Cpnhelp.org

There are two forms of the stuff one is Questran Lite, the one with the aspartame, the other is regular old Questran or generic cholestyramine which has sugar (probably corn syrup!) as the sweetener. Have your pharmacist check on the generic form or look specifically for the regular Questran... or try another pharmacy. Some comes in cans with a scooper, other comes in premeasured packets. The generic stuff I used comes in the packets and has no aspartame.

Aspartame, when it first was allowed on the market many, many years cause me mental confusion a bit like brain fog.  I duplicated the experiment several times and each time the same results.

My guess is that your pharmacy orders only the type with aspartame from their distributor.   There is  more than one drug distributor.   Each pharmacy has the ones that they have best financial deals with.  

Just this week I had to wait a day for tablet doxy and a 60 tablet bottle of Tindamax.   Wanted to change from Doxy Capsules to tablets to see if they were easier on my stomach.  Guess they get the best price on the capsules, as I have been given the same generic capsules from this pharmacy for more than a year.   The tablets on an empty stomach are somewhat better.   Also asked about the cash price on Doryx which is a enteric coated form of Doxy (a brand not generic) The tablets cash price for the generic was $16.80 to those that self pay without an insurance plan as the third party (they often get a lesser total ) price for their member participants, (seems a bit of an injustice but hey it is just injustice), the enteric coated Brand ofr the same number 60, 100mg of Doryx, enteric coated doxy to by pass the stomach, (like enteric coated asprin which may be a bit more expensive but)  anyway the Doryx for 60 100mg tablets was $328.93 cash price.

So I may hound my provider of for a Rx for doryx and see what that salts out to be with my insurance plans discount and my copay ultimately. 

I have done the comparison about azythro, clarithro, and roxi and it is still weighing heavily for Roxi as being most cost effective.   Full cash price locally with Rx for Azythro 250 12 tablets, $113.41 / Clarithro 500 #60 tablets $171./  Seems that it is difficult to beat Roxy 150mg 100 tablet including free postage from a different provider $95 for 7 weeks (3 more weeks).  And it is so smooth on the stomach and has such stellar reviews in trials for Bb and Cpn as I remember.    I am having a difficult time getting myself to change.  Thought it would be best to use Clari will split tabs to 250 and start there bid and see the stomach response.  And will see what sort of copay my insurance ultimately assigns to me for this med.   In the end, from all points of view, Roxi may be the best choice for me.  Loulou pmessage me regarding the Chole. generic that I use.

Louise

Thank you Louise. Hope that you can tell me where you get the aspartame free cholestyramine which is the one my doctor is recommending?

 

Loulou

First off you should telephone around your city and ask if they can fill your RX for Questran not questran-light(with aspartame) tell them you cannot take anything with aspartame.   Some of the other pharmacies may be willing to order it for you.  Ask about pricing, make a list and compare and then get your Rx to them to have it filled.

If that does not work for you, personal message me.  We can discuss other options if the local route does not work for you.  It may be best if you can get it locally.

 

I have just been told that something called colestid may be a substitute. It is available in 1 gram tablet or 5 gram granules (powdered pouches). Pharmacy is saying it's the same. Is it????????????

 

Loulou

p.s. Louise As soon as I can figure out how to pm you, I will do so. If not, do you think you might be able to pm me?  Louise(loulou)

Loulou - best deal is to get generic cholestraymine as Louise says. 

I'll see if I can find you a NDC number and you can give it to your pharmacist to order.  Most pharmacies can order something in the AM and receive in the PM or at best receive it the next day if you are in the US - even in small towns..

QUESTRAN® Powder (Cholestyramine for Oral Suspension USP) is available in cans containing 378 grams and in cartons of sixty 9 gram packets. Four grams of anhydrous cholestyra-mine resin are contained in 9 grams of QUESTRAN Powder. The 378 g can includes a 15 cc scoop. The scoop is not interchangeable with scoops from other products.

NDC-49884-936-66Can, 378 gNDC-49884-936-65Carton of 60, 9 g packets

Can is usually slightly less expensive than carton of 60 packages.

Questran light with the aspartame has a different NDC number.

 

Welchol is a bile acid sequestrant like Questran but it comes in caplets, not a powder.   The prescribing infomation does not list any sweeteners as added ingredients.  I don't know if it is available in Canada - you might have to become one of the rare people that swims against the tide by coming here to buy drugs.

