Bile acid sequestrants such as cholestyramine help reduce cholesterol, manage spells of pruritus (i.e., persistent episodes of itchiness), etc. Another proven use of this med is its capability to treat diarrhea. Though the food and drug administration (FDA) has not approved it for such usage, it is often used in an off-label mode to manage bile acid-triggered diarrhea. This drug is available in a powder form; it is this form which is more widely used. This is mainly because – the powdered form makes it easy to mix with fruit juices or other drinks. You may however need to know the dosages of the powder form prior to starting your treatment plan.

The key function of the bile acid sequestrant – cholestyramine – is its ability to reduce the quantum of bile acids. Once acid levels drop, your liver looks up to fats (which are present in your blood) to make acids. It is this process which endows cholestyramine with needful properties to reduce cholesterol or lipid levels in blood. Once bile acids digest fats – residual acids are then sent back to your liver for recycling purposes. As a result, only a bare minimal amount of acids reach your colon (through your intestines). However, conditions wherein you have a large amount of acids reaching the colon can soon trigger a spell of bile acid diarrhea.

This medical condition is also known as malabsorption of bile acids. Once the poorly absorbed acids reach your colon, you are likely to encounter watery discharge of stools or loosening of stool. The active ingredients of cholestyramine serve as binders – they get bound to the excessive amounts of bile acids; as a result, your system obtains relief from acute spells of bile acid diarrhea – BAD or bile acid malabsorption – BAM, in short.

What is the dosage recommended to treat diarrhea?

Of the various forms of this drug, the chewable form or the powdered variants are more commonly prescribed for the treatment of diarrhea. However, before starting to take this drug – ensure that you are not living with genetic conditions like phenylketonuria (PKU). You need to know that cholestyramine contains a marked level of phenylalanine – a protein. People living with PKU often find it difficult to process this protein; as a result, this can cause toxicity in your system. Also, tell your doctor if you are taking any other dietary supplements, proteins or vitamins on a daily basis. Your caregiver needs to know of such intake because cholestyramine can hinder the normal absorption of a few nutrients – especially, vitamins and some forms of proteins.

On dosages

Bile acid diarrhea or acid malabsorption may require regular doses of this drug. At the very start, a dose of upto 3 to 4 grams (g) is provided to people living with the above conditions. This dose is given for a 24-hour time interval – especially, during the commencement of your medication plan. Once your system accepts (or, does not respond adversely) the initial doses, a maintenance dose of upto 6 g is prescribed per day. If your condition is turning acute – the dosage frequency is increased within a 24-hour period. You can buy the powdered form of cholestyramine packed either in a canister (with a measuring spoon packed inside) or as sachets / packets.

At times, children or teens may develop a bout of bile acid diarrhea; in such instances, the dose must never exceed 7 grams within a day; in order to avoid likely episodes of an overdose, this daily dose is also split / divided into equal shares. The doses are taken with a time interval of at least 6 to 8 hours. It is always recommended to take this drug (especially, the powder variant) before food. You may also consider taking the dose before your bedtime. The standard measure is mixed to three or five ounces of fluids. While selecting a fluid, ensure not to choose a carbonated drink (such as soda, etc.) or caffeinated fluids (like coffee). It is a safe practice to take the powdered drug mixed along with fruit juices or water.

Things you need to be watchful of while taking cholestyramine

It is essential to adhere to the instructions of your medical team. Those with hepatic conditions such as inflammation of the liver or cirrhosis must inform your doctor and pharmacist about such ailments. Also, if you are living with chronic spells of constipation (or, difficulties to pass stools) – it is advised to keep away from bile acid sequestrants such as cholestyramine. Severe spells of constipation may lead to blood from rectum – especially while passing stools, infrequent or irregular bowel movements, etc.; in such instances, always talk to your doctor prior to taking this drug.

In general, you must share all needful details about your family’s clinical history as well as your own medical history. If diseases like Crohn’s disorder, removal of a section of the bowel or intestine are present in your medical history, your doctor must know of all such prior / pre-existing conditions. In very remote cases, the drug may trigger some allergies; adverse signs such as swelling of facial parts, breathing problems – including wheezing or gasping, etc., may show up. If you encounter one or more of these severe signs, talk to your doctor on an emergency mode. Canadian residents may reach out to a poison control center or may contact Health Canada without any delay. Residents of US can call 911 for clinical help or reach out to the helpline of the food and drug administration (FDA) for needful attention.

In sum, cholestyramine can be administered in the powder form for treating bile acid diarrhea or bile acid malabsorption. Treatment plan may involve intake of 4 to 7 grams of the powder. It is recommended to take your dosages prior to taking a meal or before going to bed. The powder is mixed with 4 ounces of fluids such as water or fruit juices. It is not recommended to take this powder with caffeinated fluids or carbonated drinks such as soda. If you need any additional inputs about the safe intake of the powder form of cholestyramine, talk to your treating doctor and / or pharmacist.

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