Names and pronunciation
(koe-leh-seve′eh-lam) WelChol
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Drug reference
(koe-leh-seve′eh-lam) WelChol
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Func. class.: Antilipemic
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Chem. class.: Bile acid sequestrant
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ACTION: Adsorbs, combines with bile acids to form insoluble complex excreted through feces; loss of bile acids lowers cholesterol levels
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USES: Elevated LDL cholesterol, alone or in combination with HMG- COA reductase inhibitor; type 2 diabe- tes (adjunct)
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CONTRAINDICATIONS: Hyper- sensitivity, bowel disease, primary biliary cirrhosis, triglycerides >500 mg/dL, bowel obstruction, pancreatitis, biliary obstruction, dysphagia, fat-soluble vita- min deficiency Precautions: Pregnancy, breastfeeding, children
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SIDE EFFECTS CNS: Headache, fatigue ENDO: Hypoglycemia CV: Hypertension GI: Constipation, nausea, flatulence, C hypertriglyceridemia
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INTERACTIONS Decrease: absorption of—diltiaZEM, gem- fibrozil, mycophenolate, phenytoin, pro- pranolol, warfarin, thiazides, digoxin, peni- cillin G, tetracyclines, corticosteroids, iron, thyroid, fat-soluble vitamins, glyBURIDE, fluoroquinolones Decrease: action of—oral contracep- tives, give ≥4 hr prior to colesevelam Drug/Lab Test Increase: LFTs
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DOSAGE AND ROUTES Hyperlipidemia • Adult: PO three 625-mg tablets bid with meals or 6 tablets daily with meal; may increase to 7 tablets if needed (mono- therapy); 3 tablets bid with meals or 6 tablets daily with meal given with an HMG- CoA reductase inhibitor (combination) Type 2 diabetes • Adult and geriatric: PO approx 3.8 g (6 tablets)/day or approx 1.9 g (3 tablets) bid
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Available forms: Tablets 625 mg; gran- ules for oral suspension 3.75 g/packet
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Administer: • Swallow tablets whole; do not break, crush, or chew • Give product daily or bid with meals; give all other medications 4 hr before colesevelam; with liquid to avoid poor absorption • Granules for oral suspension: empty contents of packet into a cup/glass, add ½-1 cup (4-8 oz) of water, fruit juice, diet soda; stir well before drinking
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Assess: • Cardiac glycoside level if used with an HMG-CoA • Hypercholesterolemia: fasting LDL, HDL, total cholesterol, triglyceride levels baseline and q4-6wk after initiation of treatment and periodically, electrolytes if on extended therapy; monitor BUN/cre- atinine, take diet history • Bowel pattern daily; increase bulk, water in diet for constipation • Diabetes: hypoglycemia (weakness, hunger, dizziness, diaphoresis) can re- sult from use of this product, monitor blood glucose, A1c
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Evaluate: • Therapeutic response: decreased total cholesterol level, LDL cholesterol, apoli- poproteins
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About the importance of compliance; timing of dose 4 hr after other meds • Hypercholesterolemia: That risk factors should be decreased: high-fat diet, smoking, alcohol consumption, absence of exercise • To take with meal and fluids • To discuss with health care professional all OTC, herbals, supplements, to use oral con- traceptive at least 4 hr prior to this product • Diabetes: to monitor glucose • Pregnancy/breastfeeding: to notify prescriber if pregnancy is planned or sus- pected or if breastfeeding; that insulin may be used in diabetes during preg- nancy; to use another form of contracep- tion other than oral contraceptives
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PHARMACOKINETICS Excreted in feces, peak response 2 wk
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• Adult: PO three 625-mg tablets bid with meals or 6 tablets daily with meal; may increase to 7 tablets if needed (mono- therapy); 3 tablets bid with meals or 6 tablets daily with meal given with an HMG- CoA reductase inhibitor (combination) Type 2 diabetes
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• Adult and geriatric: PO approx 3.8 g (6 tablets)/day or approx 1.9 g (3 tablets) bid
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