What is the treatment protocol for patients taking Colestid (colestipol) for high cholesterol levels?

Treatment Protocol for Colestid (Colestipol) for High Cholesterol

The recommended treatment protocol for patients taking Colestid (colestipol) for high cholesterol is a dosage of 2-16g/day orally, which can be given once daily or in divided doses, and should be taken with meals and liquid to improve tolerability. 1

Dosing and Administration

• Standard dosage range: 2-16g/day orally 1
• Administration options:
  • Once daily dosing (10g once daily)
  • Divided dosing (e.g., 5g twice daily) 2
  • Take with meals and liquid to improve tolerability 1, 3

Research has shown that colestipol can be effective at various dosing schedules:

• 5g twice daily (morning and evening)
• 10g once daily in the morning
• 10g once daily in the evening 2

All three regimens have demonstrated similar efficacy in reducing LDL cholesterol (17-19% reduction) compared to placebo 2.

Mechanism of Action and Expected Effects

Colestipol works as a non-absorbed, lipid-lowering polymer that:

• Binds bile acids in the intestine and prevents their reabsorption
• Depletes the hepatic bile acid pool, increasing cholesterol conversion to bile acids
• Increases hepatic LDL receptor activity, enhancing LDL clearance from blood 1

Expected Clinical Outcomes

• LDL cholesterol reduction: 16-27% depending on dosage 1
• Total cholesterol reduction: 10-12% 2
• HDL cholesterol effect: Small increase (4-7%) 2
• Triglycerides: May increase or remain unchanged 1, 4

Long-term studies have shown sustained cholesterol reduction of 19-23% over multiple years of treatment 5.

Drug Interactions and Timing Considerations

Important precaution: Colestipol can bind to and reduce absorption of many medications. All other medications should be taken:

• At least 1 hour before colestipol, OR
• At least 4 hours after colestipol 1, 3

This is particularly important for medications like:

• Warfarin (decreased INR)
• Phenytoin (decreased levels)
• Thyroid hormone replacement (increased TSH)
• Other lipid-lowering agents 1

Monitoring Parameters

• Baseline lipid profile before starting treatment
• Follow-up lipid profile 4-6 weeks after initiation
• Periodic determinations of serum cholesterol levels as outlined in the National Cholesterol Education Program (NCEP) guidelines 4
• Monitor for constipation and other gastrointestinal side effects
• If combined with statins, monitor liver enzymes

Side Effects Management

Common side effects include:

• Constipation (most common) 5
• Dyspepsia and nausea
• Bloating/meteorism 6

Management strategies:

• Ensure adequate fluid intake
• Gradually increase dose to improve tolerance
• Consider stool softeners if constipation is problematic
• Start with lower doses and titrate up as tolerated

Combination Therapy

For enhanced LDL reduction, colestipol can be combined with:

• Statins (additional 10-16% LDL reduction) 1
• Niacin 4
• Ezetimibe 1

Special Populations

• Pediatric use: Colesevelam (another bile acid sequestrant) is indicated for boys and postmenarcheal girls aged 10-17 years with familial hypercholesterolemia 1
• Homozygous familial hypercholesterolemia: Higher doses (up to 30g/day) may be used 6

Treatment Duration

Colestipol is typically prescribed for long-term use. Studies have demonstrated safety and efficacy for treatment periods of 5-7.5 years 5, 7.

Remember that when colestipol is discontinued, serum cholesterol levels usually return to baseline within one month 4.