Once again, many many thanks for the quick and most appreciated responses. Hopefully, cholestyramine will be ordered without aspartame at the beginning of next week. Problem is my prescribing doc is American and I am Canadian so have to get my Canadian gp to at the very least communicate with gp here so that I can get drug. Hope this is worth it.

Many thanks. Still working on how to post private msg.

 

Loulou

Twickle, Have you tried a straw, that is how it works for me.  And you cannot wait or it will thicken and be less appealing.  Personally, I see the powder as giving more surface coverage than a capsule but perhaps it expands or something like that.  I drink another glass of water after the choleystramine.

Pain is not an effect of porphoria that I personally am concerned with it is the mind and body fatigue and brain fog that I find relief from in the use of cholestyramine.

Loulou, to post a private message go to the box on the left side of the screen with your user name.

Click on my inbox.   Explore that option.

Or click on the posters username on the top of a post.  It will bring you to a page where you can read send personal message, click on that phrase which is in brown I think.

If the comment box is reduced, click and hold the bottom right hand corner and draw it down, the box will open.   I had this difficulty in the past, it seems intermittent but is confusing, particularly with brain fog in force.

Hope that helps.

Louise

I got one of those battery powered frother things designed to make "latte" at home (Melitta). Turns out it works great to mix cholestyramine powder. A little citrus flavored juice and the frother and it's smooth and unremarkable.

I think that the Barcelona Mfg Brand Resincolestiramina (brand) Spanish may taste better than Questran Brand?  Seems to be selling well and is currently out of stock once again.  Last time I inquired when it was out of stock I said I could not take Questran Light and notify me when it becomes available again.   It was a very short time that they had it for me.   I would think the questran light would work but if you know you are sensitive to aspartame it is out of the question. The light is also more expensive through this provider. 

I asked my abx provider to rx it but he was hesitant and mumbled something about needing bile acids.   I did not want to argue my point as I already had a way to use it intermittently, I can see his point on a multiple times a day with meals for long periods of time for cholesterol mgmt but for my application since I eat three meals a day, away from the cholesty and not taking it with my meals only a little fat to stimulate bile flow, I see it as of little impact on my nutrition.   This comment is not for those that need to take it multiple times a day to get an effect due to high porphorin load on agressive treatment.   Just my take on my treatment needs.  I also like to stress the need to consider constipation which can occur and the use of the generic brand of colace stool softener particularly if you have limited mobility associated with MS or are just prone to constipation.  Also be mindful during the day to keep up fluid  intake,  if you need more fluids than you ingest the first place it is drawn from is the distal end of the large intestine aka as the sigmoid where constipation sets in.    If you find yourself with this event get a generic brand of a small fleet enema most stores have a house brand for cheeper and it does not really go bad so can be a hand thing to have in the closet and when needed getting out to the store may not be convenient.  These are all the self care measures I have used to deal with the less than lovely side effects of cholestyramine, which I feel are minimal for the increase in energy and stability of mind and mood that follow a good "porphoria cleanse".  

My experience is that it takes multiple days to start getting clearer, one dose here or there has limited impact, I have found that it takes about 6 - 7 to really feel remarkably improved.  The first time I took it I took it for several weeks to really clear porphorins out and since then intermittently as I begin to see signs off porphoria which can be found under the Getting Started tab at the top of this page under the subpage Reactions and Remedies.  You can review the list when you get out of sorts and see if you think you might benefit from the measures suggested there and/ or the phorphria cleanse that works for me.

OK enough for now.   Hope it helps some as much as it seems to help me.  

Jim I think I will try the mixer and froth suggestion with some of that instant lemon concentrate (one of those little plastic lemons or limes too) might make a festive ritual to look forward to !

Louise

 

 

Cholestyramine, generic   as available at www.drugstore.com website

Entire Monograph

 

Adult DosingDosage forms:  

4 g/scoop pwdr; 4 g pwdr pkt

 

Special Note

formulation clarification

Info: 1 scoop/pkt regular formulation = 9 g powder = 4 g cholestyramine; 1 scoop/pkt sugar-free formulation = 5 g powder = 4 g cholestyramine; dosing presented in g cholestyramine

 

Hypercholesterolemia

4-8 g PO bid

Start: 4 g PO qd-bid, may incr. dose by 4 g/day q4wk; Max: 24 g/day; Info: give before meals; may dose 1-6x/day

 *pruritus

4-8 g PO bid

Start: 4 g PO qd-bid, may incr. dose by 4 g/day q4wk; Max: 16 g/day; Info: give before meals; may dose 1-6x/day; for pruritus assoc. w/ cholestasis, uremia, polycythemia vera

