From the Guidelines
Cholestyramine should be started at a low dose of 2 to 4 g/d and titrated based on response, with a maximum dose of 4‒24 g/d, to manage chronic diarrhea, particularly bile acid diarrhea, as recommended by the Canadian Association of Gastroenterology clinical practice guideline 1. The dose can be gradually increased to 4 grams 2-4 times daily as needed, with a maximum daily dose of 16 grams (divided into multiple doses).
- Key considerations for cholestyramine dosing include:
- Starting with a low dose to minimize side effects and maximize symptom relief
- Gradually titrating the dose based on patient response
- Maintaining adequate fluid intake to prevent constipation
- Considering supplementation with fat-soluble vitamins (A, D, E, K) during long-term use
- Taking the medication at least 1 hour before or 4-6 hours after other medications to prevent interference with absorption
- The medication works by binding bile acids in the intestine, preventing them from irritating the colon and causing diarrhea, as discussed in the clinical practice guideline 1.
- Common side effects of cholestyramine include constipation, bloating, and nausea, which can be mitigated by gradual dose titration and adequate fluid intake, as noted in the guideline 1.
From the FDA Drug Label
The recommended starting adult dose for Cholestyramine for Oral Suspension, USP powder is 1 pouch or 1 level scoopful (9 grams of Cholestyramine for Oral Suspension, USP powder contains 4 grams of anhydrous cholestyramine resin) once or twice a day The recommended maintenance dose for Cholestyramine for Oral Suspension, USP powder is 2 to 4 pouches or scoopfuls daily (8 to 16 grams anhydrous cholestyramine resin) divided into two doses.
The dose of cholestyramine for chronic diarrhea is not explicitly stated in the provided drug label. However, based on the available information, the recommended maintenance dose is 2 to 4 pouches or scoopfuls daily (8 to 16 grams anhydrous cholestyramine resin) divided into two doses 2.
- The maximum recommended daily dose is 6 pouches or scoopfuls of Cholestyramine for Oral Suspension, USP powder (24 grams of anhydrous cholestyramine resin).
- It is essential to note that the drug label does not provide specific guidance for chronic diarrhea, and the dosing recommendations are general.
- Therefore, a conservative approach would be to start with the recommended starting adult dose and adjust as needed, with close monitoring of the patient's response and potential side effects.
From the Research
Cholestyramine Dose for Chronic Diarrhea
- The dose of cholestyramine for chronic diarrhea is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
- However, it is mentioned that cholestyramine is a bile acid sequestrant that is generally considered as the first-line treatment for bile acid diarrhea 3.
- Cholestyramine is also mentioned as a medication of value in the treatment of chronic diarrhea, particularly in cases where bile acid malabsorption is suspected 5.
- The studies primarily focus on the comparison of different antidiarrheal agents, such as loperamide, codeine, and diphenoxylate, in the treatment of chronic diarrhea 6, 7.
- There is no specific information provided on the optimal dose of cholestyramine for chronic diarrhea, and it is recommended to consult the prescribing information or a healthcare professional for guidance on dosing.