Cholestyramine Side Effects
More frequently reported side effects include: heartburn, constipation, dyspepsia, nausea, vomiting, and stomach pain. See below for a comprehensive list of adverse effects.
For the Consumer
Applies to cholestyramine: oral powder for suspension, oral tablet
In some animal studies, cholestyramine was found to cause tumors. It is not known whether cholestyramine causes tumors in humans.
In addition to its needed effects, some unwanted effects may be caused by cholestyramine. In the event that any of these side effects do occur, they may require medical attention.
You should check with your doctor immediately if any of these side effects occur when taking cholestyramine:Rare:
- Black, tarry stools
- stomach pain (severe) with nausea and vomiting
If any of the following side effects occur while taking cholestyramine, check with your doctor or nurse as soon as possible:More common:
- Loss of weight (sudden)
Some of the side effects that can occur with cholestyramine may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:More common:
- Heartburn or indigestion
- nausea or vomiting
- stomach pain
For Healthcare Professionals
Applies to cholestyramine: compounding powder, oral powder for reconstitution
Gastrointestinal side effects include constipation (28%), heartburn (17%), belching or bloating (11%), nausea (9%), eructation, anorexia, steatorrhea, hemorrhoids, rectal pain and irritation, diverticulitis, and bleeding from a known duodenal ulcer. Intestinal obstruction and pancreatitis are also reported in the literature.[Ref]
Gastrointestinal side effects occur in the majority of patients treated with cholestyramine. Constipation is most common and can be severe. Intestinal obstruction has been reported in pediatric patients. Elderly patients are probably at risk for this as well. In one large study, gastrointestinal side effects diminished with continued therapy. If gastrointestinal side effects are significant, dosage reductions, even if temporary, may be beneficial.[Ref]
Metabolic side effects include hyperchloremic metabolic acidosis, weight loss, and weight gain. Cholestyramine has been reported to decrease the absorption of thyroxine (T4).[Ref]
Hyperchloremic metabolic acidosis has been reported in pediatric as well as adult patients. Onset of clinical illness ranged from days to several weeks after beginning cholestyramine therapy. In three out of four adult cases in the literature, spironolactone was used as concomitant therapy. Several patients had moderate underlying renal disease. With appropriate supportive care, correction of the acidosis, and discontinuation of cholestyramine, the patients recovered.
The mechanism by which cholestyramine causes metabolic acidosis has not been completely resolved. However, it may involve the release of chloride ions by cholestyramine (a chloride salt form) in addition to binding of bicarbonate and carbonate ions to the resin, creating a metabolic imbalance. Patients with impaired renal function may be at increased risk due to impairment of chloride elimination.[Ref]
Hematologic side effects include rare cases of elevated prothrombin time, ecchymoses, and anemia.[Ref]
Hepatic side effects of cholestyramine include rare cases of abnormal liver function tests although causality is unknown. In addition, calcification in the right upper quadrant and of the biliary tree has been reported, as has biliary colic.[Ref]
Respiratory side effects include asthma, wheezing, and shortness of breath although causality is unknown.[Ref]
Nervous system side effects include headache, anxiety, vertigo, dizziness, syncope, drowsiness, femoral nerve pain, and paresthesia although causality is unknown.[Ref]
Renal side effects include hematuria, dysuria, burnt odor to the urine, and diuresis, as well as a case report of urethral calculi composed of uric acid.[Ref]
Hypersensitivity in the form of urticaria has been reported.[Ref]
Musculoskeletal side effects include osteoporosis, muscle and joint pain, muscle weakness, arthritis, and osteomalacia.[Ref]
Loss of dental enamel has been reported when cholestyramine was mixed with a relatively acidic liquid (in the case-report Kool-Aid was used).[Ref]
Ocular side effects include uveitis although causality is unknown.[Ref]
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2. "Product Information. Questran (cholestyramine)." Bristol-Myers Squibb, Princeton, NJ.
3. LaRosa J "Review of clinical studies of bile acid sequestrants for lowering plasma lipid levels." Cardiology 76 (1989): 55-61;
4. Cohen MI, Winslow PR, Boley SJ "Intestinal obstruction associated with cholestyramine therapy." N Engl J Med 280 (1969): 1285-6
5. Faergeman O "Effects and side-effects of treatment of hypercholesterolemia with cholestyramine and neomycin." Acta Med Scand 194 (1973): 165-7
6. Kleinman PK "Letter: Cholestyramine and metabolic acidosis." N Engl J Med 290 (1974): 861
7. Surks MI, Sievert R "Drugs and thyroid function." N Engl J Med 333 (1995): 1688-94
8. Scheel PJ Jr, Whelton A, Rossiter K, Watson A "Cholestyramine-induced hyperchloremic metabolic acidosis." J Clin Pharmacol 32 (1992): 536-8
9. Hartline JV "Letter: Hyperchloremia, metabolic acidosis, and cholestyramine." J Pediatr 89 (1976): 155
10. Eaves ER, Korman MG "Cholestyramine induced hyperchloremic metabolic acidosis." Aust N Z J Med 14 (1984): 670-2
11. Clouston WM, Lloyd HM "Cholestyramine induced hyperchloremic metabolic acidosis ." Aust N Z J Med 15 (1985): 271
12. Gross L, Brotman M "Hypoprothrombinemia and hemorrhage associated with cholestyramine therapy." Ann Intern Med 72 (1970): 95-6
13. Wells RF, Knepshield JH, Davis C "Right upper quadrant calcification in a patient receiving long-term cholestyramine therapy for primary biliary cirrhosis." Am J Dig Dis 13 (1968): 86-94
14. Courtney SP, Wightman JA "Urethral calculi caused by cholestyramine." Br J Urol 68 (1991): 654
15. Heaton KW, Lever JV, Barnard D "Osteomalacia associated with cholestyramine therapy for postileectomy diarrhea." Gastroenterology 62 (1972): 642-6
16. Curtis DM, Driscoll DJ, Goldman DH, Weidman WH "Loss of dental enamel in a patient taking cholestyramine." Mayo Clin Proc 66 (1991): 1131
Not all side effects for cholestyramine may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.
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