What to Know Before Starting a Bile Acid Resin

Ihar Ulashchyk; istockphoto

Bile acid resins, also known as bile acid sequestrants, are a class of cholesterol-lowering medications that mainly lower LDL cholesterol. Drugs in this category include:

  • Cholestyramine (Questran)
  • Colesevelam (Welchol)
  • Colestipol (Colestid)

Bile acid resins are not commonly prescribed – not only because there are more potent cholesterol-lowering drugs on the market, but also because these medications have not been proven to directly lower your risk of cardiovascular disease.


If you have very high LDL cholesterol levels, your healthcare provider may have you take a statin or other cholesterol-lowering drug in addition to a bile acid resin, since this will help lower your LDL levels even more.

Although they are effective in slightly lowering your LDL levels, there are some things that you should know before you begin bile acid resin therapy, such as common side effects and medications that may interact with bile acid resins.


The Side Effects

Some individuals taking a bile acid resin may experience some mild side effects. The most common problem faced with taking bile acid resins are gastrointestinal complaints, which include a sense of fullness, bloating, constipation, flatulence, and nausea. These side effects can be reduced by:

  • Adding more fiber to your diet
  • Drinking more water
  • Taking a stool softener to decrease the constipation and flatulence
  • Adding exercise to your everyday routine


    Gritty Taste

    If you are prescribed one of the powdered forms of bile acid resins, you may find that the taste is a little gritty. In fact, the taste is one of the reasons that bile acid resins are often discontinued. You can improve the taste by adding the resin to fruit juice. If, despite these tricks, you find the taste to still be intolerable, you should talk to your healthcare provider before stopping therapy.

    He or she may modify your therapy or switch you to a bile acid resin that is available in a tablet form.


    Drug and Vitamin Interactions

    Although bile acid resins are able to bind to bile acids and prevent cholesterol from being absorbed into the body, they may also prevent certain drugs and vitamins from being absorbed, too. If a drug or vitamin is not absorbed from the small intestine, it is not doing its job and is of no use to your body. Although this list is not complete, these are some of the vitamins and more common drugs that are affected by bile acid resins. If you are taking one of these products, do not take them within two hours before or six hours after taking your bile acid resin.

    • Fat soluble vitamins, such as vitamins A, D, K, and E
    • Folic acid
    • Coumadin (warfarin)
    • Thyroid hormones
    • Hydrochlorothiazide
    • Lanoxin (digoxin)
    • Hydrocortisone
    • Tylenol (acetaminophen)
    • Imodium (loperamide)
    • Niacin

    Additionally, if you should let your physician or pharmacist know if you are taking a bile acid resin.

    They will be able to screen for any potential interactions between your bile acid resin and other medications.


    Other Health Conditions

    There are some medical conditions that may be aggravated by taking a bile acid resin. Your healthcare provider will make the decision to place you on a bile acid resin based on your lipids – and your general health. If you have any of the following conditions below, your healthcare provider may decide not to place you on this medication:

    • Hypertriglyceridemia (high triglycerides). Bile acid resins do not directly affect triglycerides, but and may increase triglyceride levels further with prolonged use. 
    • Gastrointestinal dysfunction or recent major gastrointestinal surgery. Bile acid resins may cause fecal impaction if your intestinal tract is not functioning properly.
    • Hemorrhoids. If you have hemorrhoids, bile acid resins may worsen this condition.



    Dipiro JT, Talbert RL. Pharmacotherapy: A Pathophysiological Approach, 9th ed 2014.

    Micromedex 2.0.  Truven Health Analytics, Inc. Greenwood Village, CO.  Available at: http://www.micromedexsolutions.com.  Accessed February 10, 2016

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