Colesevelam interactions. Colesevelam: Uses, Mechanism of Action, and Interactions

22.08.202317.07.2023 by alexxlab

What are the main indications for colesevelam. How does colesevelam work to lower cholesterol and blood glucose. What are the potential side effects and drug interactions of colesevelam.

Содержание

Indications and Approved Uses of Colesevelam

Colesevelam is an FDA-approved antihyperlipidemic medication used to treat several conditions related to high cholesterol and blood glucose levels. Its primary indications include:

Lowering elevated low-density lipoprotein cholesterol (LDL-C) in patients with primary hyperlipidemia
Reducing LDL-C levels in children and adolescents aged 10-17 with heterozygous familial hypercholesterolemia
Improving glycemic control in adults with type 2 diabetes mellitus

Colesevelam can be used as monotherapy or in combination with other lipid-lowering medications like statins, ezetimibe, or niacin. For optimal results, it should be used in conjunction with dietary modifications and increased physical activity.

Off-Label Use for Irritable Bowel Syndrome

While not FDA-approved for this indication, studies have shown that colesevelam may improve stool consistency and overall bowel function in patients with diarrhea-predominant irritable bowel syndrome (IBS-D). This effect is likely due to its ability to sequester bile acids in the intestines.

Mechanism of Action: How Does Colesevelam Work?

Colesevelam is a bile acid sequestrant with a unique mechanism of action for lowering cholesterol and improving glycemic control. Understanding its mode of action helps explain its effectiveness in treating hyperlipidemia and type 2 diabetes.

Cholesterol-Lowering Effects

Colesevelam works primarily by binding to bile acids in the gastrointestinal tract, forming non-absorbable complexes. This binding is enhanced by the drug’s numerous hydrophobic side chains. By preventing bile acid reabsorption, colesevelam disrupts the enterohepatic bile acid recirculation system, leading to several beneficial effects:

Upregulation of 7-alpha-hydroxylase enzyme, which converts intracellular cholesterol into bile acids
Increased expression of hepatic LDL receptors to provide cholesterol for bile acid synthesis
Diversion of cholesterol towards bile acid production, resulting in decreased plasma LDL and total cholesterol levels

Blood Glucose-Lowering Effects

The exact mechanism by which colesevelam reduces plasma glucose levels is not fully understood. However, animal studies have provided some insights:

Increased production of glucagon-like peptide-1 (GLP-1) and other incretins
Activation of TGR5 receptors in the gastrointestinal tract due to bile acid binding
Suppression of hepatic glycogenolysis, which is often elevated in type 2 diabetes patients

These effects collectively contribute to improved glycemic control in patients with type 2 diabetes.

Administration and Dosage Forms of Colesevelam

Colesevelam is available in multiple formulations to accommodate patient preferences and needs. The various dosage forms include:

Oral tablets
Prepared suspension
Chewable bar (recently approved)

Typically, colesevelam is administered once or twice daily to achieve therapeutic effects. Healthcare providers should consider individual patient factors when determining the most appropriate dosage form and regimen.

Important Considerations for Administration

When prescribing colesevelam, healthcare providers should be aware of the following considerations:

Patients susceptible to fat-soluble vitamin and folic acid deficiencies should take these supplements at least 4 hours after colesevelam to ensure proper absorption
Statins should be taken at least 4 hours after colesevelam to avoid potential interactions
Adequate fluid intake is crucial for patients taking colesevelam to prevent constipation and other gastrointestinal side effects

Potential Adverse Effects of Colesevelam

While colesevelam is generally well-tolerated, it can cause certain side effects. Understanding these potential adverse reactions is crucial for healthcare providers and patients alike.

Common Side Effects

The most frequently reported side effects of colesevelam include:

Constipation
Dyspepsia
Nausea
Abdominal pain
Flatulence

These gastrointestinal side effects are generally mild and can often be managed with proper hydration and dietary adjustments.

Less Common but Serious Side Effects

While rare, some patients may experience more severe adverse reactions to colesevelam, such as:

Severe constipation or bowel obstruction
Hypertriglyceridemia (in patients with pre-existing high triglyceride levels)
Vitamin deficiencies (particularly fat-soluble vitamins)

Healthcare providers should monitor patients closely for these potential complications and adjust treatment as necessary.

