From the FDA Drug Label
The discontinuance of cholestyramine resin could pose a hazard to health if a potentially toxic drug such as digitalis has been titrated to a maintenance level while the patient was taking cholestyramine resin
- Cholestyramine (Questran) should be held when the patient is taking other medications that may be affected by its binding properties, such as digitalis, and the patient's condition requires a change in the medication regimen.
- It is recommended to hold Cholestyramine when the patient is at risk of decreased absorption of other medications, such as fat-soluble vitamins, and alternative supplementation is not feasible.
- Hold Cholestyramine if the patient's condition requires the administration of other medications that may interact with Cholestyramine, such as warfarin or phenylbutazone, and the patient's health may be compromised by the interaction 1.
From the Research
Indications for Holding Cholestyramine (Questran)
- Cholestyramine should be held in patients who are volume depleted, in renal failure, or taking spironolactone, as it can cause hyperchloremic nonanion gap metabolic acidosis 2.
- There is no direct evidence to suggest when Cholestyramine should be held in other situations, but its use should be carefully considered in patients with certain medical conditions, such as terminal ileal resection, cholecystectomy, or abdominal radiotherapy, as they may be at risk for bile acid diarrhea 3.
- In patients with chronic diarrhea, Cholestyramine may be suggested as initial therapy, but it should be used with caution and at the lowest effective dose, with a trial of intermittent, on-demand administration, concurrent medication review and reinvestigation for patients whose symptoms persist despite treatment 3.
- Cholestyramine should be avoided in patients with extensive ileal Crohn's disease or resection, and alternative antidiarrheal agents should be suggested if Cholestyramine is not tolerated 3.
Special Considerations
- The effect of cholesterol reduction with Cholestyramine on renal function is not well established, and prospective intervention trials are needed to determine whether decreasing serum cholesterol levels benefits kidney function in otherwise healthy individuals 4.
- Cholestyramine has a relatively weak effect on lowering low-density-lipoprotein (LDL)-cholesterol and poor tolerability, and its use should be carefully considered in patients with hyper-LDL-cholesterolemia 5.