colestipol, Colestid (cont.)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
DOSING: Colestipol is most often prescribed in 2 to 4 divided doses but may also be prescribed once daily. The usual adult dose is 2-16 gm of tablets administered once or twice daily or 5-30 grams of granules once daily or 4 times daily.
Tablets should not be cut, crushed or chewed. Granules should be mixed in three ounces of fluid (water or fruit juice).
DRUG INTERACTIONS: Colestipol binds many different compounds in the gastrointestinal tract, thereby inhibiting their absorption into the body. For example, colestipol can bind with and decrease the oral absorption of carbamazepine (Tegretol), diuretics such as hydrochlorothiazide (found in Dyazide, Maxzide) and furosemide (Lasix), propranolol (Inderal), tetracyclines, and fat-soluble vitamins (vitamins A, D, and K). Colestipol can bind with and inhibit the absorption of thyroid hormones. Colestipol also can bind with ursodiol (Actigall, Urso).
Separating the doses of colestipol and these other compounds by several hours should prevent binding with colestipol. Generally, other drugs should be administered one hour before colestipol or 4 hours after colestipol is administered.
Colestipol binds to vitamin K, a vitamin which is required by the liver to make the factors that allow blood to clot. Colestipol, by reducing the action of vitamin K, may exaggerate the effect of warfarin (Coumadin), reducing the body's ability to form blood clots. This interaction could lead to abnormal bleeding. On the other hand, colestipol can bind with warfarin directly and inhibit the absorption of warfarin. To avoid this interaction, doses of warfarin and colestipol should be separated by at least 4-6 hours.
Colestipol is closely related to cholestyramine. Cholestyramine has been more extensively studied than colestipol. Therefore, there are several drug interactions which have been described with cholestyramine for which data is lacking with colestipol. It would be prudent to assume that a similar interactions exist for both drugs and to separate ingestion of colestipol from the other drugs by several hours. These interactions with cholestyramine include: acetaminophen (Tylenol), amiodarone (Cordarone), gemfibrozil (Lopid), pravastatin (Pravachol), piroxicam (Feldene), imipramine (Tofranil), glipizide (Glucotrol), and others.
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