Posology
Adults:
1. Monotherapy: For primary prevention of coronary heart disease and to reduce cholesterol: After initial introduction over a three to four week period, 3 to 6 sachets per day, administered either as a single daily dose or in divided doses up to four times daily, according to dosage requirements and patient acceptability. Dosage may be modified according to response and can be increased to 9 sachets per day if necessary.
Occasional slight gastrointestinal upsets, e.g. constipation, may occur when starting Colestyramine. These usually pass with continued usage of Colestyramine and are minimised by starting therapy gradually.
Final dose required | Week 1 | Week 2 | Week 3 | Week 4 |
Sachets per day |
3 | 1 | 2 | 3 | 3 |
4 | 1 | 2 | 3 | 4 |
6 | 1 | 2 | 3 | 6 |
Combination therapy
The cholesterol-lowering effect of colestyramine on total and LDL-cholesterol is enhanced when it is combined with an HMG-CoA reductase inhibitor (e.g. pravastatin, simvastatin, lovastatin). Enhanced lowering of LDL-cholesterol is also seen with combined nicotinic acid/colestyramine therapy. There is also evidence to support the addition of colestyramine to gemfibrozil therapy in order to further lower LDL-cholesterol in patients with high LDL- cholesterol and triglycerides and low HDL-cholesterol.
2. To relieve pruritus: One or two sachets daily are usually sufficient.
3. To relieve diarrhoea: As for reduction of cholesterol but it may be possible to reduce this dosage. In all patients presenting with diarrhoea induced by bile acid malabsorption, if a response is not seen within 3 days, then alternative therapy should be initiated.
Doses of more than 24 g a day of colestyramine resin may interfere with normal fat absorption.
Paediatric population
Children 6 - 12 years:
The initial dose is determined by the following formula:
Subsequent dosage adjustment may be necessary where clinically indicated.
To minimise potential gastrointestinal side effects, it is desirable to begin all therapy in children with one dose of this medicine daily. The dosage is then increased gradually, every five to seven days to the desired level for effective control.
Children under 6 years:
Colestyramine should not be used in children under 6 years. There are no data to support its use.
Colestyramine should not be used in patients with exudative or bloody diarrhoea.
Elderly:
No dosage adjustment is necessary.
Method of administration
As a precautionary measure, where concurrent drug therapy exists then such drugs should be administered at least one hour before or 4-6 hours after taking this medicine.
Colestyramine should not be taken in its dry form.
Colestyramine should be administered mixed with water or a suitable liquid, such as fruit juice, and stirred to a uniform consistency.
Colestyramine may also be mixed with skimmed milk, thin soups, pulpy fruits with high moisture content, e.g. apple sauce, etc.
The suggested time of administration is mealtime, but this may be modified to avoid interference with absorption of other medications.