Colestipol Hydrochloride

Pronunciation

Class: Bile Acid Sequestrants
VA Class: CV350
CAS Number: 37296-80-3
Brands: Colestid

Introduction

Antilipemic agent; bile acid sequestrant.

Uses for Colestipol Hydrochloride

Dyslipidemias

Adjunct to dietary therapy to decrease elevated serum total and LDL-cholesterol concentrations in the management of primary hypercholesterolemia in patients who do not respond adequately to diet.166 167

Slideshow: Newly Approved Weight Loss Drugs: Can They Help You?

Generally has no clinically relevant effect on serum triglyceride concentrations.100 167 However, because triglyceride concentrations may be increased in some patients,167 do not use alone in the management of hypertriglyceridemia.d

As effective as cholestyramine in lowering serum cholesterol concentrations.d Select bile acid sequestrant based on patient tolerance, including palatability and taste preference, and cost.136 163

Colestipol Hydrochloride Dosage and Administration

General

  • Patients should be placed on a standard lipid-lowering diet before initiation of colestipol therapy and should remain on this diet during treatment with the drug.166 167

  • To optimize antilipemic effects while minimizing the risk of adverse GI effects, adjust dosage carefully and titrate slowly.135 136 166

  • Instruct patients to take other drugs at least 1 hour before or 4 hours after taking colestipol tablets or suspension to minimize possible interference with absorption.166 167 (See Effects on GI Absorption of Drugs under Interactions.)

Monitoring during Antilipemic Therapy

  • Monitor lipoprotein concentrations periodically to ensure that target LDL-cholesterol goals are achieved and maintained at <100 mg/dL (optional goal: <70 mg/dL) for patients with CHD or CHD risk equivalents; <130 mg/dL (optional goal: <100 mg/dL) for patients with ≥2 risk factors and 10-year risk of 10–20%; <130 mg/dL for patients with ≥2 risk factors and 10-year risk <10%; or <160 mg/dL for patients with 0–1 risk factor.

Administration

Oral Administration

Administer tablets one at a time; promptly swallow whole, using plenty of water or other appropriate liquid.167 The tablets must not be cut, crushed, or chewed.167

To avoid accidental inhalation or esophageal distress, do not administer colestipol hydrochloride for oral suspension in its dry form.166

To minimize excessive swallowing of air, advise patients to avoid rapid ingestion of suspensions of the drug.136 After the mixture is ingested, rinse the glass with a small amount of additional fluid and ingest the remaining liquid to ensure that the entire dose has been taken.166

Reconstitution

Add the prescribed amount of colestipol hydrochloride granules to at least 90 mL of a liquid (e.g., fruit juice, water, milk, soft drink) and stir until completely mixed (colestipol will not dissolve in the liquid).166 Palatability and compliance may be increased if the entire next-day’s dose is mixed in one of these liquids in the evening and then refrigerated.121 Use of a heavy or pulpy fruit juice may minimize complaints about consistency of suspensions of the drug.135 136 166 If a carbonated beverage is used, mix the powder slowly in a large glass to minimize excessive foaming; however, use of a carbonated beverage as a vehicle may be associated with adverse GI effects.166

Alternatively, mix colestipol powder with milk in hot or regular breakfast cereals, a highly fluid soup, or pulpy fruit (e.g., crushed pineapple, pears, peaches, fruit cocktail).166

Dosage

Available as colestipol hydrochloride; expressed in terms of the salt.166 167

One dose (1 packet or 1 level teaspoon) of colestipol hydrochloride granules contains 5 g of colestipol hydrochloride.166 One dose (1 packet or 1 level scoop) of flavored colestipol hydrochloride granules contains 7.5 g of granules, which contains 5 g of colestipol hydrochloride.166

Pediatric Patients

Dyslipidemias
Oral

Pediatric dosage has not been established;100 166 167 however, dosages of 10–20 g or 500 mg/kg daily in 2–4 divided doses have been used.115 116 118 119 Lower dosages (e.g., 125–250 mg/kg daily) have also been used in some children when serum cholesterol concentrations were only 15–20% above normal after dietary management alone.117

Adults

Dyslipidemias
Oral (Tablets)

Initially, 2 g once or twice daily.167 Increase dosage by 2 g once or twice daily at intervals of 1 or 2 months.167 Usual daily dosage range is 2–16 g taken once or in divided doses.167

