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Prevalite 4g Powder
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Indications & Clinical Uses
- Prevalite (cholestyramine) is a bile-acid-binding resin supplied as an oral powder; each 5.5 g packet or scoop provides 4 g of active cholestyramine, which must be mixed with water or another suitable liquid before drinking, never taken dry.
- It is approved in adults as an adjunct to diet for lowering elevated total and LDL ('bad') cholesterol in primary hypercholesterolemia that has not responded adequately to diet alone, and for relieving itching (pruritus) associated with partial bile duct obstruction.
- Prevalite does not treat the underlying cause of high cholesterol and should be combined with dietary changes and treatment of other conditions that raise cholesterol, such as diabetes or hypothyroidism.
- It is taken by mouth, once or twice daily with meals, and contains aspartame.
Side Effects
- The most common side effect is constipation, which becomes more frequent at higher doses and in people over 60; increasing fluid and fibre intake, and starting at a low dose, can help.
- Other common effects include abdominal discomfort, bloating, flatulence, nausea, vomiting and heartburn.
- There is no boxed warning for Prevalite, but the label does carry a specific caution for people with phenylketonuria (PKU): each 5.5 g dose contains 14.1 mg of phenylalanine from the aspartame sweetener, so Prevalite is unsuitable for people who must strictly avoid phenylalanine.
- Seek medical advice for severe or worsening constipation, black or tarry stools, or unusual bruising or bleeding, which can signal vitamin K deficiency from long-term use.
Precautions & Warnings
- Prevalite is contraindicated in complete biliary obstruction, where bile cannot reach the intestine for the resin to bind, and in known hypersensitivity to the product.
- Because it binds fat-soluble vitamins A, D, E and K along with folic acid, prolonged use can cause vitamin deficiencies and increased bleeding risk from low vitamin K, so supplementation may be needed, especially in children or people on long-term therapy.
- It contains phenylalanine (14.1 mg per dose) from aspartame, and people with phenylketonuria must avoid it.
- Cholestyramine can worsen constipation and, rarely, contribute to hyperchloremic acidosis, particularly in children and people with kidney impairment.
- Discuss use in pregnancy and breastfeeding with a healthcare provider, since vitamin absorption effects apply to the mother too.
- Oral use only, taken with plenty of liquid.
Avoid Interactions
- Cholestyramine can delay or reduce the absorption of many oral medicines taken at the same time, reducing their effect - this includes warfarin and other anticoagulants, thyroid hormone replacement, thiazide diuretics, tetracyclines and other antibiotics, digoxin, and statins and other lipid-lowering drugs.
- To avoid this, take other oral medicines at least one hour before, or four to six hours after, Prevalite.
- It also binds fat-soluble vitamins A, D, E and K, so vitamin supplements should be timed the same way, and levels monitored with long-term use.
- Tell the healthcare provider about all medicines and supplements being taken so dosing times can be planned, and never mix Prevalite with other medicines in the same dose of liquid.
References
Frequently Asked Questions
Prevalite (cholestyramine) lowers high cholesterol as an add-on to diet, and relieves itching caused by partial bile duct blockage. It works by binding bile acids in the gut so the body removes them, along with cholesterol used to make more bile acid.
Mix one 5.5 g packet or scoop (4 g cholestyramine) with water or another liquid and drink it once or twice daily with meals; never swallow the dry powder. Your healthcare provider may increase this to two to four packets a day.
The most common side effect is constipation, especially at higher doses or in people over 60. Other effects include bloating, gas, nausea and heartburn. Report severe constipation, black stools or unusual bruising, which can signal vitamin K deficiency from long-term use.
Take other oral medicines at least one hour before, or four to six hours after, Prevalite, since it reduces absorption of many drugs, including warfarin, thyroid hormone and digoxin. Tell your healthcare provider about everything you take so doses can be timed correctly.
Take the missed dose with your next meal if you remember in time; if it is close to your next scheduled dose, skip the missed one rather than doubling up. Missing occasional doses will not cause immediate harm, but regular use works best for lowering cholesterol.
Yes. Each 5.5 g dose of Prevalite contains 14.1 mg of phenylalanine from aspartame sweetener, so people with phenylketonuria (PKU), who must strictly limit phenylalanine, should not use it. This is stated clearly on the product label.
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