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Interactions between Cholestyramine and T-Lite

1 drug interaction and 16 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

cholestyramine multivitamins with minerals

Applies to: cholestyramine and T-Lite (multivitamin with minerals)
Adjust dosing interval

Bile acid sequestrants and the phosphate binder, sevelamer, can decrease the absorption of fat-soluble vitamins A, D, E, and K. By binding bile acids, these agents may interfere with normal fat digestion and absorption, thereby preventing the absorption of fat-soluble vitamins. When 8 grams of cholestyramine was administered simultaneously with a normal meal containing 250,000 units of vitamin A acetate in four healthy young adult subjects, plasma vitamin A levels were significantly reduced during a 9-hour postprandial period compared to the values obtained with the control meal. Coadministration with 4 grams of cholestyramine had no significant effect. In a crossover study involving healthy subjects, coadministration of sevelamer with calcitriol resulted in a significant reduction in bioavailability for calcitriol (calcitriol with sevelamer vs calcitriol alone: AUC 137 pg*h/mL vs 318 pg*h/mL and Cmax 40.1 pg/mL vs 49.7 pg/mL, respectively). Chronic use of bile acid sequestrants has been rarely associated with an increased bleeding tendency due to hypoprothrombinemia resulting from vitamin K deficiency. Isolated cases of Vitamin A (including one case of night blindness) and D deficiencies have also been reported with chronic cholestyramine therapy.

Management

When bile acid sequestrants are given for prolonged periods, some manufacturers recommend that concomitant supplementation with water-miscible or parenteral forms of fat-soluble vitamins be considered. If oral vitamin supplements are used with cholestyramine or colestipol, advise patients to take them at least 1 to 2 hours before or 4 to 6 hours after the bile acid sequestrant to minimize the potential impact on their absorption. No recommendations are available for sevelamer, but it may be advisable to follow the same precautions.

References (14)
  1. Gross L, Brotman M (1970) "Hypoprothrombinemia and hemorrhage associated with cholestyramine therapy." Ann Intern Med, 72, p. 95-6
  2. Shojania AM, Grewar D (1986) "Hypoprothrombinemic hemorrhage due to cholestyramine therapy." Can Med Assoc J, 134, p. 609-10
  3. Longstreth GF, Newcomer AD (1975) "Drug-induced malabsorption." Mayo Clin Proc, 50, p. 284-93
  4. Acuna R, Gonzalez Ceron M (1977) "Hypoprothrombinemia and bleeding associated to treatment with cholestyramine (author's transl)." Rev Med Chil, 105, p. 27-8
  5. (2001) "Product Information. Rocaltrol (calcitriol)." Roche Laboratories
  6. (2005) "Product Information. Fosamax Plus D (alendronate-cholecalciferol)." Merck & Co., Inc
  7. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  8. Cerner Multum, Inc. "Australian Product Information."
  9. Peirce D, Hossack S, Poole L, et al. (2011) "The effect of sevelamer carbonate and lanthanum carbonate on the pharmacokinetics of oral calcitriol." Nephrol Dial Transplant, 26, p. 1615-21
  10. Vroonhof K, van Rijn HJM, van Hattum J (2003) "Vitamin K deficiency and bleeding after long-term use of cholestyramine." Neth J Med, 61, p. 19-21
  11. (2024) "Product Information. Rayaldee (calcifediol)." OPKO Pharmaceuticals LLC, SUPPL-13
  12. "Product Information. HIDROFEROL SEMANAL (calcifediol)." FAES FARMA, S.A.
  13. (2023) "Product Information. Domnisol (calcifediol)." Flynn Pharma Ltd
  14. (2025) "Product Information. Vistella (calcifediol)." Aspen Pharmacare Australia Pty Ltd, 2

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

cholestyramine multivitamins with minerals

Applies to: cholestyramine
Adjust dosing interval

Bile acid sequestrants and the phosphate binder, sevelamer, can decrease the absorption of fat-soluble vitamins A, D, E, and K. By binding bile acids, these agents may interfere with normal fat digestion and absorption, thereby preventing the absorption of fat-soluble vitamins. When 8 grams of cholestyramine was administered simultaneously with a normal meal containing 250,000 units of vitamin A acetate in four healthy young adult subjects, plasma vitamin A levels were significantly reduced during a 9-hour postprandial period compared to the values obtained with the control meal. Coadministration with 4 grams of cholestyramine had no significant effect. In a crossover study involving healthy subjects, coadministration of sevelamer with calcitriol resulted in a significant reduction in bioavailability for calcitriol (calcitriol with sevelamer vs calcitriol alone: AUC 137 pg*h/mL vs 318 pg*h/mL and Cmax 40.1 pg/mL vs 49.7 pg/mL, respectively). Chronic use of bile acid sequestrants has been rarely associated with an increased bleeding tendency due to hypoprothrombinemia resulting from vitamin K deficiency. Isolated cases of Vitamin A (including one case of night blindness) and D deficiencies have also been reported with chronic cholestyramine therapy.

