and removal of bile acids. Onset, to reduce plasma cholesterol: Within 24-48 hr, but levels may continue to fall for 1 yr; to relieve pruritus: 1-3 weeks; relief of diarrhea associated with bile acids: 24 hr. Cholesterol levels return to pretreatment levels 2-4 weeks after discontinuance. Fat-soluble vitamins (A, D, K) and possibly folic acid may have to be administered IM during long-term therapy because cholestyramine binds these vitamins in the intestine. Uses: Adjunct to reduce elevated serum cholesterol in primary hyper-cholesterolemia in those who do not respond adequately to diet. Pruritus associated with partial biliary obstruction. Diarrhea due to bile acids. Non-FDA Approved Uses: Antibiotic-induced pseudomembranous colitis (i.e., due to toxin produced by Clos-tridium difficile), digitalis toxicity, treatment of chlordecone (Kepone) poisoning, treatment of thyroid hormone overdose.
Contraindications: Complete obstruction or atresia of bile duct, hyper-sensitivity.
Special Concerns: Use during pregnancy only if benefits outweigh risks. Use with caution during lactation and in children. Long-term effects and efficacy in decreasing cho lesterol levels in pediatric clients are not known. Geriatric clients may be more likely to manifest GI side effects as well as adverse nutritional effects.
■ Caution should be exercised by phenylketonurics as Prevalite contains 14.1 mg phenylalanine per 55-g dose.
Side Effects: Oral: Dental bleeding, sour taste. GI: Constipation (may be severe), N&V, diarrhea, heartburn, GI bleeding, anorexia, flatulence, belching, abdominal distention, abdominal pain or cramping, loose stools, indigestion, aggravation of hemorrhoids, rectal bleeding or pain, black stools, bleeding duodenal ulcer, peptic ulceration, GI irritation, dysphagia, dental bleeding, hiccoughs, sour taste, pancreatitis, di-verticulitis, cholescystitis, cholelithiasis. Fecal impaction in elderly clients. Large doses may cause steatorrhea. CNS: Migraine or sinus headaches, dizziness, anxiety, vertigo, insomnia, fatigue, lightheadedness, syncope, drowsiness, femoral nerve pain, paresthesia. Hypersensitivity: Urticaria, dermatitis, asthma, wheezing, rash. Hematologic: Increased PT, ecchymosis, anemia. Musculoskeletal: Muscle or joint pain, backache, arthritis, osteoporosis. GU: Hematuria, dysuria, burnt odor to urine, diuresis. Other: Bleeding tendencies (due to hypoprothrombine-mia). Deficiencies of vitamins A and D. Uveitis, weight loss or gain, osteoporosis, swollen glands, increased libido, weakness, SOB, edema, swelling of hands/feet; hyperchloremic acidosis in children, rash and irritation of the skin, tongue, and perianal area.
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