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Welchol
Welchol, the brand name for colesevelam, is a bile acid sequestrant used to lower cholesterol and improve blood sugar control in patients with type 2 diabetes. It is primarily prescribed to reduce low-density lipoprotein (LDL) cholesterol levels in patients with primary hyperlipidemia and to help manage blood sugar in patients with type 2 diabetes. Welchol works by binding to bile acids in the intestine, preventing their reabsorption, which helps to lower cholesterol levels and improve glycemic control.
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Frequently Asked Questions
How long does it take for Welchol to lower cholesterol?
It may take several weeks to a few months for Welchol to fully lower cholesterol levels. Regular blood tests will help monitor progress.
Can Welchol be used with other cholesterol medications?
Yes, Welchol is often used in combination with other cholesterol-lowering medications such as statins or ezetimibe. However, the timing of taking these medications may need to be adjusted to avoid absorption issues.
Can Welchol cause weight gain?
Weight gain is not a common side effect of Welchol. In fact, it may help some patients with type 2 diabetes manage their blood sugar levels, which can support weight management when used with diet and exercise.
What should I do if I miss a dose of Welchol?
If you miss a dose, take it as soon as you remember unless it is close to your next scheduled dose. Do not take two doses at once to make up for a missed one.
Can I take Welchol for type 1 diabetes?
No, Welchol is not indicated for the treatment of type 1 diabetes. It is used to improve blood sugar control in patients with type 2 diabetes in conjunction with other medications and lifestyle changes.
Comprehensive Drug Guide
How Does Welchol Work?
Welchol works by binding to bile acids in the intestine. Bile acids are produced from cholesterol in the liver and are necessary for fat absorption. By preventing bile acid reabsorption, Welchol forces the liver to use more cholesterol to make additional bile acids, thereby reducing LDL cholesterol in the blood. Additionally, Welchol helps control blood sugar levels in type 2 diabetes, although the exact mechanism for its glucose-lowering effect is not fully understood.
Common Dosages
- 625 mg tablets: The typical dose is six tablets daily.
- 3.75 g oral suspension packets: The typical dose is one packet mixed with liquid once daily.
Typical Dosing
- For cholesterol reduction: The usual dose is six 625 mg tablets daily or one 3.75 g oral suspension packet once daily. The tablets can be taken all at once or split into three tablets twice daily with meals.
- For blood sugar control: The same dosing applies for type 2 diabetes—six tablets daily or one oral suspension packet. It is recommended to take Welchol with meals to maximize its effects.
Typical Dosing
FDA Approved Indications
- Primary hyperlipidemia: To lower LDL cholesterol levels in patients with high cholesterol.
- Type 2 diabetes: To improve blood sugar control, in combination with diet and exercise.
Who Shouldn't Take Welchol?
- Bowel obstruction (blockage of the intestines)
- Triglyceride levels greater than 500 mg/dL, or a history of hypertriglyceridemia-induced pancreatitis
- Known hypersensitivity to colesevelam or any of the components of the formulation
Advice From The Pharmacist
- Take Welchol with meals and plenty of water to improve its effectiveness and reduce gastrointestinal side effects.
- If taking the oral suspension, mix the powder with 4 to 8 ounces of water or other liquids and drink immediately.
- Welchol can interfere with the absorption of other medications. Take other medications at least 4 hours before or 4 hours after taking Welchol.
- Do not crush, chew, or break the tablets, as they should be swallowed whole.
- It may take several weeks to see full cholesterol-lowering effects, so keep taking the medication as prescribed.
Side Effects of Welchol
Common Side Effects
- Constipation
- Gas or bloating
- Nausea
- Indigestion
- Muscle aches
Uncommon/Severe Side Effects
- Severe constipation or bowel obstruction
- Pancreatitis (inflammation of the pancreas)
- Increased triglyceride levels, especially in patients with pre-existing high triglycerides
Risks and Warnings of Welchol
- Constipation: Welchol can cause or worsen constipation, which may be severe in some patients. This is particularly important in patients who are already prone to gastrointestinal issues. Increasing fluid intake and dietary fiber may help reduce constipation.
- Increased triglycerides: Welchol can raise triglyceride levels in some patients. Regular monitoring of triglyceride levels is recommended, especially in patients with a history of high triglycerides.
- Bowel obstruction: In rare cases, Welchol may cause bowel obstruction, especially in patients with pre-existing gastrointestinal conditions. Patients should contact their healthcare provider if they experience severe abdominal pain or inability to pass stool.
Interactions with Welchol
Common Drug Interactions
- Fat-soluble vitamins: Welchol may reduce the absorption of fat-soluble vitamins (A, D, E, and K). Patients taking long-term Welchol therapy may need vitamin supplementation.
- Other medications: Welchol can interfere with the absorption of other medications, including thyroid hormone replacement (levothyroxine), phenytoin, oral contraceptives, and warfarin. These medications should be taken 4 hours before or after taking Welchol.
- Antidiabetic medications: If used in combination with other glucose-lowering medications, monitor blood sugar levels closely to avoid hypoglycemia.
Alternatives to Welchol
- Cholestyramine (Questran): Another bile acid sequestrant used to lower cholesterol.
- Ezetimibe (Zetia): A non-statin cholesterol-lowering medication that works by reducing cholesterol absorption in the intestines.
- Statins: Such as atorvastatin or simvastatin, which are often prescribed to lower cholesterol by inhibiting cholesterol production in the liver.
- Fibrates (fenofibrate): Used to lower triglycerides and cholesterol levels in patients with mixed dyslipidemia.
