Does Welchol (colesevelam) need to be taken with food?

Does Welchol Need to Be Taken with Food?

Yes, Welchol (colesevelam) must be taken with meals and liquid. This is an FDA-mandated administration requirement, not merely a suggestion for tolerability.

Administration Requirements

Both tablet and oral suspension formulations of colesevelam must be administered with meals:

• Tablets: Take 6 tablets once daily or 3 tablets twice daily with a meal and liquid 1
• Oral suspension: Mix one 3.75-gram packet once daily or one 1.875-gram packet twice daily with 4-8 ounces of water, fruit juice, or diet soft drink; take with meal 1, 2

The FDA label explicitly states to "take with meal" for both formulations, and this instruction appears consistently across all official prescribing information 2.

Rationale for Food Requirement

While the evidence does not explicitly detail why food is required, colesevelam's mechanism of action provides context:

• Colesevelam binds bile acids in the intestine, which are released during digestion of meals 1
• Taking the medication with food ensures optimal interaction with bile acids released during the digestive process 1
• This timing maximizes the drug's ability to sequester bile acids and achieve its lipid-lowering effect 1

Critical Drug Interaction Timing

A major clinical pitfall is failing to separate other medications from colesevelam administration:

• Other drugs should be taken at least 1 hour before or 4 hours after colesevelam to avoid impaired absorption 1
• This is particularly critical for medications with narrow therapeutic windows, including thyroid hormone replacement, warfarin, phenytoin, and oral contraceptives 1, 2
• Colesevelam has been reported to increase TSH in patients on thyroid replacement therapy and decrease INR in warfarin users 1

Practical Implementation

To optimize therapy while managing drug interactions:

• Schedule colesevelam with breakfast and/or dinner 1
• Take other medications either first thing in the morning (1+ hours before colesevelam) or at bedtime (4+ hours after colesevelam) 1
• For patients on thyroid replacement: take levothyroxine upon waking, then colesevelam with breakfast at least 1 hour later 1, 3
• Fat-soluble vitamins (A, D, E, K) should also be taken at least 4 hours before colesevelam if supplementation is needed 2

Common Adverse Effects Related to Administration

Gastrointestinal side effects are the primary tolerability concern:

• Constipation, dyspepsia, and nausea are most common 1
• Taking with adequate liquid (as directed) may help mitigate some GI symptoms 1
• More serious but rare GI complications include bowel obstruction, esophageal obstruction, and fecal impaction 1, 2