Skip to main content

Cholestyramine (Monograph)

Brand names: Prevalite, Questran, Questran Light
Drug class: Bile Acid Sequestrants
VA class: CV350
CAS number: 11041-12-6

Medically reviewed by Drugs.com on Jul 16, 2024. Written by ASHP.

Introduction

Antilipemic agent; bile acid sequestrant.100

Uses for Cholestyramine

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.100

As effective as colestipol in lowering serum cholesterol concentrations.b Select bile acid sequestrant based on patient tolerance, including palatability and taste preference, and cost.148 181

AHA/ACC cholesterol management guideline states that lifestyle modification is the foundation of cardiovascular risk reduction.400 If pharmacologic therapy is needed, statins are first-line drugs of choice because of their demonstrated benefits in reducing risk of ASCVD.400 The addition of a nonstatin drug (e.g., ezetimibe, bile acid sequestrants, PCSK9 inhibitor) may be considered in certain circumstances such as in patients with very severe elevations of LDL-cholesterol concentrations who are not achieving adequate LDL lowering with maximally tolerated statin therapy.400

Pruritus Associated with Partial Cholestasis

Relief of pruritus associated with partial cholestasis.100 Effects on serum cholesterol in these patients is variable.100

Cholestyramine Dosage and Administration

General

Monitoring during Antilipemic Therapy

Administration

Oral Administration

Administer orally at mealtime.100

Do not administer the powder in its dry form; always mix with water or other fluids before ingesting.100 187 188

Mix cholestyramine powder for oral suspension with an adequate amount (60–180 mL for 1 packet or level scoop of powder) of a liquid (e.g., water, fruit juice, other noncarbonated beverage) and stir to uniform consistency.100 186 187 188

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.127

Use of a heavy or pulpy fruit juice may minimize complaints about consistency of suspensions of the drug.148

If a carbonated beverage is used, mix the powder slowly in a large glass to minimize excessive foaming.b To minimize excessive swallowing of air, advise patients to avoid rapid ingestion of suspensions of the drug.148

Alternatively, mix cholestyramine powder with a highly fluid soup or a pulpy fruit with a high moisture content such as applesauce or crushed pineapple.100 157 173

Instruct patients to take other drugs at least 1 hour before or 4–6 hours after taking cholestyramine to minimize possible interference with absorption.100 157 173 187 188 (See Effects on GI Absorption of Drugs under Interactions.)

Dosage

Available as cholestyramine resin; dosage expressed in terms of anhydrous (i.e., dried) cholestyramine resin.100

Each 9 g of Questran100 or generic cholestyramine (1 dose, 1 packet, or 1 level scoop),188 5.5 g of Prevalite (1 dose, 1 packet, or 1 level scoop),187 or 5 g of Questran Light100 or generic cholestyramine light (1 dose, 1 packet, or 1 level scoop)188 contains about 4 g of anhydrous cholestyramine resin.100 187 188

In calculating pediatric dosages, each 100 mg of the commercially available powders contains either 44.4 mg (e.g., Questran, generic cholestyramine), 72.7 mg (e.g., Prevalite), or 80 mg (e.g., Questran Light, generic cholestyramine light) of anhydrous cholestyramine resin.100 187 188

Pediatric Patients

Dyslipidemias† [off-label]
Oral

240 mg/kg daily in 2–3 divided doses suggested by manufacturers and some clinicians.100 187 188 c

Adults

Dyslipidemias or Pruritus Associated with Partial Cholestasis
Oral

Initially, 4 g of anhydrous resin (1 packet or 1 level scoop) once or twice daily at mealtime.100 187 188

Increase dosage gradually to minimize adverse GI effects (e.g., fecal impaction).100 187 188

Usual maintenance dosage recommended by manufacturers is 8–16 g daily, given in 2 divided doses.100 187 188 Usual dosage range suggested by Third Report of the National Cholesterol Education Program (NCEP) (Adult Treatment Panel [ATP] III) is 4–16 g daily.186

Although the recommended dosing schedule is twice daily, may be administered in 1–6 doses per day.100 187 188

In patients with preexisting constipation: Initially, 4 g of anhydrous resin (1 packet or 1 level scoop) once daily for 5–7 days; then increase dosage to 4 g twice daily and monitor constipation and serum lipoprotein values, at least twice, 4–6 weeks apart.100 187 188 Thereafter, increase dosage as needed by 1 dose (i.e., 4 g) per day (at monthly intervals) with periodic monitoring of serum lipoprotein values.100 187 188