 

*pseudomembranous colitis, adjunct tx

2-4 g PO bid-qid Max: 16 g/day; Info: give before meals; may dose 1-6x/day; not for severe diarrhea

 

renal dosing

no adjustment

HD/CAPD: no supplement

 

hepatic dosing

not defined

Peds Dosing

Dosage forms:  4 g/scoop pwdr; 4 g pwdr pkt

Special Note

formulation clarification

Info: 1 scoop/pkt regular formulation = 9 g powder = 4 g cholestyramine; 1 scoop/pkt sugar-free formulation = 5 g powder = 4 g cholestyramine; dosing presented in g cholestyramine

*hypercholesterolemia

6-12 yo

Dose: 80 mg/kg PO tid; Alt: 2-4 g PO bid; Max: 8 g/day; Info: give before meals; may dose 1-6x/day

adolescents

Dose: 4 g PO bid; Alt: 80 mg/kg PO tid; Max: 8 g/day; Info: give before meals; may dose 1-6x/day

 

renal dosing

see Adult Dosing

renal impairment: dose adjustment may be required although specific pediatric dosing adjustments not defined; see adult renal dosing for guidance

 

hepatic dosing

not defined

 

Contraindications/Cautions

• hypersens. to drug/class/compon.
• biliary obstruction
• caution if constipation
• caution if CAD
• caution if renal dysfxn
• caution if volume depletion
• caution if >60 yo
• caution if PKU (sugar-free forms)

 

Drug Interactions

Avoid/Use Alternative

• amiodarone
• leflunomide
• meloxicam
• raloxifene
• sodium phosphate
• thyroid hormones
• ursodiol
• warfarin

Monitor/Modify Tx

• A2R blocker/HCTZ combos
• ACE inhibitor/HCTZ combos
• alendronate/cholecalciferol
• aliskiren/hydrochlorothiazide
• amiloride/hydrochlorothiazide
• amlodipine/atorvastatin
• atropine/hyoscyamine/phenobarbital/scopolamine
• beta blocker/thiazide combos
• bismuth subcitrate potassium/metronidazole/tetracycline
• bismuth subsalicylate/metronidazole/tetracycline
• contraceptives, oral combo
• contraceptives, oral progestin
• digoxin
• diuretics, thiazide
• ezetimibe
• ezetimibe/simvastatin
• fat-soluble vitamins
• fibric acid derivatives
• folic acid
• HRT, estrogen
• HRT, estrogen/progestin combo
• HRT, progestin
• hydrochlorothiazide/spironolactone
• hydrochlorothiazide/triamterene
• metronidazole
• mycophenolate mofetil
• mycophenolic acid
• niacin
• niacin/lovastatin
• niacin/simvastatin
• phenobarbital
• phosphate supplements
• statins, all
• tetracyclines
• tinidazole
• valproic acid derivatives

Caution Advised

• carbidopa/levodopa/entacapone
• corticosteroids, systemic
• entacapone
• gotu kola
• spironolactone

 

Adverse Reactions

 

Serious Reactions

• fecal impaction
• intestinal obstruction
• metabolic acidosis
• fat-soluble vitamin deficiency
• folate levels decreased
• osteoporosis (long-term use)

Common Reactions

• constipation
• abdominal pain
• flatulence
• nausea
• vomiting
• dyspepsia
• eructation
• anorexia
• steatorrhea
• bleeding
• rash
• urticaria
• fatigue
• fecal impaction

 

Safety Monitoring

Pregnancy: C

Lactation: Safe

Monitoring Parameters
no routine tests recommended

 

Look/Sound-Alike Drug Names
[from www.usp.org]
cholestyramine confused with: chlorpheniramine

 

Pharmacology

Metabolism: none;

CYP450: none;

Info: no systemic absorption

Excretion: feces; Half-life: unknown

Class: Cholesterol Lowering

 

Mechanism of Action
binds intestinal bile acids

 

Manufacturer/Pricing

Manufacturer: generic

 DEA/FDA: Rx 

Approximate Retail Price

from  www.drugstore.com 

powder:

• 4 gm/dose (1 can, 378 gm): $37.00

powder:

• 4 gm/dose (1 can, 210 gm): $50.00

Patient Education - English

Show Spanish

• Generic Name: cholestyramine

• Pronounced: koe le STYE ra meen

• Brand Names: Cholestyramine Light, Locholest, Locholest Light, Prevalite, Questran, Questran Light

What is the most important information I should know about cholestyramine?

