Management of High Cholesterol with Colesevelam

Introduction to Colesevelam

Colesevelam is an effective second-line or add-on therapy for managing high cholesterol, particularly for patients who cannot achieve LDL-C targets with statins alone or who are statin-intolerant, offering 15-20% LDL-C reduction as monotherapy and an additional 10-16% reduction when combined with statins, as recommended by the American College of Cardiology 1
The American College of Cardiology suggests that colesevelam works through a non-systemic mechanism as a non-absorbed, polymeric bile acid sequestrant that binds bile acids in the intestine and prevents their reabsorption 1

The American Academy of Pediatrics recommends colesevelam for pediatric patients (10-17 years) with heterozygous familial hypercholesterolemia (HeFH) who have failed an adequate trial of diet therapy 2
The American College of Cardiology indicates that colesevelam is appropriate for patients with severe primary hypercholesterolemia who haven't achieved target LDL-C levels despite maximal tolerated statin and ezetimibe therapy 4
The American College of Cardiology also recommends colesevelam for patients with type 2 diabetes who need both glycemic control and LDL-C reduction, as it improves glycemic control (reduces HbA1c by approximately 0.5%) 1

The American College of Cardiology suggests that colesevelam is available in two formulations: tablets (6 tablets once daily or 3 tablets twice daily) and oral suspension (one 3.75g packet daily or one 1.875g packet twice daily) 1

The American College of Cardiology reports that colesevelam reduces LDL-C by approximately 15-20% as monotherapy and provides an additional 10-16% reduction in LDL-C beyond statin therapy alone 1
The American College of Cardiology notes that colesevelam may slightly increase triglyceride levels, which is a consideration for patient selection, and may exacerbate hypertriglyceridemia 1
The American College of Cardiology warns of common adverse effects, including constipation, dyspepsia, and nausea, though less severe than older bile acid sequestrants 1
The American College of Cardiology advises that medications should be taken at least 1 hour before or 4 hours after colesevelam to avoid impeding their absorption 1

The American College of Cardiology recommends monitoring lipid levels, particularly triglycerides, during treatment, and being vigilant about potential drug interactions, especially with warfarin (decreased INR) and thyroid hormone replacement (increased TSH) 1