If constipation worsens or the desired effect is not achieved with acceptable adverse effects with the usual dosage of 1–6 doses (i.e., 4–24 g) per day, consider combined therapy or alternative treatment.100 187 188

Prescribing Limits

Pediatric Patients

Oral

Maximum 8 g daily.100 187 188

Adults

Oral

Maximum 24 g (6 packets or 6 level scoops) daily.100 187 188

Detailed Cholestyramine dosage information

Cautions for Cholestyramine

Contraindications

Warnings/Precautions

Warnings

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 each 5-g dose of Questran Light, 5-g dose of generic cholestyramine light, or 5.5-g dose of Prevalite contains aspartame (NutraSweet), which is metabolized in the GI tract to provide about 14, 14, or 14.1 mg, respectively, of phenylalanine following oral administration.100 187 188

Major Toxicities

GI Effects

Mild constipation has occurred, especially after high doses and in patients >60 years of age.100 Exacerbation of preexisting constipation and aggravation of hemorrhoids secondary to constipation may occur.100

Encourage increased fluid and fiber intake to alleviate constipation;100 a stool softener can be added if necessary.100 In addition, adjust dosage carefully and titrate slowly to minimize adverse GI effects (e.g., fecal impaction).100 (See Dosage under Dosage and Administration.)

Make particular effort to avoid constipation in patients with symptomatic CHD.100 167

Discontinuance of cholestyramine therapy may be required in some patients.100

Abdominal discomfort and/or pain, flatulence, nausea, vomiting, diarrhea, eructation, anorexia, biliary colic, and steatorrhea also reported.100 Intestinal obstruction, which rarely has been fatal, reported in pediatric patients.100

General Precautions

Hypertriglyceridemia

Use with caution in patients with baseline triglyceride concentrations of 250-299 mg/dL; discontinue when triglyceride concentrations <400 mg/dL.

Do not use in patients with baseline fasting triglyceride concentrations ≤300 mg/dL or in those with primary dysbetalipoproteinemia (Frederickson type III).

Fat-soluble Vitamin Deficiency

May interfere with the absorption of fat-soluble vitamins (e.g., vitamins A, D, E, K).100 Bleeding tendency due to hypoprothrombinemia secondary to vitamin K deficiency, night blindness secondary to vitamin A deficiency, and vitamin D deficiency have been reported.100 (See Specific Drugs under Interactions.)

Hyperchloremic Acidosis

Because cholestyramine is the chloride form of an anion-exchange resin, there is a possibility that prolonged use may lead to the development of hyperchloremic acidosis.100 Hyperchloremic acidosis reported in children.100

Caution during long-term therapy in patients with renal impairment or volume depletion and in patients receiving concomitant spironolactone.100 187 188

Specific Populations

Pregnancy

Category C.100 187 188

Interferes with absorption of fat-soluble vitamins, and regular prenatal supplementation may not be adequate.100 187 188 (See Specific Drugs under Interactions.)

Lactation

Use with caution; possible lack of proper vitamin absorption associated with cholestyramine therapy may have an effect on nursing infants.100

Pediatric Use

Safety and efficacy of long-term administration not established.100 The potential effect of cholestyramine on vitamin absorption and on electrolytes should be considered.100 116 117 118 119 120 121 122 123 124 125 157 173 181

Common Adverse Effects

Constipation, osteoporosis, rash, irritation of the skin/tongue/perianal area.100

Drug Interactions

Effects on GI Absorption of Drugs

May bind to a number of drugs (e.g., phenylbutazone, warfarin, propranolol, tetracycline, penicillin G, phenobarbital, thyroid and thyroxine preparations, estrogens and progestins, digoxin, iron salts, loperamide) in the GI tract and may delay or reduce their absorption.100 Instruct patients to administer other drugs at least 1 hour before or 4–6 hours after cholestyramine (or allow as long a time interval as possible between ingestion of other drugs and cholestyramine).100

May interfere with the pharmacokinetics of drugs that undergo enterohepatic circulation.100

Consider the possibility that discontinuance of cholestyramine in patients stabilized on potentially toxic drugs that bind to the resin may lead to toxicity and that administration of cholestyramine to patients stabilized on other drugs may reduce the effect of these drugs.100

