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Lipid modification - primary and secondary CVD prevention - Management
What are the adverse effects of bile acid sequestrants?

  • Adverse effects are predominantly gastrointestinal (GI) in nature.
    • Constipation is the most common adverse effect and is usually mild, transient, and responsive to usual adjunctive measures. Severe constipation (accompanied by impaction) has been reported.
    • Other, less frequent, GI complaints are abdominal discomfort, belching, flatulence, indigestion, nausea, and vomiting. Diarrhoea can also occur, especially when large doses of colestyramine are used.
  • Bile acid sequestrants may elevate serum triglyceride levels when used as sole therapy.
    • This elevation is generally transient but may persist in some people.
    • The manufacturer of colestipol recommends that a significant increase in triglycerides should be considered as an indication for dose reduction, drug discontinuation, or combined or alternate therapy.
  • Bile acid sequestrants may interfere with normal fat absorption and thus may alter the absorption of fat soluble vitamins (vitamins A, D, E, and K). Case reports of increased prothrombin time (hypoprothrombinaemia associated with vitamin K deficiency) have been reported.
  • Transient and modest elevation in serum transaminase levels have been reported with colesevelam and colestipol.

[ABPI Medicines Compendium, 2005a; ABPI Medicines Compendium, 2007a; ABPI Medicines Compendium, 2008a; ABPI Medicines Compendium, 2008d]

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