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(koe-LESS-tih-pole HIGH-droe-KLOR-ide)
Colestid
Class: Antihyperlipidemic/Bile acid sequestrant

 Action Increases removal of bile acids from body by forming insoluble complexes in intestine, which are then excreted in feces. As body loses bile acids, it converts cholesterol from blood to bile acids, thus lowering serum cholesterol.

 Indications Reduction of cholesterol in patients with primary hypercholesterolemia who do not respond adequately to diet. Unlabeled use(s): Treatment of digitalis toxicity.

 Contraindications Hypersensitivity to bile acid sequestering resins; complete biliary obstruction.

 Route/Dosage

ADULTS: Tablets PO 2–16 gm/day given once or in divided doses. Start with 2 gm once or twice daily and increase in amounts of 2 gm, once or twice daily at 1- or 2-month intervals. ADULTS: Granules PO 5–30 gm/day given once or in divided doses. Start with 5 gm once or twice daily and increase in amounts of 5 gm daily over 1–2 month intervals.

 Interactions

Digitalis glycosides, furosemide, gemfibrozil, hydrocortisone, penicillin G, phosphate supplements, propanolol, tetracyclines, thiazide diuretics, fat soluble vitamins (ie, A, D, E, K): Absorption of these drugs may be decreased.

 Lab Test Interferences None well documented.

 Adverse Reactions

DERM: Rash; urticaria. EENT: Difficulty swallowing. GI: Constipation; abdominal pain and cramping; intestinal bloating; flatulence; indigestion; heartburn; diarrhea; nausea; vomiting; bloody hemorrhoids and stools; esophageal obstruction. HEMA: Bleeding tendencies related to vitamin K deficiency. HEPA: Elevated liver function tests. META: Fat soluble vitamin deficiencies.

 Precautions

Pregnancy: Category undetermined. Lactation: Undetermined. Children: Safety and efficacy not established.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer before meals.
  • Do not administer simultaneously with other medicines. Administer other medications 1 hr before or 4–6 hours after colestipol.
  • Tablets are large and may be difficult to swallow.
  • Swallow each tablet whole. Do not cut, crush or chew tablets.
  • Drink plenty of fluids as the tablets are swallowed.
  • Granulated form of medication should not be taken dry. Mix well in at least 90 ml of liquids of any type (except alcoholic beverages), soups, cereal or pulpy fruits. Colestipol will not dissolve.
  • Rinse glass with small amount of beverage to ensure that all the medication is consumed.
  • Store granules and tablets at room temperature.

 Assessment/Interventions

  • Obtain patient history.
  • Monitor for signs of increased bleeding tendencies, such as swollen joints, ecchymotic areas and petechiae.
  • Assess for bowel function, particularly pre-existing problems with constipation that may worsen with its use.
  • Document serum cholesterol and triglyceride levels.
  • Provide diet high in fiber; increase fluids to 2–3 L unless contraindicated. If constipation develops, notify physician.
  • Obtain baseline serum total and LDLC, and triglyceride levels.

OVERDOSAGE: SIGNS & SYMPTOMS
  GI obstruction

 Patient/Family Education

  • Instruct patient to take medication before meals.
  • Advise patient to take any other medications, including over-the-counter medications, 1 hr before or 4–6 hrs after taking colestipol.
  • Advise patient regarding proper mixing of granules.
  • Advise patient to implement any vitamin and mineral supplementation recommended by healthcare provider.
  • Advise patient to drink prune juice, eat fruit and vegetables, and maintain good fluid intake on a regular basis to avoid constipation.
  • Advise patient to notify healthcare provider if GI side effects (eg, constipation, cramping, heartburn, bloating, gas) become bothersome.
  • Instruct patient in lifestyle changes (eg, low fat diet, regular exercise, weight reduction) that facilitate cholesterol/triglyceride control.
  • Advise patient that lab tests will be required to monitor therapy. Be sure to keep appointments.

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