If the desired therapeutic effect is not achieved with the usual dosage of 2–16 g daily with good compliance and acceptable adverse effects, consider combined therapy or alternative treatment.167

If triglyceride concentrations increase markedly, consider reducing dosage, discontinuing therapy, or using combined or alternative treatment.167

Oral (Granules for oral suspension)

Initially, 5 g (1 packet or 1 level scoop) once or twice daily.100 166 Titrate dose upward as necessary in 5-g increments at 1- or 2-month intervals.135 136 166 Usual daily dosage range is 5–30 g (1–6 packets or level scoops) taken once or in divided doses.100 166

If the desired therapeutic effect is not achieved with the usual dosage of 1–6 doses per day with good compliance and acceptable adverse effects, consider combined therapy or alternative treatment.166

If triglyceride concentrations increase markedly, consider reducing dosage, discontinuing therapy, or using combined or alternative treatment.166

Patients with preexisting constipation receiving granules for oral suspension: Initially, 5 g once daily for 5–7 days; then increase dosage to 5 g twice daily and monitor constipation and serum lipoprotein values, at least twice, 4–6 weeks apart.166 Thereafter, increase dosage as needed by 1 dose per day (at monthly intervals) with periodic monitoring of serum lipoprotein values;166 adjust dosage accordingly to achieve the desired effect while avoiding excessive dosage.135 136 If constipation worsens or the desired effect is not achieved with acceptable adverse effects with the usual dosage of 1–6 doses per day, consider combined therapy or alternative treatment.135 136 166

30 g daily (as granules for oral suspension) has been used in combination with niacin in adults with heterozygous familial hypercholesterolemia.111 112 113 114

Cautions for Colestipol Hydrochloride

Contraindications

  • Known hypersensitivity to colestipol or any ingredient in the formulation.166

Warnings/Precautions

Warnings

Administration

To avoid accidental inhalation or esophageal distress, do not administer colestipol hydrochloride for oral suspension in its dry form.166 Always mix colestipol hydrochloride granules with water or other fluids before ingesting.166 (See Administration under Dosage and Administration.)

Phenylketonuria

Individuals with phenylketonuria (i.e., homozygous genetic deficiency of phenylalanine hydroxylase) and other individuals who must restrict their intake of phenylalanine should be warned that Flavored Colestid granules for oral suspension contain aspartame (NutraSweet), which is metabolized in the GI tract following oral administration to provide 18.2 mg of phenylalanine per 7.5-g packet.166

General Precautions

GI Effects

Mild and, occasionally, severe constipation has occurred.166 167 Exacerbation of preexisting constipation and aggravation of hemorrhoids secondary to constipation may occur.166 167 Encourage increased fluid and fiber intake to alleviate constipation;111 114 121 136 166 167 173 a stool softener can be added if necessary.135 136 166 167 In addition, adjust dosage carefully and titrate slowly to minimize adverse GI effects (e.g., fecal impaction).135 166 167 (See Dosage under Dosage and Administration.) Make particular effort to avoid constipation in patients with symptomatic CHD.166 167 Discontinuation of colestipol therapy may be required in some patients.166 167

Difficulty swallowing and transient esophageal obstruction have been reported rarely.166 167 Patients with a history of swallowing difficulties or choking with food, liquids, or other tablets or capsules should consult a clinician before initiating therapy with colestipol hydrochloride tablets.167 If abdominal pressure or discomfort (secondary to esophageal obstruction) occurs, advise patients to consult a clinician prior to administering the next dose.167

Abdominal discomfort (including pain and cramping), belching, flatulence, indigestion, heartburn, nausea, vomiting, and diarrhea or loose stools also have been reported.166 167 Bleeding hemorrhoids and blood in the stool have been reported infrequently.166 167 Peptic ulceration, cholecystitis, and cholelithiasis have been reported occasionally but are not necessarily drug-related.166 167

Fat-soluble Vitamin Deficiency

May interfere with the absorption of folic acid and fat-soluble vitamins (e.g., vitamins A, D, E, K).166 167 Prolonged use may be associated with an increased bleeding tendency as a result of hypoprothrombinemia secondary to vitamin K deficiency.166 167 (See Specific Drugs under Interactions.)

