CHOLESTYRAMINE
Drugs in Pregnancy and Lactation.
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Name: CHOLESTYRAMINE
Class: Antilipemic
Risk Factor: B
Fetal Risk Summary
Cholestyramine is a resin used to bind bile acids in a nonabsorbable complex. In a reproductive study involving rats and rabbits, the resin was given in doses up to 2 g/kg/day without evidence of fertility impairment or adverse fetal effects (1). In a comparison between pregnant and nonpregnant rats, administration of cholestyramine failed to lower the plasma cholesterol concentration or to increase bile acid synthesis (2). The drug therapy had no effect, in comparison to control animals, on maternal weight gain, number of fetuses, and fetal weight.
Cholestyramine has been used for the treatment of cholestasis of pregnancy (3,4,5,6 and 7). Except for the case described below, no adverse fetal effects were observed in these studies. One review recommended the resin as first-line therapy for the pruritus that accompanies intrahepatic cholestasis of pregnancy (6). Cholestyramine also binds fat-soluble vitamins, and long-term use could result in deficiencies of these agents in either the mother or the fetus (8). In one study, treatment with 9 g daily up to a maximum duration of 12 weeks was not associated with fetal or maternal complications (3).
A 31-year-old woman in her third pregnancy was treated with cholestyramine (8 g/day) beginning at 19 weeks' gestation for intrahepatic cholestasis of pregnancy (7). At 22 weeks', the dose was increased to 16 g/day. Four weeks later, she was clinically jaundiced and at 29 weeks' gestation, she was admitted to the hospital for reduced fetal movements. Fetal ultrasound scans over the next week revealed expanding bilateral subdural hematomas with hydrocephalus, an enlarged liver, and bilateral pleural effusions (7). The mother's prothrombin ratio was markedly elevated but responded to two doses of IV vitamin K. One week later, following labor induction for fetal distress, a 1660-g infant was delivered who died at 15 minutes of age. It was thought that the fetal subdural hematomas were the result of vitamin K deficiency caused by the cholestyramine, cholestasis, or both (7).
A 1989 report described the use of cholestyramine and other agents in the treatment of inflammatory bowel disease during pregnancy (9). Seven patients were treated during gestation with the resin. One of the seven delivered prematurely (<37 weeks' gestation) and one of the newborns was small for gestational age (<10th percentile for gestational age). Both of these outcomes were probably related to the mother's disease, rather than to the therapy.
In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, four newborns had been exposed to cholestyramine during the 1st trimester (10). Thirty-three other newborns were exposed after the 1st trimester. None of the infants had congenital malformations.
Breast Feeding Summary
Cholestyramine is a nonabsorbable resin. No reports describing its use during lactation have been located. Because it binds fat-soluble vitamins, prolonged use may result in deficiencies of these vitamins in the mother and her nursing infant.
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References
- Koda S, Anabuki K, Miki T, Kahi S, Takahashi N. Reproductive studies on cholestyramine. Kiso to Rinsho 1982;16:2040–94. As cited in Shepard TH. Catalog of Teratogenic Agents. 7th ed. Baltimore, MD:Johns Hopkins University Press, 1992:90.
- Innis SM. Effect of cholestyramine administration during pregnancy in the rat. Am J Obstet Gynecol 1983;146:13–6.
- Lutz EE, Margolis AJ. Obstetric hepatosis: treatment with cholestyramine and interim response to steroids. Obstet Gynecol 1969;33:64–71.
- Heikkinen J, Maentausta O, Ylostalo P, Janne O. Serum bile acid levels in intrahepatic cholestasis of pregnancy during treatment with phenobarbital or cholestyramine. Eur J Obstet Gynecol Reprod Biol 1982;14:153–62.
- Shaw D, Frohlich J, Wittmann BAK, Willms M. A prospective study of 18 patients with cholestasis of pregnancy. Am J Obstet Gynecol 1982;142:621–5.
- Schorr-Lesnick B, Lebovics E, Dworkin B, Rosenthal WS. Liver disease unique to pregnancy. Am J Gastroenterol 1991;86:659–70.
- Sadler LC, Lane M, North R. Severe fetal intracranial haemorrhage during treatment with cholestyramine for intrahepatic cholestasis of pregnancy. Br J Obstet Gynaecol 1995;102:169–70.
- American Hospital Formulary Service. Drug Information 1997. Bethesda, MD:American Society of Health-System Pharmacists, 1997:1330–4.
- Fedorkow DM, Persaud D, Nimrod CA. Inflammatory bowel disease: a controlled study of late pregnancy outcome. Am J Obstet Gynecol 1989;160:998–1001.
- Rosa F. Anticholesterol agent pregnancy exposure outcomes. Presented at the 7th International Organization for Teratogen Information Services, Woods Hole, MA, April 1994.
Q&A about Cholestyramine
Is there an over the counter alternative for Cholestyramine?
