Cholestyramine is an oral medication that reduces the levels of cholesterol in the blood and improves the itching associated with liver disease.

Cholesterol that is ingested or manufactured in the body is eliminated primarily by conversion to bile acids in the liver and excretion in bile. The bile enters the intestine and most of the bile acids are reabsorbed from the intestine. These reabsorbed bile acids are removed from the blood by the liver and excreted again into bile. Thus bile acids re-circulate in the body. Cholestyramine binds to bile acids in the intestine. This prevents their absorption and the cholestyramine/bile acid complexes are eliminated in the stool. As a result the body loses bile acids. To compensate for this loss the liver increases the conversion of cholesterol to bile acids. The conversion of cholesterol to bile acids reduces the cholesterol in the body and the levels of cholesterol drop in the blood.

One of the most troubling symptoms in patients with liver and biliary disease is itching. The itching is believed to be the result of accumulation of bile acids in the skin due to the inability of the liver or bile ducts to eliminate bile acids normally. By binding bile acids in the intestines and preventing their absorption cholestyramine hastens the elimination of bile acids from the body and skin and the itching improves.

Cholestyramine also binds some drugs in the intestine preventing their absorption and hastening their elimination. Therefore cholestyramine is useful in some situations in which there has been an overdose of drugs.

The usual dose is 4 to 8 grams once or twice a day. The maximum dose is 24 grams per day. Powder should be mixed with 60 to 180 ml 2 to 6 fl oz of water noncarbonated beverage pulpy fruits or soup.

The most common side effects are constipation abdominal pain bloating vomiting diarrhea weight loss and excessive passage of gas flatulence. Long-term use of cholestyramine may cause a deficiency of vitamin A D E and K.

Cholestyramine decreases the absorption of warfarin Coumadin thyroid hormones Synthroid Levoxyl. Liotrix digoxin Lanoxin And thiazide diuretics Hydrodiuril Oretic Dyazide Maxide. Therefore these drugs should be administered 1 hour before or 4-6 hours after the administration of cholestyramine. Cholestyramine decreases the conversion of leflunomide Arava to its active form and reduces the absorption of vitamin A D E and K.

Cholestyramine is used for reducing cholesterol levels in the blood to relieve the itching of liver and biliary disease and to treat overdoses of digoxin or thyroid hormone. Cholestyramine also is recommended for the rapid elimination of leflunomide Arava.

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