Hypothyroidism

Theoretical risk for the development of hypothyroidism, especially in patients with limited thyroid reserve.166 167

Hyperchloremic Acidosis

Because colestipol is the chloride form of an anion-exchange resin, there is a possibility that prolonged use may lead to the development of hyperchloremic acidosis.135 166 167

Specific Populations

Pregnancy

Category B.c

Interferes with absorption of fat-soluble vitamins, which may be detrimental even in the presence of supplementation.166 167

Lactation

Use with caution; possible lack of proper vitamin absorption associated with colestipol therapy may have an effect on nursing infants.166 167

Pediatric Use

Safety and efficacy not established.166 167

Common Adverse Effects

Constipation.166 167

Interactions for Colestipol Hydrochloride

Effects on GI Absorption of Drugs

May bind to a number of drugs in the GI tract and may delay or reduce their absorption.166 167 Instruct patients to allow as long a time interval as possible between ingestion of other drugs and colestipol.166 167 The manufacturer recommends administering other drugs at least 1 hour before or 4 hours after colestipol.166 167

Consider the possibility that discontinuance of colestipol in patients stabilized on potentially toxic drugs that bind to the resin may lead to toxicity and that administration of colestipol to patients stabilized on other drugs may reduce the effect of these drugs.166 167

Specific Drugs

Drug

Interaction

Comments

Antidiabetic agents (sulfonylureas)

Decreased antilipemic effects of colestipold

β-adrenergic blocking agents (propranolol)

Decreases and/or delays GI absorption of propranolol;133 134 135 166 167 effect on absorption of other β-adrenergic blocking agents not fully determined134 135 166 167

Monitor closely whenever colestipol therapy is initiated or discontinued in patients receiving propranolol;133 135 166 167 adjust propranolol dosage as necessary133 134

Digoxin

Colestipol may bind digoxin in the GI tract and impair its absorption166 167

Diuretics, thiazide (e.g., hydrochlorothiazide, chlorothiazide)

Substantially decreased absorption of diuretic166 167

Decreases absorption of chlorothiazide even when administered 1 hour before colestipol hydrochloride166 167

Fat-soluble Vitamins (i.e., vitamins A, D, E, K)

Decreased absorption of fat-soluble vitamins166 167

Consider supplemental administration of vitamins A and D if colestipol is to be given for a prolonged period.d

Bleeding secondary to vitamin K deficiency usually responds promptly to parenteral administration of phytonadione; recurrences can be prevented by oral administration of phytonadione166 167

Furosemide

Substantially decreased absorption of furosemide166 167

Gemfibrozil

Substantially decreased absorption of gemfibrozil166 167

Hydrocortisone

Possible interference with absorption of hydrocortisone166 167

Lovastatin

Possible additive antilipemic effects166 167

Niacin

Additive antilipemic effects166 167

Penicillin G

Substantially decreased absorption of penicillin G166 167

Phosphate supplements, oral

Possible interference with absorption of oral phosphate supplements166 167

Tetracycline

Substantially decreased absorption of tetracycline166 167

Colestipol Hydrochloride Pharmacokinetics

Absorption

Bioavailability

Not absorbed from the GI tract.166 167

Onset

Therapeutic response usually occurs within 1 month.166 167

Elimination

Elimination Route

Binds to bile acids in the intestine and forms a nonabsorbable complex that is excreted in feces.166 167

Stability

Storage

Oral

Tablets

20–25°C.166 167

Granules for Suspension

20–25°C.100

Actions and Spectrum

  • Binds to bile acids in the intestine and forms a nonabsorbable complex that is excreted in feces.166 167 Partial removal of bile acids from the enterohepatic circulation via this mechanism results in increased conversion of cholesterol to bile acids in the liver.166 167 This causes an increased demand for cholesterol in liver cells, resulting in a compensatory increase in hepatic uptake (and thus systemic clearance) of circulating LDL-cholesterol.166 167

  • Reduces serum total and LDL-cholesterol concentrations.166 167 Serum triglyceride concentrations may increase or remain unchanged.166 167

  • Antilipemic effects are additive when used with lovastatin or niacin.166 167

Advice to Patients

  • Importance of adherence to prescribed directions for use.166 167 (See Oral Administration Under Dosage and Administration.)

