lINTERACTIONS→Appendix 1 : colestyramine
lDIRECTIONS FOR ADMINISTRATIONThe contents of each
sachet should be mixed with at least 150 mL of water or
other suitable liquid such as fruit juice, skimmed milk, thin
soups, and pulpy fruits with a high moisture content.
lPATIENT AND CARER ADVICEPatient counselling on
administration is advised for colestyramine powder (avoid
other drugs at same time).lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Powder
CAUTIONARY AND ADVISORY LABELS 13
EXCIPIENTS:May contain Aspartame, sucrose
▶Colestyramine (Non-proprietary)
Colestyramine anhydrous 4 gramColestyramine 4 g oral powder
sachets| 50 sachetPsDT = £ 10. 76
Colestyramine 4 g oral powder sachets sugar free sugar-free|
50 sachetP£ 30. 00 DT = £ 16. 15
▶Questran(Bristol-Myers Squibb Pharmaceuticals Ltd)
Colestyramine anhydrous 4 gramQuestran 4 g oral powder sachets
| 50 sachetP£ 10. 76 DT = £ 10. 76
▶Questran Light(Bristol-Myers Squibb Pharmaceuticals Ltd)
Colestyramine anhydrous 4 gramQuestran Light 4 g oral powder
sachets sugar-free| 50 sachetP£ 16. 15 DT = £ 16. 15LIPID MODIFYING DRUGS›CHOLESTEROL
ABSORPTION INHIBITORSEzetimibe 19-May-2016
lDRUG ACTIONEzetimibe inhibits the intestinal absorption
of cholesterol.lINDICATIONS AND DOSE
Adjunct to dietary measures and statin treatment in
primary hypercholesterolaemia|Adjunct to dietary
measures and statin in homozygous familial
hypercholesterolaemia|Primary hypercholesterolaemia
(if statin inappropriate or not tolerated)|Adjunct to
dietary measures in homozygous sitosterolaemia
▶BY MOUTH
▶Child 10–17 years: 10 mg dailylINTERACTIONS→Appendix 1 : ezetimibe
lSIDE-EFFECTS
▶Common or very commonAsthenia.diarrhoea.
gastrointestinal disorders
▶UncommonAppetite decreased.arthralgia.chest pain.
cough.hotflush.hypertension.muscle complaints.
nausea.pain
▶Frequency not knownConstipation.depression.dizziness.
dyspnoea.hepatitis.myopathy.pancreatitis.
paraesthesia.skin reactions.thrombocytopenia
lPREGNANCYManufacturer advises use only if potential
benefit outweighs risk—no information available.
lBREAST FEEDINGManufacturer advises avoid—present in
milk inanimalstudies.
lHEPATIC IMPAIRMENTAvoid in moderate and severe
impairment—may accumulate.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Tablet
▶Ezetimibe (Non-proprietary)
Ezetimibe 10 mgEzetimibe 10 mg tablets| 28 tabletP£ 22. 36 –
£ 26. 31 DT = £ 26. 31
▶Ezetrol(Merck Sharp & Dohme Ltd)
Ezetimibe 10 mgEzetrol 10 mg tablets| 28 tabletP£ 26. 31 DT =
£ 26. 31
Combinations available:Simvastatin with ezetimibe,p. 134LIPID MODIFYING DRUGS›FIBRATES
Bezafibrate
lDRUG ACTIONFibrates act by decreasing serum
triglycerides; they have variable effect on LDL-cholestrol.lINDICATIONS AND DOSE
Hyperlipidaemia including familial hypercholesterolaemia
(administered on expert advice)
▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶Child 10–17 years: 200 mg once daily (max. per dose
200 mg 3 times a day), adjusted according to responselUNLICENSED USENot licensed for use in children.
lCONTRA-INDICATIONSGall bladder disease.
hypoalbuminaemia.nephrotic syndrome.
photosensitivity tofibrates
lCAUTIONSCorrect hypothyroidism before initiating
treatment
lINTERACTIONS→Appendix 1 :fibrates
lSIDE-EFFECTS
▶Common or very commonAppetite decreased.
gastrointestinal disorder
▶UncommonAcute kidney injury.alopecia.cholestasis.
constipation.diarrhoea.dizziness.erectile dysfunction.
gastrointestinal discomfort.headache.muscle complaints
.muscle weakness.nausea.photosensitivity reaction.
skin reactions
▶Rare or very rareCholelithiasis.depression.insomnia.
interstitial lung disease.pancreatitis.pancytopenia.
paraesthesia.peripheral neuropathy.rhabdomyolysis
(increased risk in renal impairment).severe cutaneous
adverse reactions (SCARs).thrombocytopenic purpura
lPREGNANCYManufacturers advise avoid—no information
available.
lBREAST FEEDINGManufacturer advises avoid—no
information available.
lHEPATIC IMPAIRMENTAvoid in severe liver disease.
lRENAL IMPAIRMENT
MyotoxicitySpecial care needed in patients with renal
disease, as progressive increases in serum creatinine
concentration or failure to follow dosage guidelines may
result in myotoxicity (rhabdomyolysis); discontinue if
myotoxicity suspected or creatine kinase concentration
increases significantly.
Avoid if estimated glomerularfiltration rate less than
15 mL/minute/ 1. 73 m^2.
Dose adjustmentsReduce dose if estimated glomerular
filtration rate 15 – 60 mL/minute/ 1. 73 m^2.
lMONITORING REQUIREMENTSConsider monitoring of liver
function and creatine kinase whenfibrates used in
combination with a statin.
lPRESCRIBING AND DISPENSING INFORMATIONFibrates are
mainly used in those whose serum-triglyceride
concentration is greater than 10 mmol/litre or in those
who cannot tolerate a statin (specialist use).lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension
Tablet
CAUTIONARY AND ADVISORY LABELS 21
▶Bezafibrate (Non-proprietary)
Bezafibrate 200 mgBezafibrate 200 mg tablets| 100 tabletP
£ 8. 50 DT = £ 4. 69
▶Bezalip(Teva UK Ltd)
Bezafibrate 200 mgBezalip 200 mg tablets| 100 tabletP£ 8. 63
DT = £ 4. 69130 Hyperlipidaemia BNFC 2018 – 2019
Cardiovascular system2