From the Guidelines
Yes, Cholestyramine (Questran) can cause diarrhea.
Side Effects of Cholestyramine
- The most common side effects of cholestyramine include abdominal bloating and pain, dyspepsia, nausea/vomiting, flatulence, borborygmi, abdominal distension, constipation, and increased severity of diarrhea 1.
- In some cases, cholestyramine can exacerbate diarrhea, particularly in patients with extensive ileal resection, leading to an increased rate of steatorrhea 1.
Evidence of Diarrhea as a Side Effect
- A systematic review and meta-analysis found that 44% of patients with bile acid diarrhea failed to respond to cholestyramine alone, and some patients experienced worsening of diarrhea 1.
- A study found that 11% of patients found cholestyramine intolerable due to side effects, including increased severity of diarrhea 1.
Clinical Considerations
- The risk of steatorrhea and worsening diarrhea should be carefully considered when prescribing cholestyramine, particularly in patients with extensive ileal resection 1.
- Patients should be evaluated on a case-by-case basis, and the benefits and risks of cholestyramine therapy should be weighed carefully 1.
From the FDA Drug Label
The most common adverse reaction is constipation... Less Frequent Adverse Reactions - ... diarrhea,
- Diarrhea is listed as a less frequent adverse reaction to Cholestyramine (Questran) 2.
- Diarrhea can occur as a side effect of this medication.
From the Research
Cholestyramine and Diarrhea
- Cholestyramine is a bile acid binder used to treat bile acid malabsorption, which can cause chronic, watery diarrhea 3.
- In patients with mild to moderate bile acid malabsorption, cholestyramine can be effective in abolishing diarrhea 3.
- However, in patients with more severe bile acid malabsorption, cholestyramine may not be beneficial and can even worsen steatorrhea 3.
- Studies have shown that cholestyramine can be effective in treating diarrhea in patients with bile acid malabsorption, with response rates ranging from 72% to 79% 4, 5, 6, 7.
- The SeHCAT test can be used to diagnose bile acid malabsorption and predict response to cholestyramine treatment 4, 5, 6, 7.
Potential for Cholestyramine to Cause Diarrhea
- There is no direct evidence to suggest that cholestyramine causes diarrhea in the provided studies.
- However, it is noted that cholestyramine may worsen steatorrhea in patients with severe bile acid malabsorption 3.
- It is possible that cholestyramine may have different effects on different patients, and more research may be needed to fully understand its potential to cause diarrhea.