  • Importance of adherence to National Cholesterol Education Program (NCEP)’s dietary recommendations.166 167

  • Inform patients that colestipol hydrochloride tablets may be larger than typical tablets or capsules.167 (See GI Effects under Cautions.)

  • Importance of administering other medications at least 1 hour before or 4 hours after colestipol.166 167

  • For phenylketonurics, importance to inform them that Flavored Colestid granules for oral suspension contains aspartame.166

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.166 167

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.166 167

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Colestipol Hydrochloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

For suspension

5 g/packet or calibrated scoop*

Colestid Granules

Pfizer

Colestipol Hydrochloride for Oral Suspension

Global

5 g/7.5 g packet or calibrated scoop

Colestid Flavored Granules (with aspartame)

Pfizer

Tablets (micronized)

1 g

Colestid (with povidone)

Pfizer

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Colestid 1GM Tablets (PFIZER U.S.): 120/$111.29 or 360/$318.12

Colestid 5GM Granules (PFIZER U.S.): 500/$158.55 or 1500/$457.80

Colestid 5GM Packet (PFIZER U.S.): 30/$90.30 or 90/$251.99

Colestid 5GM Packet (PFIZER U.S.): 90/$225.99 or 270/$671.98

Colestid Flavored 5GM Granules (PFIZER U.S.): 450/$136.50 or 1350/$394.76

Colestid Flavored 5GM/7.5GM Packet (PFIZER U.S.): 60/$210.00 or 180/$600.00

Micronized Colestipol HCl 1GM Tablets (GREENSTONE): 30/$26.99 or 60/$42.97

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions May 1, 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

100. Pfizer. Colestid and Flavored Colestid (colestipol hydrochloride for oral suspension) prescribing information. New York, NY; 2006 Jun.

101. Anon. Addition to labeling of cholestyramine. FDA Drug Bull. 1985; 15:7-8. [PubMed 3858190]

102. National Institutes of Health Offices of Medical Applications of Research. Consensus conference: lowering blood cholesterol to prevent heart disease. JAMA. 1985; 25:2080-6.

103. Rahimtoola SH. Cholesterol and coronary heart disease: a perspective. JAMA. 1985; 253:2094-5. [PubMed 3974101]

104. American Heart Association Committee to Design a Dietary Treatment of Hyperlipoproteinemia. Recommendations for treatment of hyperlipidemia in adults: a joint statement of the Nutrition Committee and the Council on Arteriosclerosis. Circulation. 1984; 69:1065-90A. [PubMed 6713610]

105. American Medical Association Council on Scientific Affairs. Dietary and pharmacologic therapy for the lipid risk factors. JAMA. 1983; 250:1873-9. [IDIS 176576] [PubMed 6620484]

106. Glueck CJ. Nonpharmacologic and pharmacologic alteration of high-density lipoprotein cholesterol: therapeutic approaches to prevention of atherosclerosis. Am Heart J. 1985; 110:1107-15. [IDIS 208439] [PubMed 2865887]

107. National Heart, Lung and Blood Institute Lipid Metabolism-Atherogenesis Branch. The Lipid Research Clinics Coronary Primary Prevention Trial results. Part I: reduction in incidence of coronary heart disease. JAMA. 1984; 251:351-64. [IDIS 180094] [PubMed 6361299]

108. National Heart, Lung and Blood Institute Lipid Metabolism-Atherogenesis Branch. The Lipid Research Clinics Coronary Primary Prevention Trial results. Part II: relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA. 1984; 251:365-74. [IDIS 180095] [PubMed 6361300]

109. Kronmal RA. Commentary on the published results of the lipid research clinics coronary primary prevention trial. JAMA. 1985; 253:2091-3. [PubMed 3883022]

110. Oliver MF. Hypercholesterolaemia and coronary heart disease: an answer. BMJ. 1984; 288:423-4. [IDIS 182823] [PubMed 6419948]

111. Kane JP, Malloy MJ, Tun P et al. Normalization of low density-lipoprotein levels in heterozygous familial hypercholesterolemia with a combined drug regimen. N Engl J Med. 1981; 304:251-8. [IDIS 126648] [PubMed 7003391]

112. Illingworth DR, Phillipson BE, Rapp JH et al. Colestipol plus nicotinic acid in treatment of heterozygous familial hypercholesterolaemia. Lancet. 1981; 1:296-7. [IDIS 127354] [PubMed 6109940]