Dr. has prescribed it but is so expensive for one on Social Security even with Medicare. Can anyone help?
Tried Web Md and Drugs.com no help there.
If the answer is yes, plus your high cholesterol., very simple explanation for your situation is as follows:
One of the most troubling symptoms in patients with liver and biliary disease is itching. The itching is believed to be the result of accumulation of bile acids in the skin due to the inability of the liver or bile ducts to eliminate bile acids normally. By binding bile acids in the intestines and preventing their absorption, cholestyramine hastens the elimination of bile acids from the body and skin, and the itching improves.
The main thing is for you to take care of liver and strengthen it's capability to remove bile acids.
Try the following natural supplements for your live and reducing your cholesterol level -
1.Policosanol/Octacosanol - 10mg tablet twice per day with meals; one in the afternoon and one in the evening. Policosanol is a natural supplement made from sugar cane, the main ingredient being octacosanol.
2.Vitamin E : 400 IU twice a day. Check with your doctor if taking anticoagulant drugs.
3.Vitamin C : 1,000 mg twice a day.Reduce dose if diarrhea develops.
4.Garlic: 400-600 mg a day. Each pill should provide 4,000 mcg allicin potential.
5. Fish oil - a daily dosage of a product containing at least 480 mg of EPA and 360 mg of DHA.
For the liver - Bile movement enhancement
1.Dandelion root tea - greatlly support liver detoxification, and stimulates the flow of bile and is a liver and digestive tonic. Have a cup of tea everyday.
2. Silymarin / Milk Thistle - 200mg of an extract standardized for 70-80% silymarin.
Follow a low-fat diet, not fat-free. Alcohol avoidance is a must. Consume more high-water -insoluble fiber foods or a Green/fiber supplement first thing in the morning on an empty stomach would benefit your live and helps with your cholestrol as well. Pears, apple and bran are good choices.
Try Beets, and carrots juice. Freshly prepared is the better choice.
I am pregnant and was prescribed Cholestryamine (for cholestatis) for my itchyness. I just want to sleep and am sick of being up all night scratching. If anyone has any info, it would make my day! Thank you!
High density lipoprotein — This is the good or "healthy" cholesterol.
Triglycerides — This is a form of fat that circulates in the bloodstream.
Common side effects include:
Heartburn, bloating, or gas
-- Do not mix cholestyramine with carbonated beverages or soda water.
-- Do not gulp the medicine. You might be swallowing air, which increases gas.
-- If you experience heartburn, take 2 or 3 teaspoons of antacid. A good choice is one that contains simethicone (such as Malox Plus or Mylanta II).
-- For gas or bloating, take plain simethicone tablets. Simethicone is sold over-the-counter. (One example is Mylicon tablets.)
Constipation
-- Drink one 8-ounce glass of liquid with each dose of cholestyramine.
-- Drink three to four more glasses of liquids than your present daily intake. (Coffee does not count.)
-- Increase the amount of fiber in your diet by eating more fresh fruits and vegetables.
-- Exercise more.
-- Use Metamucil or other bulk-forming agents as needed. Metamucil can be mixed right in with cholestyramine.
-- Drink prune juice as needed.
used to help at the nursing home and had to do a report for it
Yes you can ,but with a time interval of at least an hour.
Cholestyramine is also used in patients who have undergone post ileal (part of the small bowel) resection in Crohn's disease to prevent diarrhoea.
Both are for lowering cholesterol levels.
Cholestyramine has the added effect of dereasing itching in certain types of liver disease.
They both have similar side effects but Cholestyramine can cause vitamin A, D, E, and K deficiencies if used long term.
So assuming theres no liver problems involved I would say that colestipol is possibly the better choice;
Anybody know about this stuff? Its used on people with diarrhea to normalize bile salt levels I believe, but I never took it because the first day I did, I got incredibly bad stomach pains and had to go to the hospital.
I couldn't figure out what caused the pain, because I ate alot of bad food that day, foods I didn't eat often if ever.
tested for Krones gullstones, gallbladder function, UC, parasites, diabetes, hormones- several colonoscopies including small colon-EVERYTHING OKAY thirty six year old female total hysterectomy five years prior for indemetreosis no hormonal therapy
tried lotronex with no success Just trying Cholestyramine
If you have any ideas i would REALLy appreciate your help thank you
Good luck!
I had an emergency colon resection about a year ago to due a mishap in the surgery room..ever since then, I have had absolutely horrible diarrhea and all my tests are coming back ok so far...they are calling it IBS Irritable bowel syndrome right now because there is no specific reason.
I have tried everything on the market for this problem. questran, cholestyramine, works for a day, then I bust loose for 4...
I need help ! Does anyone have any other ideas please!!!!!!!!!!
Are there any organizations that take unused, unopened medicine. (i.e. - I have 5 cans of Prevalite Cholestyramine for Oral Suspension and my doctor has taken me off) Any thoughts? Would hate to have to dump it at $60.00 a can......
