What to Know Before Starting a Bile Acid Resin

Bile acid sequestrants, also known as bile acid resin drugs, are a class of cholesterol-lowering medications that mainly lower LDL cholesterol. Drugs in this category include:

• Cholestyramine (Questran)
• Colesevelam (Welchol)
• Colestipol (Colestid)

Bile acid sequestrants are not commonly prescribed because there are more potent cholesterol-lowering drugs on the market and also because these medications have not been proven to directly lower your risk of cardiovascular disease.

If you have very high LDL cholesterol levels, your healthcare provider may have you take a bile acid resin drug in addition to a statin or other cholesterol-lowering drug since this will help lower your LDL levels even more.

If you can't take a statin (the usual standard treatment for lowering cholesterol) or if your LDL doesn't get low enough with a statin, other medications, such as Zetia (ezetimibe) or a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor such as Praluent (alirocumab) or Repatha (evolocumab) would typically be considered before bile acid sequestrants.

However, in situations such as during pregnancy, a bile acid sequestrant may be considered the safest medication to lower cholesterol and thus be chosen as treatment.

Although they are effective in slightly lowering your LDL levels, there are some things that you should know before you begin bile acid resin therapy, such as common side effects and medications that may interact with bile acid resins.

The Side Effects

Some individuals taking a bile acid resin drug may experience some mild side effects. The most common problem faced with taking bile acid resins are gastrointestinal complaints, which include a sense of fullness, bloating, constipation, flatulence, and nausea. These side effects can be reduced by:

• Adding more fiber to your diet
• Drinking more water
• Taking a stool softener to decrease constipation and flatulence
• Adding exercise to your everyday routine

Gritty Taste

If you are prescribed one of the powdered forms of bile acid sequestrants, you may find that the taste is a little gritty. In fact, the taste is one of the reasons that bile acid resin drugs are often discontinued. You can improve the taste by adding the resin to fruit juice.

If, despite these tricks, you find the taste to still be intolerable, you should talk to your healthcare provider before stopping therapy. He or she may modify your therapy or switch you to a bile acid resin that is available in a tablet form.

Drug and Vitamin Interactions

Although bile acid sequestrants are able to bind to bile acids and prevent cholesterol from being absorbed into the body, they may also prevent certain drugs and vitamins from being absorbed, too. If a drug or vitamin is not absorbed from the small intestine, it is not doing its job and is of no use to your body.

Although this list is not complete, these are some of the vitamins and more common drugs that are affected by bile acid resin drugs. If you are taking one of these products, do not take them within two hours before or six hours after taking your bile acid resin.

• Fat-soluble vitamins, such as vitamins A, D, E, and K
• Folic acid
• Coumadin (warfarin)
• Thyroid hormones
• Hydrochlorothiazide
• Lanoxin (digoxin)
• Hydrocortisone
• Imodium (loperamide)
• Niacin
• Some birth control pills

Additionally, you should let your physician or pharmacist know if you are taking a bile acid sequestrant. They will be able to screen for any potential interactions between your bile acid resin drug and other medications.

Other Health Conditions

There are some medical conditions that may be aggravated by taking a bile acid sequestrant. Your healthcare provider will make the decision to place you on a bile acid sequestrant based on your lipids and your general health. If you have any of the following conditions below, your healthcare provider may decide not to place you on this medication:

• Hypertriglyceridemia (high triglycerides): Bile acid sequestrants may increase triglyceride levels further in people with underlying hypertriglyceridemia, which can increase the risk of pancreatitis (inflammation of the pancreas)
• Gastrointestinal dysfunction or recent major gastrointestinal surgery: Bile acid sequestrants may cause fecal impaction if your intestinal tract is not functioning properly.
• Hemorrhoids: If you have hemorrhoids, bile acid sequestrants may worsen this condition.