Drug Interactions: What to Watch Out For

Colesevelam can interact with various medications, potentially affecting their absorption or efficacy. Understanding these interactions is crucial for safe and effective treatment.

Medications Requiring Separation from Colesevelam

The following medications should be taken at least 4 hours before or after colesevelam to ensure proper absorption:

Fat-soluble vitamins (A, D, E, K)
Folic acid supplements
Statins
Oral contraceptives
Thyroid hormones
Certain antibiotics (e.g., ciprofloxacin)

Potential Impact on Other Medications

Colesevelam may affect the absorption or efficacy of other medications, including:

Warfarin (may require closer monitoring of INR)
Metformin (may enhance the glucose-lowering effect)
Phenytoin (may require dose adjustments)

Healthcare providers should carefully review a patient’s medication list before prescribing colesevelam and make appropriate adjustments to dosing schedules or monitoring plans.

Clinical Considerations and Patient Education

When prescribing colesevelam, healthcare providers should consider several factors to optimize treatment outcomes and patient safety.

Patient Selection

Colesevelam may be particularly beneficial for:

Patients with statin intolerance or those requiring additional LDL-C lowering
Individuals with both hyperlipidemia and type 2 diabetes
Children and adolescents with familial hypercholesterolemia who have not responded adequately to diet and lifestyle modifications

Monitoring and Follow-up

Regular monitoring is essential to ensure the effectiveness and safety of colesevelam therapy. Healthcare providers should:

Assess lipid profiles and glycemic control at appropriate intervals
Monitor for signs of vitamin deficiencies, especially in long-term use
Evaluate liver function tests periodically
Address any emerging side effects or concerns promptly

Patient Education

Proper patient education is crucial for maximizing the benefits of colesevelam therapy. Key points to discuss with patients include:

The importance of adhering to the prescribed dosing schedule
Proper timing of colesevelam in relation to other medications and supplements
The need for adequate fluid intake and a balanced diet
Potential side effects and when to seek medical attention
The importance of continuing lifestyle modifications alongside medication therapy

Interprofessional Team Strategies for Optimizing Colesevelam Therapy

Effective management of patients on colesevelam often requires a collaborative approach involving various healthcare professionals. Implementing interprofessional team strategies can improve care coordination, enhance patient outcomes, and minimize potential complications.

Role of Pharmacists

Pharmacists play a crucial role in optimizing colesevelam therapy by:

Reviewing drug interactions and providing recommendations for medication scheduling
Counseling patients on proper administration and potential side effects
Monitoring for adherence and addressing any barriers to compliance
Collaborating with physicians to adjust dosages or suggest alternative treatments when necessary

Involvement of Dietitians

Registered dietitians can contribute to the success of colesevelam therapy by:

Developing individualized meal plans that complement the medication’s effects
Educating patients on dietary strategies to manage potential gastrointestinal side effects
Providing guidance on maintaining adequate nutrition, particularly for patients at risk of vitamin deficiencies

Nursing Support

Nurses can enhance patient care and outcomes by:

Assisting with patient education and reinforcing key points about medication use
Monitoring for side effects and alerting the healthcare team to any concerns
Coordinating follow-up appointments and laboratory tests
Providing ongoing support and encouragement to patients throughout their treatment journey

Regular Team Communication

Establishing regular channels for communication among healthcare team members is essential for optimizing colesevelam therapy. This may include:

Regular case conferences to discuss complex patients or treatment challenges
Shared electronic health records to facilitate information exchange
Collaborative development of treatment protocols and guidelines
Ongoing education and training for team members on the latest developments in lipid management and diabetes care

By implementing these interprofessional strategies, healthcare teams can provide comprehensive, patient-centered care that maximizes the benefits of colesevelam therapy while minimizing potential risks and complications.

Future Directions and Research Opportunities

As our understanding of colesevelam and its mechanisms of action continues to evolve, several areas of research and development hold promise for expanding its therapeutic potential and improving patient outcomes.

Exploring New Indications

Ongoing research is investigating the potential use of colesevelam in additional clinical scenarios, including:

Treatment of non-alcoholic fatty liver disease (NAFLD)
Management of bile acid diarrhea in patients with inflammatory bowel disease
Potential neuroprotective effects in neurodegenerative disorders

These emerging areas of research may lead to new approved indications for colesevelam in the future, expanding its therapeutic utility.

