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What Should I Know Before Taking Bile Acid Sequestrants?

Conditions & Drug Interactions With Bile Acid Sequestrants


Updated September 15, 2013

Bile acid resins, or bile acid sequestrants, are a class of cholesterol-lowering drugs that mainly lower LDL cholesterol and slightly raise HDL cholesterol. If you have very high LDL cholesterol levels, your healthcare provider may have you take a statin and/or nicotinic acid in addition to a bile acid resin, since this will help lower your cholesterol even more.

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

The Side Effects

The most common problem faced with taking bile acid resins are the gastrointestinal complaints, which include a sense of fullness, bloating, constipation, flatulence, and nausea. These side effects can be decreased by:
  • Adding more fiber to your diet.
  • Drinking more water.
  • Taking a stool softener to decrease the constipation and flatulence.
  • Adding exercise to your everyday routine.

Gritty Taste

If you are prescribed one of the powdered forms of bile acid resins, you may find that the taste is a little gritty. In fact, taste is one of the reasons that bile acid resins are often discontinued. You can improve the taste, however, such as by adding the resin to fruit juice. If, despite these tricks, you find the taste to still be intolerable, your healthcare provider may switch you to a bile acid resin that is available in a tablet form.

Drug And Vitamin Interactions

Although bile acid resins are able to bind to bile acid 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 resins. 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, K, and E
  • Folic acid
  • Coumadin (warfarin)
  • Thyroid hormones
  • Hydrochlorothiazide
  • Lanoxin (digoxin)
  • Hydrocortisone
  • Tylenol (acetaminophen)
  • Imodium (loperamide)
  • Niacin

Other Health Conditions

Some individuals should not take bile acid resins. 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 resins do not affect triglycerides, and may increase triglyceride levels further with prolonged use.
  • Gastrointestinal dysfunction or recent major gastrointestinal surgery – bile acid resins may cause fecal impaction if your intestinal tract is not functioning properly.
  • Hemorrhoids – some bile acid resins may make hemorrhoids worse.


Dipiro JT, Talbert RL. Pharmacotherapy: A Pathophysiological Approach, 6th ed 2005.

Lacy CF, Armstrong LL, Goldman MP, et al. Lexicomp's Drug Information Handbook, 15th ed 2007.

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