Therapeutic Category:
Antilipemic Agent, Bile Acid Sequestrant

Use: Adjunct to diet and exercise therapy for the treatment of adults with elevated low-density- lipoprotein (LDL) in primary hypercholesterolemia. It is used alone or in combination with an HMG-CoA reductase inhibitor.

Contraindications: Bowel obstruction

Warnings: Use with caution in treating patients with serum triglyceride levels >300 mg/dL. Use with caution in dysphagia, swallowing disorders, severe gastrointestinal (GI) motility disorders, major GI tract surgery, pregnancy, nursing mothers, and in patients susceptible to fat-soluble vitamin deficiencies (vitamins A, D, E, and K). Minimal effects are seen on high-density lipoprotein cholesterol and triglyceride levels.

Adverse Reactions: dyspepsia, constipation, weakness

Mechanism of Action: WelChol binds bile acids including glycocholic acid in the intestine, impeding their absorption. It also increases the fecal loss of bile salt-bound LDL.

Pharmacodynamics:
Peak Effect: ~ 2 weeks
Absorption:  insignificant
Excretion: urine

Dosage Forms: Tablet-  625 mg

Usual Dosage: 3 tablets twice daily with meals or 6 tablets daily with a meal; maximum dose: 7 tablets/day

Nutrition Considerations: Take with low fat, low cholesterol meal(s). 

Monitoring Parameters: Serum cholesterol, LDL, and triglyceride levels should be obtained before initiating treatment and periodically thereafter (in accordance with National Cholesterol Education Program {NCEP} guidelines).

Additional Information: Visit the WelChol web site  for more information. 

References

• Lacy C, et al. Drug Information Handbook  2003. 10th Edition. Lexi-Comp: Hudson, OH; 2003: 331-332.

• Welchol Prescribing Information. Sankyo Pharma Inc: New York, NY;June 2000.

• Pronsky ZM. Food Medication Interactions. 12th Edition. Food-Medication Interactions: Birchrunville, PA; 2002:88.