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INTRODUCTION

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colesevelam (koe-le-sev-e-lam)

Welchol

Classification

Therapeutic: Npid-lowering agents

Pharmacologic: bile acid sequestrants

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Indications
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Adjunctive therapy to diet and exercise for the reduction of LDL cholesterol in patients with primary hypercholesterolemia; may be used alone or in combination with hepatic hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitor. Adjunctive therapy to diet and exercise to improve glycemic control in patients with type 2 diabetes.

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Action
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Binds bile acids in the GI tract. Result in increased clearance of cholesterol. Mechanism for lowering blood glucose unknown. Therapeutic Effects: Decreased cholesterol and blood glucose.

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Adverse Reactions/Side Effects
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GI: constipation, dyspepsia.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor any untoward GI responses such as constipation and indigestion. Notify physician if these responses become problematic.

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Interventions
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  • Design and implement aerobic exercise and endurance training programs to improve cardiovascular function and glycemic control and help to reduce the risk of coronary heart disease.

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Patient/Client-Related Instruction
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  • Remind patients to take medication as directed to control hyperlipidemia even though they are asymptomatic.

  • Counsel patients about additional interventions to help control lipid disorders and improve cardiovascular health, including dietary modification, regular exercise, moderation of alcohol consumption, and smoking cessation.

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Pharmacokinetics
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Absorption: Not absorbed; action is primarily local in the GI tract.

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Distribution: Unknown.

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Metabolism and Excretion: Unknown.

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Half-life: Unknown.

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TIME/ACTION PROFILE (cholesterol-lowering effect)

ROUTE ONSET PEAK DURATION
PO 24–48 hr 2 wk unknown

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Bowel obstruction; Triglycerides >500 mg/dL; History of pancreatitis due to hypertriglyceridemia.

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Use Cautiously in: Triglycerides >300 mg/dL; Dysphagia, swallowing disorders, severe GI motility disorders, or major GI tract surgery; Pregnancy, lactation, or children (safety not established).

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Interactions
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Drug-Drug: May ↓ absorption of glyburide, levothyroxine, phenytoin, estrogen-containing oral contraceptives (give ≥4 hr before colesevelam).

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Route/Dosage
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PO (Adults): 3 tablets twice daily or 6 tablets once daily.

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Availability
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Tablets: 625 mg.

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