From the Guidelines
Cholestyramine for diarrhea should be started at a low dose of 2 to 4 g/d and titrated based on response, with a maximum of 4‒24 g/d. This approach is supported by the Canadian Association of Gastroenterology clinical practice guideline on the management of bile acid diarrhea 1. The guideline suggests that gradual dose titration of cholestyramine can help maximize symptom relief and minimize side effects.
Some key points to consider when taking cholestyramine for diarrhea include:
- Starting with a low dose and gradually increasing as needed to minimize side effects
- Taking the medication with meals to reduce gastrointestinal upset
- Mixing the medication thoroughly with 4-6 ounces of water, juice, or other non-carbonated beverage
- Avoiding taking cholestyramine at the same time as other medications, as it can interfere with their absorption
- Maintaining adequate fluid intake to prevent constipation, a common side effect of cholestyramine
It's also important to note that cholestyramine works by binding bile acids in the intestine, making it particularly effective for bile acid diarrhea or chronic diarrhea following gallbladder removal, as discussed in the guideline 1. By following these guidelines and adjusting the dose based on response, patients can find relief from diarrhea while minimizing the risk of side effects.
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 diarrhea is not explicitly stated in the label, but the recommended doses for other indications are:
- Starting dose: 1 pouch or 1 level scoopful (4 grams of anhydrous cholestyramine resin) once or twice a day
- Maintenance dose: 2 to 4 pouches or scoopfuls daily (8 to 16 grams anhydrous cholestyramine resin) divided into two doses 2 Key points:
- The dose may be adjusted based on individual response
- The maximum recommended daily dose is 6 pouches or scoopfuls of Cholestyramine for Oral Suspension, USP powder (24 grams of anhydrous cholestyramine resin) 2
From the Research
Dosage of Cholestyramine for Diarrhea
- The dosage of cholestyramine for diarrhea is not explicitly stated in the provided studies, but its effectiveness in treating chronic diarrhea, particularly bile acid diarrhea, is discussed 3, 4, 5, 6, 7.
Cholestyramine as a Treatment for Diarrhea
- Cholestyramine is a bile acid sequestrant that can be used to treat chronic diarrhea, especially bile acid diarrhea 4, 7.
- It is considered a first-line treatment for bile acid diarrhea and has been shown to be effective in reducing stool frequency and improving stool consistency 4, 5, 7.
Administration and Side Effects
- The mean dose of cholestyramine used in one study was 3.6 g, with 62% of subjects requiring dose titration and 33% reporting minor side effects 5.
- Cholestyramine can be used as an adjunct to other treatments, such as biofeedback therapy, to improve symptoms of fecal incontinence and diarrhea 5.
Comparison with Other Treatments
- Cholestyramine is one of several pharmacologic agents that can be used to treat chronic diarrhea, including loperamide, 5-HT3 receptor antagonists, diosmectite, probiotics, antispasmodics, rifaximin, and anti-inflammatory agents 4, 6.
- The choice of treatment depends on the underlying cause of the diarrhea and the patient's individual needs 4, 6, 7.