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Lipid modification - primary and secondary CVD prevention - Management
What dose of bile acid sequestrant is recommended?
- For colestyramine, the dosage should be titrated from 4 g daily to 24 g daily, if tolerated.
- For colesevelam and colestipol, use the licensed dosages outlined in Table 1.
Clarification / Additional information
- The licensed dosages (for adults) and advice regarding administration for bile acid sequestrants available in the UK are shown in Table 1.
Table 1. Bile acid sequestrants available in the UK: licensed dosages for adults.
Colesevelam hydrochloride 625 mg tablets | Colestipol hydrochloride 5 g sachets | Colestyramine 4 g sachets |
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Dosage |
Adjunct therapy: The recommended dose is four to six tablets per day. The maximum recommended dose is three tablets taken twice per day with meals or six tablets taken once per day with a meal.
Monotherapy: The recommended starting dose is three tablets taken twice per day with meals or six tablets once per day with a meal. The maximum recommended dose is seven tablets per day. | Initial dosage: An initial daily adult dosage of colestipol hydrochloride of 5 g either once or twice daily is recommended.
Dose titration: Recommended dosage for Colestid® is 5–30 g taken as one dose or two divided doses.
Dose should be increased with 5 g increments at one month intervals.
If the desired therapeutic effect is not obtained at a dose of 5–30 g per day with good compliance and acceptable adverse-effects, combined therapy or alternate treatment should be considered. | Initial dosage: One 4 g sachet daily for 7 days.
Dose titration: Increase the dose by one 4 g sachet at weekly intervals.
After initial introduction over a 3 to 4 week period, three to six sachets per day, administered either as a single daily dose or in divided doses up to four times daily, according to dosage requirements and acceptability.
Dosage may be modified according to response and can be increased to nine sachets (36 g) per day if necessary. |
Method of admininstration |
Cholestagel® tablets are taken orally with a meal and liquid. | Mix the granules in 100 mL or more of a suitable liquid (e.g. orange or tomato juice, water, skimmed milk or non-carbonated beverage) until dispersed.
The granules may also be taken in soups or with cereals, pulpy fruits with a high water content, or yoghurt. | Mix the powder in 150 mL of water or a suitable liquid (e.g. fruit juice, skimmed milk, thin soups, pulpy fruits with high moisture content, [e.g. apple sauce]) and stirred to a uniform consistency.
Allow to stand for 1 or 2 minutes. After the powder becomes wetted, stir or shake to make a uniform suspension before administration.
Colestyramine powder should not be taken in its dry form. |
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Basis for recommendation
- The target dosage of 24 g daily for colestyramine is extrapolated from clinical trials for primary and secondary prevention of cardiovascular disease (CVD). These dosages are consistent with licensed dosages (see Table 1).
- For colesevelam and colestipol, CKS could find no trials that reported health-related quality of life or clinical endpoints such as cardiovascular morbidity and mortality. Consequently, only licensed dosages are recommended.
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