Management

When bile acid sequestrants are given for prolonged periods, some manufacturers recommend that concomitant supplementation with water-miscible or parenteral forms of fat-soluble vitamins be considered. If oral vitamin supplements are used with cholestyramine or colestipol, advise patients to take them at least 1 to 2 hours before or 4 to 6 hours after the bile acid sequestrant to minimize the potential impact on their absorption. No recommendations are available for sevelamer, but it may be advisable to follow the same precautions.

References (14)
  1. Gross L, Brotman M (1970) "Hypoprothrombinemia and hemorrhage associated with cholestyramine therapy." Ann Intern Med, 72, p. 95-6
  2. Shojania AM, Grewar D (1986) "Hypoprothrombinemic hemorrhage due to cholestyramine therapy." Can Med Assoc J, 134, p. 609-10
  3. Longstreth GF, Newcomer AD (1975) "Drug-induced malabsorption." Mayo Clin Proc, 50, p. 284-93
  4. Acuna R, Gonzalez Ceron M (1977) "Hypoprothrombinemia and bleeding associated to treatment with cholestyramine (author's transl)." Rev Med Chil, 105, p. 27-8
  5. (2001) "Product Information. Rocaltrol (calcitriol)." Roche Laboratories
  6. (2005) "Product Information. Fosamax Plus D (alendronate-cholecalciferol)." Merck & Co., Inc
  7. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  8. Cerner Multum, Inc. "Australian Product Information."
  9. Peirce D, Hossack S, Poole L, et al. (2011) "The effect of sevelamer carbonate and lanthanum carbonate on the pharmacokinetics of oral calcitriol." Nephrol Dial Transplant, 26, p. 1615-21
  10. Vroonhof K, van Rijn HJM, van Hattum J (2003) "Vitamin K deficiency and bleeding after long-term use of cholestyramine." Neth J Med, 61, p. 19-21
  11. (2024) "Product Information. Rayaldee (calcifediol)." OPKO Pharmaceuticals LLC, SUPPL-13
  12. "Product Information. HIDROFEROL SEMANAL (calcifediol)." FAES FARMA, S.A.
  13. (2023) "Product Information. Domnisol (calcifediol)." Flynn Pharma Ltd
  14. (2025) "Product Information. Vistella (calcifediol)." Aspen Pharmacare Australia Pty Ltd, 2

Disease interactions

15 potential interactions Applies to: 15 conditions, including Vitamin D Deficiency, Constipation, Anemia, Hemorrhoids, and Vitamin A Deficiency.

Anemia

Moderate:

cholestyramine

Cholestyramine has a moderate potential interaction with Anemia.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.

Biliary Obstruction

Major:

cholestyramine

Cholestyramine has a major potential interaction with Biliary Obstruction.

The use of bile acid sequestrants is contraindicated in patients with complete biliary obstruction where bile is not secreted into the intestine. These agents adsorb and combine with bile acids in the intestine to form an insoluble complex that is excreted in the feces, resulting in partial removal of bile acids from the enterohepatic circulation. Bile acid sequestrants are ineffective if bile does not reach the intestine.

Coagulation Defects and Disorders

Moderate:

cholestyramine

Cholestyramine has a moderate potential interaction with Coagulation Defects and Disorders.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.

Constipation

Moderate:

cholestyramine

Cholestyramine has a moderate potential interaction with Constipation.

The use of bile acid sequestrants may produce or worsen preexisting constipation. Constipation associated with these agents may aggravate hemorrhoids. Therapy with bile acid sequestrants should be administered cautiously in patients with preexisting constipation, hemorrhoids, or symptomatic coronary artery disease. The dosage should be increased very gradually according to manufacturer guidelines to minimize the risk of fecal impaction, and patients should be encouraged to increase fluid and fiber intake. Occasional use of a stool softener may also be indicated. If constipation worsens or develops during therapy, or the desired therapeutic response is not achieved at the maximum recommended daily dosage, combination therapy or an alternative agent should be considered.

