Colestipol Dosing for Diarrhea Management
For diarrhea management, colestipol should be initiated at 1 gram twice daily, with gradual titration by increasing 1 gram per day every other day, up to a maximum of 16 grams daily (tablets) or 30 grams daily (granules). 1
Initial Dosing and Titration
- Colestipol granules should be started at 5 grams once or twice daily, while tablets should be started at 2 grams once or twice daily 1
- Gradual dose titration is essential to minimize side effects and improve tolerance 1
- For diarrhea specifically, an open-label study used a starting dose of 1 gram twice daily with an increase of 1 gram per day every other day 1
- Dose increases should occur no more frequently than once per month according to product labeling 1, 2
Maximum Dosing
- Maximum daily dose for colestipol tablets is 16 grams 1
- Maximum daily dose for colestipol granules is 30 grams 1, 2
- Doses should be divided throughout the day for better tolerance 2
Administration Guidelines
- Colestipol should never be taken in dry form to avoid esophageal distress 2
- Always mix colestipol with water or other beverages before ingestion 2
- Can be mixed with:
- Water or other beverages (at least 3 ounces)
- Soups with high fluid content
- Cereals with milk
- Pulpy fruits such as crushed pineapple, pears, or peaches 2
- Other medications should be taken at least one hour before or four hours after colestipol to minimize interference with absorption 2
Special Considerations for Bile Acid Diarrhea
- Bile acid sequestrants like colestipol are particularly effective for bile acid malabsorption-related diarrhea 1
- In patients with bile acid diarrhea, colestipol may be used as a second-line therapy after failure of cholestyramine 1
- Avoid using colestipol in patients with Crohn's disease with extensive ileal involvement or resection (>100 cm) as it may increase steatorrhea 1
Monitoring and Side Effects
- Monitor for common side effects including constipation, bloating, gas, and abdominal discomfort 3, 4
- Gastrointestinal side effects are common as the drug is not absorbed systemically 3, 5
- Titrate dose based on clinical response and side effect profile 1
- If intolerable side effects occur, consider switching to alternative bile acid sequestrants such as colesevelam, which may have a more favorable side effect profile 1
Efficacy Considerations
- Response to colestipol should be assessed after 1-2 months of treatment 2
- If inadequate response occurs despite good compliance and acceptable side effects, consider combination therapy or alternative treatments 2
- Colesevelam may be considered as an alternative with potentially better tolerability but higher cost 1, 6