Specific Drugs

Drug

Interaction

Comments

Amiodarone

Decreased elimination half-life and plasma concentrations of amiodarone139 147

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

Decreased absorption of fat-soluble vitamins100

Consider supplemental administration of water-miscible (or parenteral) forms of fat-soluble vitamins if cholestyramine is to be given for a prolonged period.100

Bleeding secondary to vitamin K deficiency usually responds promptly to parenteral administration of phytonadione; recurrences can be prevented by oral administration of phytonadione100

Phosphate supplements, oral

Other bile acid binding resins reported to interfere with the absorption of oral phosphate supplements100

Propranolol

May decrease GI absorption of propranolol100 144 157 173 180

When cholestyramine therapy is initiated or discontinued in patients receiving oral propranolol, dosage adjustment of the β-adrenergic blocking agent may be necessary144 146

Thiazide diuretics (e.g., chlorothiazide, hydrochlorothiazide)

May decrease GI absorption of diuretic100 140 141 142 143
Cholestyramine drug interactions (more detail)

Cholestyramine Pharmacokinetics

Absorption

Bioavailability

Not absorbed from the GI tract.100

Onset

Antilipemic response usually occurs within 1 month.100 In patients with pruritus associated with partial cholestasis, relief of pruritus usually occurs within 1–3 weeks after initiation of therapy.b

Elimination

Elimination Route

Binds to bile acids in the intestine and forms a nonabsorbable complex that is excreted in feces.100

Stability

Storage

Oral

Powder for Oral Suspension

20–25°C (may be exposed to 15–30°C).100 187 188

Actions and Spectrum

Advice to Patients

Preparations

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

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

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

Cholestyramine Resin

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

For suspension

4 g (of dried cholestyramine resin) per 9 g*

Cholestyramine

Questran

Par

4 g (of dried cholestyramine resin) per 5.5 g

Prevalite

Upsher-Smith

4 g (of dried cholestyramine resin) per 5 g*

Cholestyramine Light

Questran Light

Par

AHFS DI Essentials™. © Copyright 2025, Selected Revisions July 26, 2021. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

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

References

100. Par Pharmaceutical Companies, Inc. Questran Powder (cholestyramine for oral suspension) and Questran Light (cholestyramine for oral suspension) prescribing information. Spring Valley, NY; 2005 Feb.

101. 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. https://pubmed.ncbi.nlm.nih.gov/6361299

102. 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. https://pubmed.ncbi.nlm.nih.gov/6361300

103. Anon. Addition to labeling of cholestyramine. FDA Drug Bull. 1985; 15:7-8. https://pubmed.ncbi.nlm.nih.gov/3858190

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

105. Rahimtoola SH. Cholesterol and coronary heart disease: a perspective. JAMA. 1985; 253:2094-5. https://pubmed.ncbi.nlm.nih.gov/3974101

106. 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. https://pubmed.ncbi.nlm.nih.gov/6713610

107. Detre KM, Levy RI, Kelsey SF et al. Secondary prevention and lipid lowering: results and implications. Am Heart J. 1985; 110:1123-7. https://pubmed.ncbi.nlm.nih.gov/3904378

108. Glueck CJ. Nonpharmacologic and pharmacologic alteration of high-density lipoprotein cholesterol: therapeutic approaches to prevention of atherosclerosis. Am Heart J. 1985; 110:1107-15. https://pubmed.ncbi.nlm.nih.gov/2865887

109. Kronmal RA. Commentary on the published results of the lipid research clinics coronary primary prevention trial. JAMA. 1985; 253:2091-3. https://pubmed.ncbi.nlm.nih.gov/3883022

110. Oliver MF. Hypercholesterolaemia and coronary heart disease: an answer. BMJ. 1984; 288:423-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1444755/ https://pubmed.ncbi.nlm.nih.gov/6419948

111. Brensike JF, Levy RI, Kelsey SF et al. Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: results of the NHLBI Type II Coronary Intervention Study. Circulation. 1984; 69:313-24. https://pubmed.ncbi.nlm.nih.gov/6360414

112. Levy RI, Brensike JF, Epstein SE et al. The influence of changes in lipid values induced by cholestyramine and diet on progression of coronary artery disease: results of the NHLBI Type II Coronary Intervention Study. Circulation. 1984; 69:325-37. https://pubmed.ncbi.nlm.nih.gov/6360415

113. American Medical Association Council on Scientific Affairs. Dietary and pharmacologic therapy for the lipid risk factors. JAMA. 1983; 250:1873-9. https://pubmed.ncbi.nlm.nih.gov/6620484

114. Garrettson LK, Guzelian PS, Blanke RV. Subacute chlordane poisoning. J Toxicol Clin Toxicol. 1984-85; 22:565-71.

115. Rubenstein C, Romhilt D, Segal P et al. Dyslipoproteinemias and manifestations of coronary heart disease: the Lipid Research Clinics Program Prevalence Study. Circulation. 1986; 73(Suppl I):I-91-9.

