What is the treatment regimen for patients taking Questran (cholestyramine) for high cholesterol levels?

Cholestyramine (Questran) Treatment Regimen for High Cholesterol

The recommended treatment regimen for patients taking Questran (cholestyramine) for high cholesterol is to start with 4 grams once or twice daily, gradually increasing to a maintenance dose of 8-16 grams daily divided into two doses, with a maximum of 24 grams daily. 1

Dosing Schedule and Administration

• Starting dose: 1 pouch or 1 level scoopful (4 grams of anhydrous cholestyramine resin) once or twice daily 1
• Maintenance dose: 2-4 pouches or scoopfuls daily (8-16 grams) divided into two doses 1
• Maximum dose: 6 pouches or scoopfuls daily (24 grams) 1
• Dose adjustments: Increases should be gradual with lipid/lipoprotein assessment at intervals of not less than 4 weeks 1

Proper Administration

• Always mix the dry powder with water or other non-carbonated beverages before ingesting
• Add at least 2-6 ounces of liquid to each dose and stir to a uniform consistency 1
• May also be mixed with highly fluid soups or pulpy fruits with high moisture content (applesauce, crushed pineapple) 1
• Can be taken during meals rather than before meals without loss of efficacy 2

Monitoring and Efficacy

• Baseline lipid profile should be established before starting therapy 3
• Follow-up lipid panels should be performed at 4-6 weeks after initiation and periodically thereafter 1
• Expected LDL-C reduction: approximately 10-20% with monotherapy 3
• Cholestyramine has been shown to reduce risk of coronary heart disease events by 19% in clinical trials 1

Combination Therapy

Cholestyramine is often more effective when combined with other lipid-lowering medications:

• With statins: Enhanced LDL-C lowering effect when combined with HMG-CoA reductase inhibitors 1

  • Low-dose combinations (e.g., 8g cholestyramine + low-dose statin) can achieve 25-30% LDL-C reduction 4

• With ezetimibe: May be considered for patients who don't achieve target LDL-C with statins alone 3

Important Precautions and Drug Interactions

• Drug interactions: Medications with potential interactions should be taken at least 1 hour before or 4-6 hours after cholestyramine to avoid impeding their absorption 3

• Common side effects:

  • Constipation
  • Dyspepsia
  • Nausea
  • Abdominal discomfort 3

• Contraindications:

  • Complete biliary obstruction
  • Hypertriglyceridemia (>500 mg/dL) due to risk of pancreatitis 1

Special Considerations

• Vitamin supplementation: May interfere with absorption of fat-soluble vitamins; supplementation may be necessary, particularly for folate and vitamin D 3

• Triglyceride monitoring: May increase triglyceride levels in some patients; monitor closely 3

• Palatability issues: Poor taste is a common reason for non-compliance; newer formulations like Questran Light may improve adherence while maintaining efficacy 5

Treatment Goals

Treatment goals should be based on cardiovascular risk:

• Very high CV risk patients: LDL-C goal <70 mg/dL or ≥50% reduction 3
• High CV risk patients: LDL-C goal <100 mg/dL or ≥50% reduction 3
• Primary prevention: LDL-C goal based on risk factors and baseline levels 3

Remember that cholestyramine is rarely sufficient as monotherapy to achieve target LDL-C levels in patients with significant hypercholesterolemia, and combination therapy is often required for optimal outcomes 3.