Dehydration

Moderate:

cholestyramine

Cholestyramine has a moderate potential interaction with Dehydration.

Bile acid sequestrants are chloride forms of anion exchange resins and may produce hyperchloremic acidosis with chronic use. Therapy with bile acid sequestrants should be administered cautiously in patients who may be particularly susceptible, including children or smaller patients and patients with renal impairment or volume depletion.

Folic Acid/Cyanocobalamin Deficiency

Moderate:

cholestyramine

Cholestyramine has a moderate potential interaction with Folic Acid/Cyanocobalamin Deficiency.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.

Hemorrhoids

Moderate:

cholestyramine

Cholestyramine has a moderate potential interaction with Hemorrhoids.

The use of bile acid sequestrants may produce or worsen preexisting constipation. Constipation associated with these agents may aggravate hemorrhoids. Therapy with bile acid sequestrants should be administered cautiously in patients with preexisting constipation, hemorrhoids, or symptomatic coronary artery disease. The dosage should be increased very gradually according to manufacturer guidelines to minimize the risk of fecal impaction, and patients should be encouraged to increase fluid and fiber intake. Occasional use of a stool softener may also be indicated. If constipation worsens or develops during therapy, or the desired therapeutic response is not achieved at the maximum recommended daily dosage, combination therapy or an alternative agent should be considered.

Ischemic Heart Disease

Moderate:

cholestyramine

Cholestyramine has a moderate potential interaction with Ischemic Heart Disease.

The use of bile acid sequestrants may produce or worsen preexisting constipation. Constipation associated with these agents may aggravate hemorrhoids. Therapy with bile acid sequestrants should be administered cautiously in patients with preexisting constipation, hemorrhoids, or symptomatic coronary artery disease. The dosage should be increased very gradually according to manufacturer guidelines to minimize the risk of fecal impaction, and patients should be encouraged to increase fluid and fiber intake. Occasional use of a stool softener may also be indicated. If constipation worsens or develops during therapy, or the desired therapeutic response is not achieved at the maximum recommended daily dosage, combination therapy or an alternative agent should be considered.

Phenylketonuria

Moderate:

cholestyramine

Cholestyramine has a moderate potential interaction with Phenylketonuria.

Questran Light and LoCholest Light (brands of cholestyramine) contain 16.8 mg and 22.4 mg of phenylalanine, respectively, per each dose. Flavored Colestid (brand of colestipol) contains 18.2 mg of phenylalanine per each 7.5-gram dose. WELCHOL (brand name of colesevelam) for Oral Suspension contains 13.5 mg phenylalanine per 1.875 gram dose and 27 mg phenylalanine per 3.75 gram dose. The phenylalanine content should be considered when these products are used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics). Regular Colestid, Questran and LoCholest do not contain phenylalanine.

Renal Dysfunction

Moderate:

cholestyramine

Cholestyramine has a moderate potential interaction with Renal Dysfunction.

Bile acid sequestrants are chloride forms of anion exchange resins and may produce hyperchloremic acidosis with chronic use. Therapy with bile acid sequestrants should be administered cautiously in patients who may be particularly susceptible, including children or smaller patients and patients with renal impairment or volume depletion.

Thrombocytopathy

Moderate:

cholestyramine

Cholestyramine has a moderate potential interaction with Thrombocytopathy.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.

Thrombocytopenia

Moderate:

cholestyramine

Cholestyramine has a moderate potential interaction with Thrombocytopenia.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.

Vitamin A Deficiency

Moderate:

cholestyramine

Cholestyramine has a moderate potential interaction with Vitamin A Deficiency.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.

Vitamin D Deficiency

Moderate:

cholestyramine

Cholestyramine has a moderate potential interaction with Vitamin D Deficiency.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.

Vitamin K Deficiency

Moderate:

cholestyramine

Cholestyramine has a moderate potential interaction with Vitamin K Deficiency.

Bile acid sequestrants may interfere with the absorption of folic acid and fat soluble vitamins such as A, D, and K. Chronic use of bile acid sequestrants may cause increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. Anemia may also occur due to reduced serum or red blood cell folate. Supplementation with oral vitamins and/or folate should be considered during prolonged therapy with bile acid sequestrants, particularly in patients with preexisting vitamin and/or folate deficiencies, anemia, or a bleeding diathesis.

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More resources

cholestyramine

A total of 140 drugs are known to interact with cholestyramine.

T-Lite

A total of 112 drugs are known to interact with T-Lite.

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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