GENERIC NAME: colestipol
BRAND NAME: Colestid
DRUG CLASS AND MECHANISM: Colestipol is an oral
cholesterol-lowering agent. It is not absorbed from the
intestine and into
the body. Colestipol attaches to bile acids that are made by
the liver and
secreted through the bile into the intestine. This binding in
the
intestine and subsequent elimination in the stool of bile acids
reduces
the bile acids that are absorbed from the intestine and forces
the liver
to make more bile acids to replace the lost bile acids. Since
bile acids
are made from cholesterol, the liver uses up cholesterol to
form bile
acids. This reduces the amount of cholesterol in the body.
Colestipol
works similarly to cholestyramine (Questran). Colestipol was
approved by
the FDA in 1977.
PRESCRIPTION: yes
GENERIC AVAILABLE: yes
PREPARATIONS: Granules in 5gm packets or in bulk (5gm
per
teaspoonful) in canisters; tablets: 1 gm.
STORAGE: Tablets and granules should be stored below at
room
temperature, 15-30°C (59-86°F).
PRESCRIBED FOR: Colestipol is used for the treatment of
high
cholesterol in conjunction with dietary control; for the
treatment of
diarrhea due to increased intestinal bile acids after some
types of
surgery; for the treatment of itching associated with partial
obstruction
to the flow of bile due to liver disease. (The itching is believed to be due to the
accumulation of bile acids in the body.)
DOSING: Colestipol is most often prescribed in 2 to 4
divided
doses but may also be prescribed once daily. The usual dose is
5 grams (1
packet per dose), but may be increased if necessary. In
general, the dose
is determined by the degree of cholesterol reduction and the
patient's
tolerance of the medication.
DRUG INTERACTIONS: Colestipol binds many different
compounds in
the gastrointestinal tract, thereby inhibiting the absorption
of the other
compounds. Colestipol can bind with and decrease the oral
absorption of
carbamazepine (Tegretol), diuretics such as hydrochlorothiazide
(found in Dyazide, Maxzide) and furosemide (Lasix), propranolol (Inderal),
tetracyclines, and fat-soluble vitamins (vitamins A, D, and K).
Colestipol
can bind with and inhibit the absorption of thyroid hormones.
Colestipol
also can bind with ursodiol. Separating the doses of colestipol
and these
other compounds by several hours should prevent binding with
colestipol.
Colestipol binds to vitamin K, a vitamin which is required by
the liver
to make the factors that allow blood to clot. Colestipol, by
reducing the
action of vitamin K further, may exaggerate the effect of
warfarin,
reducing the body's ability to form blood clots. This
interaction could
lead to abnormal bleeding. On the other hand, colestipol can
bind with
warfarin directly and inhibit the absorption of warfarin. To
avoid this
interaction, doses of warfarin and colestipol should be
staggered by at
least 4-6 hours.
Colestipol is closely related to cholestyramine, another resin.
Cholestyramine has been more extensively studied than
colestipol.
Therefore, there are several drug interactions which have been
described
with cholestyramine, for which data is lacking with colestipol.
It would
be prudent to assume that a similar interaction exists and to
separate
ingestion of colestipol from the other drugs by several hours.
These
interactions with cholestyramine include: acetaminophen (Tylenol),
amiodarone (Cordarone), gemfibrozil (Lopid), pravastatin (Pravachol),
piroxicam (Feldene), imipramine (Tofranil), glipizide (Glucotrol), and
others.
PREGNANCY: It is not known whether or not colestipol
causes harm
to the fetus if taken during pregnancy although it is not
absorbed and,
therefore, does not cross the placenta to the fetus. However,
colestipol
is known to interfere with the absorption of fat-soluble
vitamins
(vitamins A, D, and K), which may lead to deficiencies even with
supplementation. Colestipol, therefore, can be used in
pregnancy if the
physician feels that it is clearly indicated.
NURSING MOTHERS: It is not known if colestipol is
secreted in breast milk although it is highly unlikely since its absorption
is so
poor. Therefore, the physician needs to decide whether to
instruct the
pregnant woman to discontinue nursing or the drug or to
continue both
nursing and drug, accepting the possible risk.
Last Editorial Review: 12/31/1997
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