Optimizing Drug Delivery

Researchers are exploring novel formulations and delivery methods for colesevelam to enhance its efficacy and patient acceptability. Some areas of focus include:

Development of extended-release formulations to reduce dosing frequency
Investigation of transdermal or other non-oral delivery systems to bypass gastrointestinal side effects
Creation of combination products that incorporate colesevelam with other complementary medications

Personalized Medicine Approaches

Advancements in pharmacogenomics and precision medicine may lead to more tailored use of colesevelam based on individual patient characteristics. Research in this area may focus on:

Identifying genetic markers that predict response to colesevelam therapy
Developing algorithms for personalized dosing based on patient-specific factors
Investigating the role of the gut microbiome in modulating colesevelam’s effects

Long-term Safety and Efficacy Studies

As colesevelam continues to be used in clinical practice, ongoing research will be necessary to evaluate its long-term safety profile and efficacy. Key areas of investigation may include:

Assessment of cardiovascular outcomes in patients using colesevelam long-term
Evaluation of the drug’s impact on bone health and vitamin D metabolism over extended periods
Investigation of potential interactions with emerging therapies for hyperlipidemia and diabetes

By pursuing these research directions, the medical community can continue to refine and optimize the use of colesevelam, potentially expanding its role in managing lipid disorders, diabetes, and other related conditions. As new data emerges, healthcare providers should stay informed about the latest developments to provide the best possible care for their patients.

Colesevelam – StatPearls – NCBI Bookshelf

Parth H. Patel; Ahmet S. Can.

Author Information and Affiliations

Last Update: May 1, 2023.

Continuing Education Activity

Colesevelam is an FDA-approved antihyperlipidemic drug. When treating hyperlipidemia, colesevelam should be used in conjunction with restriction of cholesterol and fat intake and exercise and can be used as a monotherapy or combined with an HMG-CoA reductase inhibitor ezetimibe, or niacin. It is approved for the treatment of hyperlipidemia from heterozygous familial hypercholesterolemia in adults and as well as in adolescents (10 to 17 years of age) patients. Colesevelam is also indicated to improve glycemic control in adults with type 2 diabetes mellitus along with diet and exercise.

Objectives:

Identify the mechanism of action of colesevelam.
Describe the potential adverse effects of colesevelam.
Review the potential clinically significant drug-drug interactions of colesevelam.
Outline some interprofessional team strategies for improving care coordination and communication when using colesevelam and improve outcomes.

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Indications

Colesevelam is a bile acid sequestrant that is an FDA-approved drug to be used in adjunct with diet and exercise for a variety of indications. The main indication is to lower an elevated low-density lipoprotein cholesterol (LDL-C) in patients with primary hyperlipidemia and other diseases that cause hyperlipidemia. It can be used as a monotherapy or with an HMG-CoA reductase inhibitor (statin), ezetimibe, or niacin, or a three- or four-drug combination. Another approved use is to reduce LDL-C levels in boys and postmenarchal girls ages 10-17 who have heterozygous familial hypercholesterolemia. For this situation, colesevelam can be used as a monotherapy or with a statin only after a proper trial of diet and exercise has failed. Finally, the last FDA-approved indication is to improve glycemic control in type 2 diabetic adults.

While not an FDA-approved use, colesevelam has been shown to improve stool consistency in patients with irritable bowel syndrome with diarrhea, causing an overall improvement in bowel function.[1] Overall effects were consistent with increased hepatic bile synthesis and luminal bile acid sequestration by colesevelam.[1]

Mechanism of Action

Colesevelam is a novel drug created to help patients lower their LDL cholesterol levels. Its primary mechanism of action is to create nonabsorbable complexes when exposed to bile acids in the GI tract. It forms these complexes due to its numerous hydrophobic side chains, which enhance the binding of bile acids.[2] Once it forms the complexes, the bile acids are no longer able to be reabsorbed to participate in the enterohepatic bile acid recirculation system. This activity causes a reduction in the total amount of bile acids in the body, causing an upregulation of the 7-alpha-hydroxylase enzyme responsible for converting intracellular cholesterol into bile acids. With the need for bile acids increased, hepatic LDL receptors become upregulated to provide enough cholesterol for bile acid synthesis. As more and more cholesterol diverts into creating bile acids, there is an overall decrease in the plasma LDL cholesterol level, along with a decrease in total cholesterol levels.[3]

