Contraindications to Welchol (Colesevelam) Tablets
Welchol is absolutely contraindicated in three specific clinical scenarios: serum triglycerides >500 mg/dL, history of hypertriglyceridemia-induced pancreatitis, and history of bowel obstruction. 1
Absolute Contraindications
According to the FDA prescribing information and American College of Cardiology guidelines, colesevelam must not be used in patients with: 2, 1
Serum triglycerides >500 mg/dL - Bile acid sequestrants can further elevate triglyceride levels, creating dangerous hypertriglyceridemia 2, 1
History of hypertriglyceridemia-induced pancreatitis - Given the risk of worsening triglycerides, patients with prior pancreatitis from elevated triglycerides should never receive this medication 2, 1
History of bowel obstruction - Colesevelam can cause gastrointestinal obstruction, making it absolutely contraindicated in anyone with prior bowel obstruction 2, 1
Critical Clinical Context
The triglyceride threshold is a hard stop at 500 mg/dL. Before prescribing colesevelam, you must check baseline triglycerides and monitor them during therapy, as the medication can increase triglyceride levels and precipitate acute pancreatitis. 2
Additional High-Risk Situations to Avoid
While not absolute contraindications per the FDA label, the American College of Cardiology strongly recommends avoiding colesevelam in: 2
Gastroparesis or other GI motility disorders - Risk of GI obstruction is substantially elevated 2
History of major GI tract surgery with risk for bowel obstruction - Anatomical changes increase obstruction risk 2
Phenylketonuria - Some colesevelam products contain phenylalanine which can be harmful in these patients 2
Common Pitfalls to Avoid
Do not confuse colesevelam's contraindications with other bile acid sequestrants. Cholestyramine is contraindicated only for serious hypersensitivity reactions, while colestipol is contraindicated in complete biliary obstruction and hypersensitivity. 2 Colesevelam has more specific contraindications related to triglycerides and bowel obstruction.
Always check triglycerides before initiating therapy and monitor periodically. The 500 mg/dL cutoff is absolute, and failure to monitor can result in life-threatening pancreatitis. 2, 3