Questran (Cholestyramine)

(koe less' tir a meen)

Cholestyramine is used with diet changes (restriction of cholesterol and fat intake) to reduce the amount of cholesterol and certain fatty substances in your blood. Accumulation of cholesterol and fats along the walls of your arteries (a process known as atherosclerosis) decreases blood flow and, therefore, the oxygen supply to your heart, brain, and other parts of your body. Lowering your blood level of cholesterol and fats may help to prevent heart disease, angina (chest pain), strokes, and heart attacks. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

Cholestyramine comes in a chewable bar and in a powder that must be mixed with fluids or food. It usually is taken two to four times a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take cholestyramine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Take this medication before a meal and/or at bedtime, and try to take any other medications at least 1 hour before or 4 hours after you take cholestyramine because cholestyramine can interfere with their absorption. Continue to take cholestyramine even if you feel well. Do not stop taking cholestyramine without talking to your doctor. This precaution is especially important if you also take other drugs; changing your cholestyramine dose may change their effects. Do not take the powder alone. To take the powder, follow these steps:

• Stir the powder into a glass of water, milk, heavy or pulpy fruit juices such as orange juice, or other beverage. If you use a carbonated beverage, mix the powder slowly in a large glass to avoid excessive foaming.
• Drink the mixture slowly.
• Rinse the drinking glass with more of the beverage and drink it to be sure that you get all of the powder.

The powder also may be mixed with applesauce, crushed pineapple, pureed fruit, and soup. Although the powder may be mixed in hot foods, do not heat the powder. To improve the taste and for convenience, you can prepare doses for an entire day on the previous evening and refrigerate them. To take the chewable bars, chew each bite thoroughly before swallowing. Drink plenty of liquids while you are taking this medication.

Before taking cholestyramine,
• tell your doctor and pharmacist if you are allergic to cholestyramine or any other drugs.
• tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially amiodarone (Cordarone), antibiotics, anticoagulants ('blood thinners') such as warfarin (Coumadin), digitoxin, digoxin (Lanoxin), diuretics ('water pills'), iron, loperamide (Imodium), mycophenolate (Cellcept), oral diabetes medications, phenobarbital, phenylbutazone, propranolol (Inderal), thyroid medications, and vitamins.
• tell your doctor if you have or have ever had heart disease, especially angina (heart pain); stomach, intestinal, or gallbladder disease; or phenylketonuria.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking cholestyramine, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking cholestyramine.

Eat a low-fat, low-cholesterol diet. Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. You can also visit the National Cholesterol Education Program (NCEP) website for additional dietary information at http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Cholestyramine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• constipation
• bloating
• stomach pain
• gas
• upset stomach
• vomiting
• diarrhea
• loss of appetite
• heartburn
• indigestion

If you experience the following symptom, call your doctor immediately:

• unusual bleeding (such as bleeding from the gums or rectum)

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to cholestyramine. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.