considered only if dietary intervention and treatment with a
statin and a bile acid sequestrant is unsuccessful or contra-
indicated.
In hypertriglyceridaemia which cannot be controlled by
very strict diet, omega- 3 fatty acid compounds can be
considered.
LIPID MODIFYING DRUGS›BILE ACID
SEQUESTRANTS
Bile acid sequestrants f
lDRUG ACTIONBile acid sequestrants act by binding bile
acids, preventing their reabsorption; this promotes hepatic
conversion of cholesterol into bile acids; the resultant
increased LDL-receptor activity of liver cells increases the
clearance of LDL-cholesterol from the plasma.
lCAUTIONSInterference with the absorption of fat-soluble
vitamins (supplements of vitamins A, D, K, and folic acid
may be required when treatment is prolonged).
lSIDE-EFFECTS
▶Common or very commonConstipation.gastrointestinal
discomfort.gastrointestinal disorders.headaches.nausea
.vomiting
▶UncommonAcidosis hyperchloraemic.appetite decreased
.diarrhoea.dysphagia.haemorrhage.
hypoprothrombinaemia.myalgia.night blindness.
osteoporosis.skin reactions.tongue irritation.vitamin
deficiencies
▶Rare or very rarePancreatitis
▶Frequency not knownAngina pectoris.arthralgia.arthritis
.asthenia.burping.chest pain.dizziness.dyspnoea.
gallbladder disorders.inflammation.insomnia.pain.
tachycardia
lPREGNANCYBile acid sequestrants should be used with
caution as although the drugs are not absorbed, they may
cause fat-soluble vitamin deficiency on prolonged use.
lBREAST FEEDINGBile acid sequestrants should be used
with caution as although the drugs are not absorbed, they
may cause fat-soluble vitamin deficiency on prolonged
use.
lMONITORING REQUIREMENTSA child’s growth and
development should be monitored.
eiiiiFaboveColestipol hydrochloride
lINDICATIONS AND DOSE
Familial hypercholesterolaemia
▶BY MOUTH
▶Child 12–17 years:Initially 5 g 1 – 2 times a day, then
increased in steps of 5 g every month, total daily dose
may be given in 1 – 2 divided doses or as a single dose if
tolerated; maximum 30 g per daylUNLICENSED USENot licensed for use in children.
lINTERACTIONS→Appendix 1 : colestipol
lDIRECTIONS FOR ADMINISTRATIONThe contents of each
sachet should be mixed with at least 100 mL of water or
other suitable liquid such as fruit juice or skimmed milk;
alternatively it can be mixed with thin soups, cereals,
yoghurt, or pulpy fruits ensuring at least 100 mL of liquid
is provided.
lPATIENT AND CARER ADVICEPatient counselling on
administration is advised for colestipol hydrochloride
granules (avoid other drugs at same time).
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Granules
CAUTIONARY AND ADVISORY LABELS 13
▶Colestid(Pfizer Ltd)
Colestipol hydrochloride 5 gramColestid 5 g granules sachets plain
sugar-free| 30 sachetP£ 15. 05
Colestid Orange 5 g granules sachets sugar-free| 30 sachetP
£ 15. 05
Tablet
▶Colestipol hydrochloride (Non-proprietary)
Colestipol hydrochloride 1 gramColestid 1 g tablets|
120 tabletPseiiiiFaboveColestyramine
(Cholestyramine)
lINDICATIONS AND DOSE
Familial hypercholesterolaemia
▶BY MOUTH
▶Child 6–11 years:Initially 4 g once daily, then increased
to 4 gupto 3 times a day, adjusted according to
response
▶Child 12–17 years:Initially 4 g once daily, then increased
in steps of 4 g every week; increased to 12 – 24 g daily in
1 – 4 divided doses, adjusted according to response;
maximum 36 g per day
Pruritus associated with partial biliary obstruction and
primary biliary cirrhosis
▶BY MOUTH
▶Child 1–11 months: 1 g once daily, adjusted according to
response, total daily dose may alternatively be given in
2 – 4 divided doses; maximum 9 g per day
▶Child 1–5 years: 2 g once daily, adjusted according to
response, total daily dose may alternatively be given in
2 – 4 divided doses; maximum 18 g per day
▶Child 6–11 years: 4 g once daily, adjusted according to
response, total daily dose may alternatively be given in
2 – 4 divided doses; maximum 24 g per day
▶Child 12–17 years: 4 – 8 g once daily, adjusted according
to response, total daily dose may alternatively be given
in 2 – 4 divided doses; maximum 36 g per day
Diarrhoea associated with Crohn’s disease, ileal resection,
vagotomy, diabetic vagal neuropathy, and radiation
▶BY MOUTH
▶Child 1–11 months: 1 g once daily, adjusted according to
response, total daily dose may alternatively be given in
2 – 4 divided doses, if no response within 3 days an
alternative therapy should be initiated; maximum 9 g
per day
▶Child 1–5 years: 2 g once daily, adjusted according to
response, total daily dose may alternatively be given in
2 – 4 divided doses, if no response within 3 days an
alternative therapy should be initiated; maximum 18 g
per day
▶Child 6–11 years: 4 g once daily, adjusted according to
response, total daily dose may alternatively be given in
2 – 4 divided doses, if no response within 3 days an
alternative therapy should be initiated; maximum 24 g
per day
▶Child 12–17 years: 4 – 8 g once daily, adjusted according
to response, total daily dose may alternatively be given
in 2 – 4 divided doses, if no response within 3 days an
alternative therapy should be initiated; maximum 36 g
per daylUNLICENSED USENot licensed for use in children under
6 years to reduce cholesterol.
lCONTRA-INDICATIONSComplete biliary obstruction (not
likely to be effective)BNFC 2018 – 2019 Hyperlipidaemia 129
Cardiovascular system2