Questran (Cholestyramine (Colestyramine))
Also sold as: Questran, Cholestin, Colestid (colestipol), Locholest
Pregnancy
Cat B
Lactation
Safe
Schedule
H
Forms
Powder sachet 4g (mix with water or juice before taking)
Indications
- Hypercholesterolaemia — reduces LDL cholesterol (used when statins not tolerated or as adjunct)
- Primary biliary cholangitis (PBC) / cholestatic pruritus — reduces bile acid accumulation in skin
- Diarrhoea associated with bile acid malabsorption (post-cholecystectomy, post-ileal resection)
- Clostridium difficile diarrhoea adjunct (binds C. diff toxins — limited evidence; adjunct only)
- Digitalis toxicity (emergency — binds digoxin in gut)
Adult Dosing
Hypercholesterolaemia
4g PO 1–3 times daily (with meals)
Start with 4g once daily; titrate to 8–24g/day in 2–3 divided doses. Mix powder well with water, juice, or soup. Takes 4–6 weeks for full LDL-lowering effect.
Cholestatic pruritus
4g PO OD–TDS (adjust to symptom control)
Ongoing as long as cholestasis persists
Bile acid diarrhoea
4g PO once daily before breakfast
Start low; titrate to response
Pediatric Dosing
Paediatric familial hypercholesterolaemia — specialist use
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any CrCl | No systemic absorption — no renal dose adjustment needed |
Hepatic Adjustment
Use cautiously in complete biliary obstruction — no bile acids in gut (reduces efficacy and may worsen fat-soluble vitamin absorption)
Pregnancy & Lactation
Pregnancy: Category B
Not absorbed systemically — considered safe in pregnancy. However, may impair absorption of fat-soluble vitamins (A, D, E, K) — supplement and monitor. Cholestatic pruritus of pregnancy is a recognised indication.
Lactation: Safe
Not absorbed — no passage into breast milk. Safe to use while breastfeeding.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Most oral medications | CHOLESTYRAMINE BINDS MOST DRUGS IN THE GUT — can dramatically reduce absorption of: statins, levothyroxine, warfarin, digoxin, diuretics, beta-blockers, fibrates, fat-soluble vitamins (A, D, E, K), folic acid, iron, methotrexate, oral contraceptives, antidiabetics. ALL other medications must be taken 1 hour before or 4–6 hours after cholestyramine. | Major |
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Side Effects
Common
- Constipation (most common — very bothersome)
- Bloating and flatulence
- Nausea
- Abdominal discomfort
- Heartburn
Serious / Discontinue If
- Fat-soluble vitamin deficiencies (A, D, E, K — with long-term use; K deficiency → bleeding; D deficiency → osteomalacia)
- Hypochloraemic acidosis (especially in children and renal disease)
- Steatorrhoea and malabsorption (high doses)
Contraindications
- Complete biliary obstruction
- Bowel obstruction
- Phenylketonuria (aspartame in some formulations)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Questran 4g sachet | Sanofi | 30 sachets ₹1,850 |
| Cholestin 4g sachet | Abbott | 30 sachets ₹1,650 |
Monitoring Required
- LDL cholesterol (at 4–6 weeks)
- Fat-soluble vitamin levels (A, D, E, K — annually with long-term use)
- Serum electrolytes (especially in children/renal disease)
- INR if on warfarin (cholestyramine affects warfarin absorption and K-vitamin absorption)
- Bowel function (constipation management)
Patient Counseling Points
- Mix sachet well with at least 150–200 mL of water, juice, or soup — never take dry
- ⚠️ TIMING IS CRITICAL: take ALL other medications 1 hour BEFORE or 4–6 hours AFTER cholestyramine — it binds to other drugs in your gut
- Constipation is very common — increase dietary fibre and water significantly
- Take fat-soluble vitamin supplements (A, D, E, K) if on long-term therapy — discuss with your doctor
- Start with 1 sachet/day and increase slowly — reduces GI side effects
- For cholestasis itch: improvement in pruritus may take several days
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Clinically reviewed by: Dr. Pradeep Nair, DM (Gastroenterology), Consultant Gastroenterologist
Last reviewed: 2026-04-01
References
- NICE Lipid Modification Guidelines CG181
- EASL PBC Guidelines 2017
- ACG Bile Acid Diarrhoea Guidelines
- BNF — Colestyramine