The main mechanism through which colesevelam reduces plasma glucose levels is not entirely understood. In animal studies, researchers have observed colesevelam increasing the hormone glucagon-like peptide-1, GLP-1, and other incretins. Mice models show that this occurs through the activation of TGR5 secondary to the binding of bile acids in the GI tract. Once GLP1 and other incretins are activated, overall hepatic glycogenolysis becomes suppressed. This suppression occurs because patients with type 2 diabetes have increased hepatic glucose production, contributing to elevated fasting serum glucose levels. By decreasing hepatic glycogenolysis, one can expect a reduction in serum glucose levels. [2][4]

Administration

Colesevelam comes in three major forms that are available to patients. Healthcare providers have the option of choosing an oral tablet formulation, a prepared suspension, as well as a recently approved chewable bar form. The recommendation is to take either once or twice daily to achieve therapeutic effects. Also, patients with susceptibility to fat-soluble vitamin and folic acid deficiencies should take the vitamins at least 4 hours after taking colesevelam to allow for proper absorption of the vitamins. This principle also applies to statins. Statins need to be taken at least 4 hours after taking colesevelam. Patients should be counseled on proper fluid intake once started on colesevelam.

Colesevelam comes in the following formulations:

Adverse Effects

Colesevelam is part of the drug class known as bile acid sequestrants. While overall, very effective and safe to use as a nonsystemic approach to lower cholesterol, tolerability and compliance issues are not uncommon. Colesevelam has the lowest rate of side effects associated with its use, but it still shares the same side effects as the rest of the drugs in its class. Due to the mechanism of action and causing increased bile acid in the gastrointestinal tract, the predominant side effects are gastrointestinal. Symptoms like constipation, diarrhea, gas, as well as nausea, abdominal pain, and weakness are common. Patients have also noted muscle pain to be a side effect of colesevelam.[5] Another notable side effect associated with the use of colesevelam is a significant increase in triglycerides.[6] Also, steatorrhea is a common side effect of these drugs as well. Due to this, patients should receive counsel that they should take this drug at least four hours before ingesting vitamin supplements and statins.[7]

Colesevelam may decrease the bioavailability of many drugs, including but not limited to: amiodarone, oral corticosteroids, cyclosporine (systemic), estrogen derivatives, progesterone, oral contraceptives, ezetimibe, glimepiride, glipizide, glyburide, leflunomide, lomitapide, loop diuretics like furosemide, thiazides, methotrexate, mycophenolate, nonsteroidal anti-inflammatory drugs, olmesartan, phenytoin, pravastatin, niacin, propranolol, raloxifene, tetracyclines, levothyroxine, ursodiol, oral vancomycin, warfarin and fat-soluble multivitamins A, E, D, K. If these drugs are on the treatment regimen of the patient, monitor therapy or consider therapy modification. These drugs require administration either one to two hours before or four hours after colesevelam administration (see product information of the medications mentioned above).

Contraindications

While a generally well-tolerated drug with relatively mild side effects, colesevelam still has a few side effects that healthcare providers should be aware of before prescribing a patient the medication. Clinicians should not give colesevelam to patients with a history of bowel obstruction. Additionally, patients with a history of serum triglyceride concentrations greater than 500mg/dL or a history of hypertriglyceridemia-induced pancreatitis should not be given this drug due to its ability to increase triglyceride levels.[5][8]

Monitoring

Colesevelam has relatively few monitoring needs. While the drug’s desired effect is easily attainable without monitoring, the real monitoring that is necessary is with concomitantly administered drugs. Colesevelam primarily has been shown to decrease levels of fat-soluble vitamins as the drug tends to cause steatorrhea and the malabsorption of these vitamins. Patients with known deficiencies of these vitamins should understand to take their supplements either an hour before or about four hours after the administration of colesevelam.[5]

In addition to fat-soluble vitamins, studies have shown that patients with hypothyroidism that get started on colesevelam show an increase in TSH levels. This increase indicates that colesevelam causes a decreased absorption of levothyroxine. To counter this, healthcare providers should monitor the patient’s TSH levels while on this drug and advise patients to take their levothyroxine four hours after taking colesevelam.[9] Lastly, patients with triglycerides above 300 mg/dL should be given this drug with caution. Due to colesevelam’s side effect of increasing triglyceride levels, patients with already elevated levels above 300 mg/dL are at risk for increased adverse events like triglyceride-induced pancreatitis and other adverse effects associated with high triglyceride levels. [10]

Toxicity

Overall, colesevelam is a very safe drug to use with a long history of clinical use and study. The medication does not cause toxicity outside of the adverse effects mentioned above. Healthcare providers should be on the lookout for adverse effects patients may experience and work with the clinical care team as well as the patient to see if the medication needs to be adjusted or changed to help alleviate the adverse effects. Healthcare providers should also consider using an alternative formulation of the drug if there are side effects, especially gastrointestinal side effects.