• You should not take this medication if you are allergic to cholestyramine, or if you have a blockage in your stomach or intestines.
• Before taking cholestyramine, tell your doctor if you have a thyroid disorder, diabetes, kidney or liver disease, or chronic constipation.
• Avoid taking other medications at the same time you take cholestyramine. Wait at least 4 to 6 hours after taking cholestyramine before you take any other medications.
•  

What is cholestyramine?

• Cholestyramine helps reduce cholesterol (fatty acids) in the blood. High cholesterol is associated with an increased risk of heart disease and atherosclerosis (clogged arteries).
• Cholestyramine is used to lower high levels of cholesterol in the blood, especially low-density lipoprotein (LDL) ("bad" cholesterol).
• Cholestyramine powder is also used to treat itching caused by a blockage in the bile ducts of the gallbladder.
• Cholestyramine may also be used for other purposes not listed in this medication guide.

  

What should I discuss with my healthcare provider before taking cholestyramine?

 

• You should not take this medication if you are allergic to cholestyramine, or if you have a blockage in your stomach or intestines.
• Before taking this medication, tell your doctor if you are allergic to any drugs, or if you have:
  
  • a thyroid disorder;
  • diabetes,kidney disease,
  • liver disease, or
  • chronic constipation.

 

If you have any of these conditions, you may need a dose adjustment or special tests to safely take cholestyramine.

 

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

 

Taking cholestyramine can make it harder for your body to absorb certain vitamins your body needs while you are nursing a baby. Do not take cholestyramine without telling your doctor if you are breast-feeding.

This medication may contain phenylalanine. Talk to your doctor before using cholestyramine if you have phenylketonuria (PKU)

.

How should I take cholestyramine?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts or for longer than recommended by your doctor. Follow the directions on your prescription label.

Cholestyramine is sometimes taken up to 6 times per day. Follow your doctor's instructions.

 

Take cholestyramine with meals unless your doctor tells you otherwise.

Mix the cholestyramine powder with 2 to 6 ounces of water or other non-carbonated beverage. You may also mix the powder with a brothy soup, crushed pineapple, or applesauce. Measure the powder using the scoop provided with your medication. Do not use any other scoop or measuring cup to measure your cholestyramine dose.

 

Drink extra fluids to prevent constipation while you are taking cholestyramine.

It is important to take cholestyramine regularly to get the most benefit.

Cholestyramine is only part of a complete program of treatment that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

To be sure this medication is helping your condition, your blood may need to be tested on a regular basis. Do not miss any scheduled appointments.

Store cholestyramine at room temperature away from moisture and heat.

 

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

 

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include severe stomach pain or constipation.

 

What should I avoid while taking cholestyramine?

 

Avoid taking other medications at the same time you take cholestyramine. Wait at least 4 to 6 hours after taking cholestyramine before you take any other medications.

 

What are the possible side effects of cholestyramine?

 

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

 

Call your doctor at once if you have a serious side effect such as:

• blood in your urine;
• severe stomach pain;
• ongoing constipation;
• feeling short of breath;
• black, bloody, or tarry stools; or
• easy bruising or bleeding.

Less serious side effects may include:

• mild constipation, diarrhea;
• stomach pain, nausea, loss of appetite, weight changes;
• bloating or gas;
• hiccups or a sour taste in your mouth;
• skin rash or itching;
• irritation of your tongue;
• itching or irritation around your rectal area;
• muscle or joint pain; or
• dizziness, spinning sensation; ringing in your ears.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

 

What other drugs will affect cholestyramine?

 

Cholestyramine can make it harder for your body to absorb other medications, such as:

• a blood thinner such as warfarin (Coumadin);
• digoxin (digitalis, Lanoxin);
• propranolol (Inderal);
• a diuretic (water pill);
• thyroid hormones such as levothyroxine (Synthroid, Levoxyl, Levothroid);
• birth control pills or hormone replacement;
• seizure medicines such as phenytoin (Dilantin) and phenobarbital (Luminal, Solfoton); or
• an antibiotic such as amoxicillin (Amoxil, Trimox, others), doxycycline (Adoxa, Doryx, Oracea, Vibramycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), penicillin (BeePen-VK, Pen-Vee K, Veetids, others), tetracycline (Brodspec, Panmycin, Sumycin, Tetracap).

This list is not complete and there may be other drugs that can interact with cholestyramine. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

 

Where can I get more information?

Your pharmacist can provide more information about cholestyramine.

 

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise.

Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides.

The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of your healthcare professional. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment.