What are bile acid sequestrants?
Bile acid sequestrants such as cholestyramine (Questran, Prevalite), colestipol (Colestid, Flavored Colestid ), and colesevelam (Welchol) are medications for lowering LDL cholesterol in conjunction with diet modification.
How do bile acid sequestrants work?
Bile acid sequestrants bind bile acids in the intestine and increase the excretion of bile acids in the stool. This reduces the amount of bile acids returning to the liver and forces the liver to produce more bile acids to replace the bile acids lost in the stool. In order to produce more bile acids, the liver converts more cholesterol into bile acids, which lowers the level of cholesterol in the blood.
Bile acid sequestrants have modest LDL cholesterol lowering effects. Low doses (for example 8 gram/day of Cholestyramine) can lower LDL cholesterol by 10%-15%. But even high doses (24 gram/day of cholestyramine) can only lower LDL cholesterol by approximately 25%. Therefore, bile acid sequestrants used alone are not as effective as statins in lowering LDL cholesterol.
Bile acid sequestrants are most useful in combination with a statin or niacin to aggressively lower LDL cholesterol levels. The combination of a statin and bile acid sequestrant can lower LDL cholesterol levels by approximately 50%. The combination of a statin and niacin can substantially reduce LDL cholesterol and elevate HDL cholesterol.
Quick GuideLower Your Cholesterol, Save Your Heart
What are the side effects of bile acid sequestrants?
Bile acid sequestrants are not absorbed into the body, and therefore they do not have systemic side effects (affecting other organs). Their most common side effects are gastrointestinal and these include:
Which drugs interact with bile acid sequestrants?
Bile acid sequestrants can bind to and decrease the absorption (and hence the effectiveness) of other drugs, such as warfarin (Coumadin), thyroid hormones (Synthroid, Levoxyl), digoxin (Lanoxin), thiazide diuretics (Hydrodiuril, Oretic, Dyazide, Maxzide), and many others. Therefore, these medications should be taken 1 hour before or 4-6 hours after the administration of a bile acid sequestrant.
Bile acid sequestrants reduces the absorption of vitamin A, D, E, and K. Long-term use may thus cause a deficiency of vitamin A, D, E, and K.
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Angina SymptomsAngina is chest pain due to inadequate blood supply to the heart. Angina symptoms may include chest tightness, burning, squeezing, and aching. Coronary artery disease is the main cause of angina but there are other causes. Angina is diagnosed by taking the patient's medical history and performing tests such as an electrocardiogram (EKG), blood test, stress test, echocardiogram, cardiac CT scan, and heart catheterization. Treatment of angina usually includes lifestyle modification, medication, and sometimes, surgery. The risk of angina can be reduced by following a heart healthy lifestyle.
Cholesterol Drugs SlidesWhen diet and exercise aren't enough, should you turn to drugs? Learn cholesterol basics, drug classes, and available drugs along with their benefits and side effects.
Cholesterol ManagementHigh cholesterol and triglyceride levels increase the risk of cardiovascular disease. Getting your cholesterol and triglyceride levels in an optimal range will help protect your heart and blood vessels. Cholesterol management may include lifestyle interventions (diet and exercise) as well as medications to get your total cholesterol, LDL, HDL, and triglycerides in an optimal range.
Cholesterol PictureCholesterol carried in particles of low density (LDL cholesterol) is referred to as the "bad" cholesterol because elevated levels of LDL cholesterol are associated with an increased risk of coronary heart disease. See a picture of Cholesterol and learn more about the health topic.
cholestyramineCholestyramine (Questran, Questran Light) is a medication prescribed to reduce cholesterol level in the blood, relieve itching of liver disease, and to treat overdoses of dioxyin or thyroid hormone. Side effects, drug interactions, pregnancy safety information, and dosing should be reviewed prior to taking this medication.
colesevelamColesevelam (Welchol) is a drug used for the treatment of high blood cholesterol levels. Side effects, drug interactions, warnings and precautions, and pregnancy information should be reviewed prior to taking any medication.
Colestipol (Colestid) is an oral drug prescribed for the treatment of high cholesterol, diarrhea due to increased intestinal bile, and itching due to liver disease. Side effects, drug interactions, warnings, and pregnancy safety information should be reviewed prior to taking any medication.
Crohns Disease vs Ulcerative Colitis UC
Crohn's disease and ulcerative colitis are diseases that cause inflammation of part of or the entire digestive tract (GI). Crohn's affects the entire GI tract (from the mouth to the anus), while ulcerative colitis or UC only affects the large and small intestine and ilium. Researchers do not know the exact cause of either disease. About 20% of people with Crohn's disease also have a family member with the disease. Researchers believe that certain factors may play a role in causing UC. Both Crohn's disease and ulcerative colitis are a type of inflammatory bowel disease, or IBD.
Crohn's disease and ulcerative colitis both have similar symptoms and signs, for example:
- Loss of appetite
- Weight loss
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- Abdominal pain and cramping
- Rectal bleeding
- Bloody stools
- Joint pain and soreness
- Eye redness or pain
Symptoms unique to Crohn's disease include:
- Skin changes
Symptoms of unique to ulcerative colitis include:
- Certain rashes
- An urgency to defecate (have a bowel movement)
Doctors diagnose both diseases with similar tests and procedures. While there is no cure for either disease, doctors and other health care professionals can help you treat disease flares, and manage your Crohn's or UC with medication, diet, nutritional supplements, and/or surgery.
CDC. "What is inflammatory bowel disease IBD?" Updated June 21, 2017.
NIH. National Institute of Diabetes and Digestive and Kidney Diseases. "Ulcerative Colitis." September 2014.
NIH. National Institute of Diabetes and Digestive and Kidney Diseases. "Symptoms and Causes of Crohn's Disease." November 2016.
NIH. National Human Genome Research Institute. "Learning About Crohn's Disease." Updated: Sep 27, 2011.
PubMed Health. "Ulcerative Colitis." Accessed Jul 24, 2017.
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- Extreme fatigue
- Pain in the upper abdomen
Leading a healthy lifestyle with a heart healthy low-fat diet, and exercise can help prevent heart disease and heart attack.
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Primary Biliary Cirrhosis (PBC)Primary Biliary Cirrhosis (PBS) is a liver disease in which bile building up in the organ damages bile ducts. Ultimately, this can cause liver failure. A number of drugs are available to treat this disease of unknown cause, but the only ultimate cure is a liver transplant.
Triglyceride TestTriglycerides are a common form of fat that we digest. Triglycerides are the main ingredient in animal fats and vegetable oils. Elevated levels of triglycerides are a risk factor for heart disease, heart attack, stroke, fatty liver disease, and pancreatitis. Elevated levels of triglycerides are also associated with diseases like diabetes, kidney disease, and medications (for example, diuretics, birth control pills, and beta blockers). Dietary changes, and medication if necessary can help lower triglyceride blood levels.