113. Kuo PT, Kostis JB, Moreyra AE et al. Familial type II hyperlipoproteinemia with coronary heart disease: effect of diet-colestipol-nicotinic acid treatment. Chest. 1981; 79:286-91. [IDIS 149021] [PubMed 7471860]

114. Glueck CJ. Colestipol and probucol: treatment of primary and familial hypercholesterolemia and amelioration of atherosclerosis. Ann Intern Med. 1982; 96:475-82. [IDIS 147431] [PubMed 7039445]

115. Glueck CJ, Fallat RW, Tsang RG. Pediatric familial type II hyperlipoproteinemia: therapy with diet and colestipol resin. Pediatrics. 1976; 57:68-74. [IDIS 68492] [PubMed 174057]

116. Schwarz KB, Goldstein PD, Witztum JL et al. Fat-soluble vitamin concentrations in hypercholesterolemic children treated with colestipol. Pediatrics. 1980; 65:243-50. [IDIS 113975] [PubMed 7354970]

117. Schlierf G, Mrozik K, Heuck CC et al. “Low-dose” colestipol in children, adolescents and young adults with familial hypercholesterolemia. Atherosclerosis. 1982; 41:133-8. [PubMed 7073790]

118. Glueck CJ. Therapy of familial and acquired hyperlipoproteinemia in children and adolescents. Prev Med. 1983; 12:835-47. [PubMed 6676731]

119. Tsang RC, Roginsky MS, Mellies MJ et al. Plasma 25-hydroxy-vitamin D in familial hypercholesterolemic children receiving colestipol resin. Pediatr Res. 1978; 12:980-2. [PubMed 724301]

120. American Health Foundation. Summary and recommendations of the Conference on Blood Lipids in Children: optimal levels for early prevention of coronary artery disease. Prev Med. 1983; 12:728-40. [PubMed 6676727]

121. Hoeg JM, Gregg RE, Brewer HB. An approach to the management of hyperlipoproteinemia. JAMA. 1986; 255:512-21. [IDIS 209539] [PubMed 3510334]

122. National Institutes of Health Office of Medical Applications of Research. Consensus conference: treatment of hypertriglyceridemia. JAMA. 1984; 251:1196-200. [PubMed 6582287]

123. Forman MB, Baker SG, Mieny CJ et al. Treatment of homozygous familial hypercholesterolaemia with portacaval shunt. Atherosclerosis. 1982; 41:349-61. [PubMed 7066082]

124. Thompson GR, Lowenthal R, Myant NB. Plasma exchange in the management of homozygous familial hypercholesterolaemia. Lancet. 1975; 1:1208-11. [PubMed 48833]

125. Postiglione A, Thompson GR. Experience with plasma-exchange in homozygous familial hypercholesterolaemia. Prog Clin Biol Res. 1985; 188:213-20. [PubMed 3903770]

126. Starzl TE, Chase HP, Ahrens EH Jr et al. Portacaval shunt in patients with familial hypercholesterolemia. Ann Surg. 1983; 198:273-83. [PubMed 6615051]

127. King MEE, Breslow JL, Lees RS. Plasma-exchange therapy of homozygous familial hypercholesterolemia. N Engl J Med. 1980; 302:1457-9. [PubMed 7374711]

128. Hoeg JM, Demosky SJ Jr, Schaefer EJ et al. The effect of portacaval shunt on hepatic lipoprotein metabolism in familial hypercholesterolemia. J Surg Res. 1985; 39:369-77. [PubMed 4057999]

129. Schaefer EJ, Levy RI. Pathogenesis and management of lipoprotein disorders. N Engl J Med. 1985; 312:1300-10. [IDIS 199398] [PubMed 3887163]

130. Bilheimer DW, Goldstein JL, Grundy SM et al. Liver transplantation to provide low-density-lipoprotein receptors and lower plasma cholesterol in a child with homozygous familial hypercholesterolemia. N Engl J Med. 1984; 311:1658-64. [PubMed 6390206]

131. Mancini M, Postiglione A, Farinaro E et al. Diet, drugs, and plasma exchange in the treatment of hyperlipidemia in childhood. Prev Med. 1983; 12:848-53. [PubMed 6676732]

132. American Heart Association Committee on Atherosclerosis and Hypertension in Childhood of the Council of Cardiovascular Disease in the Young and the Nutrition Committee. Diagnosis and treatment of primary hyperlipidemia in childhood: a joint statement for physicians by the Committee on Atherosclerosis and Hypertension in Childhood of the Council of Cardiovascular Disease in the Young and the Nutrition Committee. Circulation. 1986: 74:1181-8A.

133. Hibbard DM, Peters JR, Hunninghake DB. Effect of cholestyramine and colestipol on the plasma concentrations of propranolol. Br J Clin Pharmacol. 1984; 18:337-42. [IDIS 191419] [PubMed 6487473]

134. Mangini RJ, ed. Drug interaction facts. St. Louis: JB Lippincott Co; 1985(Jan):110a.

135. The Upjohn Company. Colestid (colestipol hydrochloride) granules prescribing information. Kalamazoo, MI; 1990 Apr.

136. The Expert Panel (coordinated by the National Heart, Lung, and Blood Institute). Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Arch Intern Med. 1988; 148:36-69. [IDIS 236890] [PubMed 3422148]

137. Bilheimer DW. Familial hypercholesterolemia: there is a need for early detection and treatment. JAMA. 1987; 257:69-70. [PubMed 3783906]

138. Vega GL, Grundy SM. Treatment of primary moderate hypercholesterolemia with lovastatin (mevinolin) and colestipol. JAMA. 1987; 257:33-8. [IDIS 223496] [PubMed 3537351]

139. Witztum JL. Intensive drug therapy of hypercholesterolemia. Am Heart J. 1987; 113(2 Part 2):603-9. [IDIS 226100] [PubMed 3544777]

140. Blankenhorn DH, Nessim SA, Johnson RL et al. Beneficial effects of colestipol-niacin therapy on coronary atherosclerosis and coronary bypass grafts. JAMA. 1987; 257:3233-40. [IDIS 230814] [PubMed 3295315]

141. Illingworth DR. Mevinolin plus colestipol in therapy for severe heterozygous familial hypercholesterolemia. Ann Intern Med. 1984; 101:598-604. [IDIS 191769] [PubMed 6567462]

142. Mabuchi H, Sakai T, Sakai Y et al. Reduction of serum cholesterol in heterozygous patients with familial hypercholesterolemia: additive effects of compactin and cholestyramine. N Engl J Med. 1983; 308:609-13. [IDIS 166852] [PubMed 6828091]

143. Malloy MJ, Kane JP, Kunitake ST et al. Complementarity of colestipol, niacin, and lovastatin in treatment of severe familial hypercholesterolemia. Ann Intern Med. 1987; 107:616-23. [IDIS 235737] [PubMed 3662275]

144. Tobert JA. New developments in lipid-lowering therapy: the role of inhibitors of hydroxymethylglutaryl-coenzyme A reductase. Circulation. 1987; 76:534-8. [IDIS 252224] [PubMed 3113763]

145. Brown MS, Goldstein JL. The hyperlipoproteinemias and other disorders of lipid metabolism. In: Harrison’s principles of internal medicine. 11th ed. New York: McGraw-Hill Book Co; 1987;1650-61.

146. Goldstein JL, Brown MS. The low-density lipoprotein pathway and its relation to atherosclerosis. Ann Rev Biochem. 1977; 46:897-930. [PubMed 197883]

147. Brown MS, Goldstein JL. Lipoprotein receptors in the liver: control signals for plasma cholesterol traffic. J Clin Invest. 1983; 72:743-7. [PubMed 6309907]

148. Heber D, Koziol BJ, Henson LC. Low density lipoprotein receptor regulation and cellular basis of atherosclerosis: implications for nutritional and pharmacologic treatment of hypercholesterolemia. Am J Cardiol. 1987; 60(Suppl):4-8G.

149. Thompson GR, Ford J, Jenkinson M et al. Efficacy of mevinolin as adjuvant therapy for refractory familial hypercholesterolaemia. Q J Med. 1986; 60:803-11. [IDIS 222246] [PubMed 3640503]

150. East C, Grundy SM, Bilheimer DW. Normal cholesterol levels with lovastatin (mevinolin) therapy in a child with homozygous familial hypercholesterolemia following liver transplantation. JAMA. 1986; 256:2843-8. [IDIS 222763] [PubMed 3534334]

151. Grundy SM. HMG-CoA reductase inhibitors for treatment of hypercholesterolemia. N Engl J Med. 1988; 319:24-33. [IDIS 243240] [PubMed 3288867]

152. Reviewers’ comments on lovastatin (personal observations); 1988 Jul.

153. McNamara DJ, Ahrens EH Jr, Kolb R et al. Treatment of familial hypercholesterolemia by portcaval anastomosis: effect on cholesterol metabolism and pool sizes. Proc Natl Acad Sci USA. 1983; 80:564-8. [PubMed 6572906]

154. Witztum JL, Williams JC, Ostlund R et al. Successful plasmapheresis in a 4-year-old child with homozygous familial hypercholesterolemia. J Pediatr. 1980; 97:615-8. [PubMed 6775065]

155. Graisely B, Cloarec M, Salmon S et al. Extracorporeal plasma therapy for homozygous familial hypercholesterolaemia. Lancet. 1980; 2:1147. [PubMed 6107765]

156. Stoffel W, Borberg H, Greve V. Application of specific extracorporeal removal of low density lipoprotein in familial hypercholesterolaemia. Lancet. 1981; 2:1005-7. [PubMed 6118475]

157. Thompson GR, Miller JP, Breslow JL. Improved survival of patients with homozygous familial hypercholesterolaemia treated with plasma exchange. BMJ. 1985; 291:1671-3. [PubMed 3935235]

158. Illingworth DR, Bacon SP, Larsen KK. Long-term experience with HMG-CoA reductase inhibitors in the therapy of hypercholesterolemia. Atheroscler Rev. 1988; 18:161-87.

159. American Heart Association. AHA conference report on cholesterol. Circulation. 1989; 80:715-48. [PubMed 2670320]

160. Cashin-Hemphill L, Mack WJ, Pogoda JM et al. Beneficial effects of colestipol-niacin on coronary atherosclerosis: a 4-year follow-up. JAMA. 1990; 264:3013-7. [IDIS 275276] [PubMed 2243429]

161. Working Group on Management of Patients with Hypertension and High Blood Cholesterol. National education programs working group report on the management of patients with hypertension and high blood cholesterol. Ann Intern Med. 1991; 114:224-37. [IDIS 276739] [PubMed 1984747]

162. The Upjohn Company. Colestid (colestipol hydrochloride) granules prescribing information. In: Barnhart ER, publisher. Physicians’ desk reference. 45th ed. Oradell, NJ: Medical Economics Company Inc; 1991(Suppl A):A72.

163. The Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Pediatrics. 1992; 89(Suppl):525-84. [PubMed 1538956]

164. American Academy of Pediatrics Committee on Nutrition. Statement on cholesterol. Pediatrics. 1992; 90:469-73. [PubMed 1518712]

165. The Expert Panel. Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Circulation. 1994; 89:1329-1445.

166. Upjohn. Colestid (colestipol hydrochloride for oral suspension) and Flavored Colestid (colestipol hydrochloride for oral suspension) granules for oral suspension prescribing information. Kalamazoo, MI; 1998 Mar.

167. Pfizer. Colestid (micronized colestipol hydrochloride) tablets prescribing information. New York, NY; 2006 Jun.

168. Gibbons RJ, Chatterjee K, Daley J et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology, American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). J Am Coll Cardiol. 1999; 33:2092-197. [IDIS 429504] [PubMed 10362225]

169. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Survival Study (4S). Lancet. 1994; 344:1383-9. [IDIS 338582] [PubMed 7968073]

170. Sacks FN, Pfeffer MA, Maye LA et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med. 1996; 335:1001-9. [IDIS 372985] [PubMed 8801446]

171. The Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998; 339:1349-57. [IDIS 430942] [PubMed 9841303]

172. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of high Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001; 285:2486-97. [IDIS 464555] [PubMed 11368702]

173. Anon. Choice of lipid-regulating drugs. Med Lett Drugs Ther. 2001; 43:43-8. [PubMed 11378632]

174. National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Adult Treatment Panel III Report. From AHA web site.

c. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 6th ed. Baltimore, MD: Williams & Wilkins; 2002:324-5.

d. AHFS Drug Information 2003. McEvoy GK , ed. Colestipol hydrochloride. Bethesda, MD: American Society of Health-System Pharmacists; 2003:1594-6.

Hide
(web5)