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Lipid modification - primary and secondary CVD prevention - Management
What are the cautions and contraindications for bile acid sequestrants?

  • Contraindications:
    • Manufacturers differ in their recommendations regarding who should not use bile acid sequestrants:
      • Colesevelam should not be used in people with bowel or biliary obstruction.
      • Colestyramine should not be used in people with complete biliary obstruction (since the drug is likely to be ineffective if bile is not secreted into the intestine).
      • Colestipol: none specified.
    • Given that all these drugs work similarly, and are not systematically absorbed, CKS recommends that bile acid sequestrants should not be used in people with bowel or biliary obstruction.
  • Precautions:
    • Although it has not been supported by studies, the manufacturers of bile acid sequestrants warn that these drugs may interfere with normal fat absorption and thus may alter the absorption of fat soluble vitamins (vitamins A, D, E, and K) if taken long term (particularly in people with malabsorption disorders).
    • When prescribing colestyramine for people with diabetes, the sugar-free preparation is preferred:
      • Each colestyramine sachet (Questran®) contains 3.79 g sucrose. A sugar-free version is available (Questran Orange®).

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

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