Colesevelam
WELCHOL
Pronunciation: koe-le-SEV-e-lam
What it isBile acid sequestrant; hyperlipidemia and type 2 diabetes.
Why this oneBetter tolerated and less drug-binding than cholestyramine, and it lowers A1c as well as LDL.
What limits itIt still binds levothyroxine and glyburide. Constipation; it raises triglycerides.
FDA-approved for
- hyperlipidemia (2000)
- type 2 diabetes (2008)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Primary hyperlipidemia | Adults | 3.75 g/day (6 tab QD or 3 tab BID) | 3.75 g/day | 3.75 g/day |
| Primary hyperlipidemia (HeFH) | Boys & postmenarchal girls 10–17 y | 3.75 g/day | 3.75 g/day | 3.75 g/day |
| Type 2 diabetes mellitus | Adults | 3.75 g/day | 3.75 g/day | 3.75 g/day |
Renal Undefined
Hepatic Undefined
Instructions
- Take with a meal and liquid
- Obtain lipid/TG levels before starting
- For difficulty swallowing tablets, use oral suspension (also preferred in pediatrics due to tablet size)
- Give other drugs at least 4 hours before colesevelam; oral vitamins at least 4 hours before
Available strengths
- tab 625 mg
- susp 1.875, 3.75 g/packet
Contraindications
- Serum triglycerides >500 mg/dL
- History of hypertriglyceridemia-induced pancreatitis
- History of bowel obstruction
Cautions
- Can increase triglycerides; hypertriglyceridemia may cause acute pancreatitis
- Bowel obstruction; not recommended in gastroparesis, GI motility disorders, or after major GI surgery
- May decrease absorption of fat-soluble vitamins (vitamin K risk in warfarin/malabsorption patients)
- May decrease absorption of concomitant oral drugs
Adverse reactions
- Constipation
- Dyspepsia
- Nausea
Pregnancy Not absorbed systemically; fetal exposure not expected; data insufficient
Lactation Undefined
Cost
Colesevelam (WELCHOL)
What pharmacies pay · NADAC 9/30/26
Generic entry2018
NO BOXED WARNINGS
Principal riskBinds levothyroxine and glyburide; raises triglycerides
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityLocal irritation, sensitization or administration-site injury; negligible systemic toxicity at usual use.