116. West RJ, Lloyd JK. Long-term follow-up of children with familial hypercholesterolaemia treated with cholestyramine. Lancet. 1980; 2:873-5. https://pubmed.ncbi.nlm.nih.gov/6107543

117. Glueck CJ. Therapy of familial and acquired hyperlipoproteinemia in children and adolescents. Prev Med. 1983; 12:835-47. https://pubmed.ncbi.nlm.nih.gov/6676731

118. 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. https://pubmed.ncbi.nlm.nih.gov/6676732

119. Glueck CJ, Tsang RC, Fallat RW et al. Therapy of familial hypercholesterolemia in childhood: diet and cholestyramine resin for 24 to 36 months. Pediatrics. 1977; 59:433-41. https://pubmed.ncbi.nlm.nih.gov/840563

120. Glueck CJ, Fallat R, Tsang R. Pediatric familial type II hyperlipoproteinemia: therapy with diet and cholestyramine resin. Pediatrics. 1973; 52:669-79. https://pubmed.ncbi.nlm.nih.gov/4355362

121. Glueck CJ, Tsang RC, Fallat RW et al. Plasma vitamin A and E levels in children with familial type II hyperlipoproteinemia during therapy with diet and cholestyramine resin. Pediatrics. 1974; 54:51-5. https://pubmed.ncbi.nlm.nih.gov/4365953

122. West RJ, Lloyd JK. The effect of cholestyramine on intestinal absorption. Gut. 1975; 16:93-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1410988/ https://pubmed.ncbi.nlm.nih.gov/1168607

123. Glueck CJ. Pediatric primary prevention of atherosclerosis. N Engl J Med. 1986; 314:175-7. https://pubmed.ncbi.nlm.nih.gov/3941697

124. Farah JR, Kwiterovich PO, Neill CA. Dose-effect relationship of cholestyramine in children and young adults with familial hypercholesterolaemia. Lancet. 1977; 1:59-63. https://pubmed.ncbi.nlm.nih.gov/63709

125. Levy RI, Rifkind BM. Diagnosis and management of hyperlipoproteinemia in infants and children. Am J Cardiol. 1973; 31:547-56. https://pubmed.ncbi.nlm.nih.gov/4348998

126. 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. https://pubmed.ncbi.nlm.nih.gov/6676727

127. Hoeg JM, Gregg RE, Brewer HB. An approach to the management of hyperlipoproteinemia. JAMA. 1986; 255:512-21. https://pubmed.ncbi.nlm.nih.gov/3510334

128. National Institutes of Health Office of Medical Applications of Research. Consensus conference: treatment of hypertriglyceridemia. JAMA. 251:1196-200.

129. Forman MB, Baker SG, Mieny CJ et al. Treatment of homozygous familial hypercholesterolaemia with portacaval shunt. Atherosclerosis. 1982; 41:349-61. https://pubmed.ncbi.nlm.nih.gov/7066082

130. Thompson GR, Lowenthal R, Myant NB. Plasma exchange in the management of homozygous familial hypercholesterolaemia. Lancet. 1975; 1:1208-11. https://pubmed.ncbi.nlm.nih.gov/48833

131. Postiglione A, Thompson GR. Experience with plasma-exchange in homozygous familial hypercholesterolaemia. Prog Clin Biol Res. 1985; 188:213-20. https://pubmed.ncbi.nlm.nih.gov/3903770

132. Starzl TE, Chase HP, Ahrens EH Jr et al. Portacaval shunt in patients with familial hypercholesterolemia. Ann Surg. 1983; 198:273-83. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1353292/ https://pubmed.ncbi.nlm.nih.gov/6615051

133. King MEE, Breslow JL, Lees RS. Plasma-exchange therapy of homozygous familial hypercholesterolemia. N Engl J Med. 1980; 302:1457-9. https://pubmed.ncbi.nlm.nih.gov/7374711

134. 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. https://pubmed.ncbi.nlm.nih.gov/4057999

135. Schaefer EJ, Levy RI. Pathogenesis and management of lipoprotein disorders. N Engl J Med. 1985; 312:1300-10. https://pubmed.ncbi.nlm.nih.gov/3887163

136. 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2975980/ https://pubmed.ncbi.nlm.nih.gov/6390206

137. 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. https://pubmed.ncbi.nlm.nih.gov/3779908

138. Gordon DJ, Knoke J, Probstfield JL et al. High-density lipoprotein cholesterol and coronary heart disease in hypercholesterolemic men: the Lipid Research Clinics Coronary Primary Prevention Trial. Circulation. 1986; 74:1217-25. https://pubmed.ncbi.nlm.nih.gov/3536151

139. Nitsch J, Lüderitz B. Beschleunigte Elimination von Amiodaron durch Colestyramin. (German; with English abstract.) Deutsche Med Wochenschr. 1986; 111:1241-4.

140. Hunninghake DB, Hibbard DM. Influence of time intervals for cholestyramine dosing on the absorption of hydrochlorothiazide. Clin Pharmacol Ther. 1986; 39:329-34. https://pubmed.ncbi.nlm.nih.gov/3948472

141. Hunninghake DB, King S, LaCroix K. The effect of cholestyramine and colestipol on the absorption of hydrochlorothiazide. Int J Clin Pharmacol Ther Toxicol. 1982; 20:151-4. https://pubmed.ncbi.nlm.nih.gov/7076343

142. Mangini RJ, ed. Drug interaction facts. St. Louis: JB Lippincott Co; 1984(Jul):583.

143. Hansten PD. Drug interactions. 5th ed. Philadelphia: Lea & Febiger; 1985:295.

144. Hibbard DM, Peters JR, Hunninghake DB. Effects of cholestyramine and colestipol on the plasma concentrations of propranolol. Br J Clin Pharmacol. 1984; 18:337-42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1463656/ https://pubmed.ncbi.nlm.nih.gov/6487473

145. Schwartz DE, Schaeffer E, Brewer HB et al. Bioavailability of propranolol following administration of cholestyramine. Clin Pharmacol Ther. 1982; 31:268.

146. Mangini RJ, ed. Drug interaction facts. St. Louis: JB Lippincott Co; 1985(Jan):109a.

147. Hansten PD, Horn JR, eds. Amiodarone drug interactions. Drug Interact Newsl. 1987; 7:13-6.

148. 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. https://pubmed.ncbi.nlm.nih.gov/3422148

149. Bilheimer DW. Familial hypercholesterolemia: there is a need for early detection and treatment. JAMA. 1987; 257:69-70. https://pubmed.ncbi.nlm.nih.gov/3783906

150. Vega GL, Grundy SM. Treatment of primary moderate hypercholesterolemia with lovastatin (mevinolin) and colestipol. JAMA. 1987; 257:33-8. https://pubmed.ncbi.nlm.nih.gov/3537351

151. Witztum JL. Intensive drug therapy of hypercholesterolemia. Am Heart J. 1987; 113(2 Part 2):603-9. https://pubmed.ncbi.nlm.nih.gov/3544777

152. 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. https://pubmed.ncbi.nlm.nih.gov/3295315

153. Illingworth DR. Mevinolin plus colestipol in therapy for severe heterozygous familial hypercholesterolemia. Ann Intern Med. 1984; 101:598-604. https://pubmed.ncbi.nlm.nih.gov/6567462

154. 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. https://pubmed.ncbi.nlm.nih.gov/6828091

155. 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. https://pubmed.ncbi.nlm.nih.gov/3662275

156. 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. https://pubmed.ncbi.nlm.nih.gov/7003391

157. Parke-Davis. Cholybar (Cholestyramine resin bar) prescribing information. In: Barnhart ER, publisher. Physicians’ desk reference. 45th ed. Oradell, NJ: Medical Economics Company Inc; 1991:1637-8.

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

159. 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.

160. Tobert JA. New developments in lipid-lowering therapy: the role of inhibitors of hydroxymethylglutaryl-coenzyme A reductase. Circulation. 1987; 76:534-8. https://pubmed.ncbi.nlm.nih.gov/3113763

161. 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.

162. Goldstein JL, Brown MS. The low-density lipoprotein pathway and its relation to atherosclerosis. Ann Rev Biochem. 1977; 46:897-930. https://pubmed.ncbi.nlm.nih.gov/197883

163. Brown MS, Goldstein JL. Lipoprotein receptors in the liver: control signals for plasma cholesterol traffic. J Clin Invest. 1983; 72:743-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1129238/ https://pubmed.ncbi.nlm.nih.gov/6309907

164. 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.

165. 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. https://pubmed.ncbi.nlm.nih.gov/3640503

166. 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. https://pubmed.ncbi.nlm.nih.gov/3534334

167. Grundy SM. HMG-CoA reductase inhibitors for treatment of hypercholesterolemia. N Engl J Med. 1988; 319:24-33. https://pubmed.ncbi.nlm.nih.gov/3288867

168. 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC393420/ https://pubmed.ncbi.nlm.nih.gov/6572906

169. 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. https://pubmed.ncbi.nlm.nih.gov/6775065

170. Graisely B, Cloarec M, Salmon S et al. Extracorporeal plasma therapy for homozygous familial hypercholesterolaemia. Lancet. 1980; 2:1147. https://pubmed.ncbi.nlm.nih.gov/6107765

171. Stoffel W, Borberg H, Greve V. Application of specific extracorporeal removal of low density lipoprotein in familial hypercholesterolaemia. Lancet. 1981; 2:1005-7. https://pubmed.ncbi.nlm.nih.gov/6118475

172. Thompson GR, Miller JP, Breslow JL. Improved survival of patients with homozygous familial hypercholesterolaemia treated with plasma exchange. BMJ. 1985; 291:1671-3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1418783/ https://pubmed.ncbi.nlm.nih.gov/3935235

173. Bristol Laboratories, Div. of Bristol-Myers Co. Questran Light (cholestyramine for oral suspension) prescribing information. Evansville, IN; 1988 Feb.

174. Gossel TA. A review of aspartame: characteristics, safety and uses. US Pharm. 1984; 9:26,28-30.

175. Food and Drug Administration. Asparatame as an inactive ingredient in human drug products; labeling requirements. Proposed rule. [21 CFR Part 201] Fed Regist. 1983; 48:54993-5. (IDIS 178728)

176. Food and Drug Administration. Food additives permitted for direct addition to food for human consumption; aspartame. Final rule. [21 CFR Part 172] Fed Regist. 1983; 48:31376-82. (IDIS 172957)

177. Anon. Aspartame and other sweeteners. Med Lett Drugs Ther. 1982; 24:1-2. https://pubmed.ncbi.nlm.nih.gov/7054648

178. American Medical Association Council on Scientific Affairs. Aspartame: review of safety issues. JAMA. 1985; 254:400-2. https://pubmed.ncbi.nlm.nih.gov/2861297

179. American Heart Association. AHA conference report on cholesterol. Circulation. 1989; 80:715-48. https://pubmed.ncbi.nlm.nih.gov/2670320

180. Parke-Davis. Cholybar (cholestyramine resin bar) prescribing information. In: Physician’s desk reference. 45th ed. Medical Economics Company Inc. Oradell, NJ: 1991 (Suppl A):A41.

181. 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. https://pubmed.ncbi.nlm.nih.gov/1538956

182. American Academy of Pediatrics Committee on Nutrition. Statement on cholesterol. Pediatrics. 1992; 90:469-73. https://pubmed.ncbi.nlm.nih.gov/1518712

183. 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.

184. 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. https://pubmed.ncbi.nlm.nih.gov/11368702

185. Anon. Choice of lipid-regulating drugs. Med Lett Drugs Ther. 2001; 43:43-8. https://pubmed.ncbi.nlm.nih.gov/11378632

186. 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. http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm

187. Upsher Smith. Prevalite (cholestyramine for oral suspension) prescribing information. Minneapolis, MN; 2001 Jun.

188. Par Pharmaceutical Companies, Inc. Cholestyramine powder (cholestyramine for oral suspension) and Cholestyramine Light (cholestyramine for oral suspension) prescribing information. Spring Valley, NY; 2005 Feb.

352. Eckel RH, Jakicic JM, Ard JD et al. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63:2960-84. https://pubmed.ncbi.nlm.nih.gov/24239922

357. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011; 128 Suppl 5:S213-56. https://pubmed.ncbi.nlm.nih.gov/22084329

400. Grundy SM, Stone NJ, Bailey AL et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019; 139:e1082-e1143. https://www.ncbi.nlm.nih.gov/pmc/articles/PMCPMC7403606/ https://pubmed.ncbi.nlm.nih.gov/30586774

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

c. Medications. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson textbook of pediatrics. 16th ed. Philadelphia: WB Saunders Company; 2000:2247.

Medical Disclaimer