Sequest Special Precautions

Discontinue therapy if there is no significant reduction in cholesterol level.
Before constituting therapy with Cholestyramine, disease contributing to increased blood cholesterol such as hypothyroidism, diabetes mellitus, nephrotic syndrome, dysproteinemia and obstructive liver disease should be looked for and specifically treated. In addition, prior to instituting therapy with Cholestyramine, an attempt should be made to control serum cholesterol by appropriate dietary regimen, weight reduction and the treatment of any underlying disorder which might be the cause of the hypercholesterolemia. Serum cholesterol levels should be determined frequently during the first few months of therapy and periodically thereafter. A favourable trend in cholesterol reduction should occur during the first month of Cholestyramine therapy. The therapy should be continued to sustain cholesterol reduction.
Serum triglyceride levels should be measured periodically to detect whether significant changes have occurred.
Because it sequester bile acids, Cholestyramine resin may interfere with normal fat absorption when given in high doses (24 grams daily). When given in these high doses, Cholestyramine may prevent absorption of fat-soluble vitamins such as Vitamin A, D and K. therefore, when Cholestyramine is to be given in high doses for long time periods, daily supplement of Vitamin A, D and K should be considered.
[Chronic use of Choletyramine resin may be associated with increased bleeding tendency due to hypoprothrombinemia associated with vitamin K deficiency. This will usually respond promptly to parenteral vitamin K administration, recurrences can be prevented by oral administration of vitamin K]. Reduction of serum or red cell folate has occurred and treatment with folic acid should be considered in these cases.
Since Cholestyramine resin may bind other drugs given concurrently, the interval between the administration of Cholestyramine resin and other medication should be as great as feasible.
There is a possibility that prolonged use of Cholestyramine resin in high doses may produce hyperchloremic acidosis, since it is the chloride form an anion exchange resin. This is especially true in younger and smaller patients where the relative dosage may be higher. Cholestyramine resin may aggravate pre-existing constipation or related condition such as haemorrhoids. In patients with constipation, the dosage of Cholestyramine resin should be decreased, since it may produce impaction. In patients presenting with symptomatic coronary artery disease, where straining of the stool is to be avoided, the dosage of Cholestyramine should be titrated to avert constipation.
Pregnancy and lactation: Since Cholestyramine resin is not absorbed systematically, it is not expected to cause fetal harm when administered during pregnancy in recommended dosage. Caution should be exercised when Cholestyramine resin is administered to nursing mother. The possible lack of proper vitamin adsorption described previously may have an effect on nursing infants.