Enhancing Healthcare Team Outcomes

Colesevelam is a very safe drug in the class of bile acid sequestrants used for the treatment of various illnesses. While very safe to use, adverse events are possible. As such, all interprofessional healthcare team members should be on the lookout for the adverse effects. Also, the team members should be knowledgeable on the drug and its properties to help advise the patient on the proper information they should know when taking the medication. Clinicians can utilize pharmacist expertise if there is a question on whether the patient can take the drug safely or not and verify if any contraindications or drug-to-drug interactions might exist. Nursing can provide essential information to patients as well as education on common side effects. Also, nursing can monitor the common adverse effects and serious side effects that patients may experience and may require medical attention. Every member of the interprofessional healthcare team has a responsibility to provide the best care to their patients and should be aware of therapies they might be on to help achieve the best possible outcome for the patient. [Level 5]

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References

1.: Camilleri M, Acosta A, Busciglio I, Boldingh A, Dyer RB, Zinsmeister AR, Lueke A, Gray A, Donato LJ. Effect of colesevelam on faecal bile acids and bowel functions in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2015 Mar;41(5):438-48. [PMC free article: PMC4493894] [PubMed: 25594801]
2.: Nwose OM, Jones MR. Atypical mechanism of glucose modulation by colesevelam in patients with type 2 diabetes. Clin Med Insights Endocrinol Diabetes. 2013 Dec 08;6:75-9. [PMC free article: PMC3864737] [PubMed: 24348081]
3.: Sonnett T, Robinson J, Milani P, Campbell RK. Role of colesevelam in managing heterozygous familial hypercholesterolemia in adolescents and children. Adolesc Health Med Ther. 2010;1:53-60. [PMC free article: PMC3915789] [PubMed: 24600261]
4.: Brunetti L, DeSantis EH. Patient tolerance and acceptance of colesevelam hydrochloride: focus on type-2 diabetes mellitus. P T. 2015 Jan;40(1):62-7. [PMC free article: PMC4296594] [PubMed: 25628509]
5.: Zema MJ. Colesevelam hydrochloride: evidence for its use in the treatment of hypercholesterolemia and type 2 diabetes mellitus with insights into mechanism of action. Core Evid. 2012;7:61-75. [PMC free article: PMC3426253] [PubMed: 22936894]
6.: Aggarwal S, Loomba RS, Arora RR. Efficacy of colesevelam on lowering glycemia and lipids. J Cardiovasc Pharmacol. 2012 Feb;59(2):198-205. [PubMed: 21983746]
7.: Bays H, Jones PH. Colesevelam hydrochloride: reducing atherosclerotic coronary heart disease risk factors. Vasc Health Risk Manag. 2007;3(5):733-42. [PMC free article: PMC2291317] [PubMed: 18078024]
8.: Sekhri K, Saha L. Colesevelam hydrochloride: A novel agent in patients with type 2 diabetes. Int J Appl Basic Med Res. 2011 Jul;1(2):113-5. [PMC free article: PMC3657969] [PubMed: 23776789]
9.: Weitzman SP, Ginsburg KC, Carlson HE. Colesevelam hydrochloride and lanthanum carbonate interfere with the absorption of levothyroxine. Thyroid. 2009 Jan;19(1):77-9. [PMC free article: PMC2858370] [PubMed: 19119983]
10.: Kaufman MB. Drug-induced pancreatitis: A Potentially Serious and Underreported Problem. P T. 2013 Jun;38(6):349-51. [PMC free article: PMC3737994] [PubMed: 23946630]

: Disclosure: Parth Patel declares no relevant financial relationships with ineligible companies.
: Disclosure: Ahmet Can declares no relevant financial relationships with ineligible companies.

Colesevelam Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Uses

This medication is used along with a proper diet and exercise to lower cholesterol in people with high levels of cholesterol in the blood. Lowering cholesterol decreases the risk of heart disease and helps prevent strokes and heart attacks.Colesevelam is also used along with a proper diet and exercise to lower high blood sugar in people with type 2 diabetes. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems. Proper control of diabetes may also lessen your risk of a heart attack or stroke. Colesevelam belongs to a class of drugs called bile acid-binding resins. Bile acid is a natural substance the liver makes by using cholesterol. This medication works by removing bile acid from the body. This causes the liver to make more bile acid by using cholesterol, which reduces cholesterol levels in the blood. It is not known how colesevelam works in lowering blood sugar.

How to use Colesevelam HCL

Take this medication by mouth with a meal as directed by your doctor, usually 1 to 2 times daily. Take the tablet form with a liquid (such as water, milk). If you have trouble swallowing the tablet, talk to your doctor about switching to the powder form of this medication.

If you are using the powder form of this medication, pour the contents of one packet into a glass. Add one cup (8 ounces/240 milliliters) of water, fruit juice, or diet soda. Stir the mixture well and drink all of it. Do not take the powder without mixing it in liquid.

Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

It may take several weeks before you get the full benefit of this drug.

Colesevelam may decrease the absorption of other products you may be taking. Some examples include cyclosporine, glipizide, glimepiride, glyburide, levothyroxine, and phenytoin, as well as birth control pills that contain ethinyl estradiol and norethindrone. Take other medications as directed by your doctor, usually at least 4 hours before taking your colesevelam dose. Ask your pharmacist if you are not sure when to take your medications.

Side Effects

Constipation and upset stomach may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

To prevent constipation, eat dietary fiber, drink enough water, and exercise. You may also need to take a laxative. Ask your pharmacist which type of laxative is right for you.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: nausea/vomiting, stomach/abdominal pain, trouble swallowing, unusual bleeding/bruising.

This medication does not usually cause low blood sugar (hypoglycemia). Low blood sugar may occur if this drug is prescribed with other diabetes medications, or if you do not consume enough calories from food, or if you do unusually heavy exercise.

Symptoms of low blood sugar include sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. It is a good habit to carry glucose tablets or gel to treat low blood sugar. If you don’t have these reliable forms of glucose, rapidly raise your blood sugar by eating a quick source of sugar such as table sugar, honey, or candy, or drink fruit juice or non-diet soda. Tell your doctor right away about the reaction and the use of this product. To help prevent low blood sugar, eat meals on a regular schedule, and do not skip meals. Check with your doctor or pharmacist to find out what you should do if you miss a meal.

Symptoms of high blood sugar (hyperglycemia) include thirst, increased urination, confusion, drowsiness, flushing, rapid breathing, and fruity breath odor. If these symptoms occur, tell your doctor right away. Your dosage may need to be increased.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking colesevelam, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: pancreatitis (caused by high triglyceride levels), high triglyceride levels, trouble swallowing, stomach/intestinal disorders (such as constipation, blockage, gastroparesis), recent major intestinal surgery, hemorrhoids.

Because this drug can interfere with the absorption of certain vitamins (such as vitamins A, D, E, K) when used for a long period of time, your doctor may direct you to take a multivitamin supplement. Take the multivitamin at least 4 hours before taking your colesevelam dose.

The powder form of this medication may contain aspartame. If you have phenylketonuria (PKU) or any other condition that requires you to restrict your intake of aspartame (or phenylalanine), consult your doctor or pharmacist about using this medication safely.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Tell your doctor if you are pregnant before using this medication.

This medication is unlikely to pass into breast milk or harm a nursing infant. Consult your doctor before breast-feeding.

Interactions

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Do not share this medication with others.

Lab and/or medical tests (such as blood cholesterol levels, blood sugar) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

Lifestyle changes that may help this medication work better include exercising, stopping smoking, and eating a low-cholesterol/low-fat diet. Consult your doctor for more details.

Attend a diabetes education program to learn more about how to manage your diabetes with medications, diet, exercise, and regular medical exams.

Learn the symptoms of high and low blood sugar and how to treat low blood sugar. Check your blood sugar regularly as directed and share the results with your doctor.

If you miss a dose, take it as soon as you remember with a meal. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.