BILE ACID RESINS
Prescribed Bile Acid Resins
Bile Acid Resins
Commonly prescribed brands:
How they are given:
Powder, pill, or chewable bar
What they are used for:
To lower LDL (bad) cholesterol
You should not be treated with them if:
Possible side effects:
Constipation, gas, nausea, stomach upset
The safety of these medications during pregnancy and nursing is not known, but they interfere with the body's absorption of some vitamins which may harm fetal development
How do bile acid resins work?
Bile acids are made from cholesterol. Bile acid resins bind to bile acids in the intestines and the two are excreted from the body. Because bile acids are essential for digestion, your body makes up for the loss by converting blood cholesterol into bile acids. As a result, LDL (bad) cholesterol is removed from the blood and this lowers your LDL cholesterol level.
Bile acid resins are not absorbed by the body, so they have a low risk of serious side effects. Some bile acid resins interfere with the absorption of other medications and some vitamins. Be sure to tell your doctor of any over-the-counter or prescription medications you are taking before you start bile acid resins.
How do bile acid resins affect my cholesterol and triglyceride levels?
Bile acid resins are mostly prescribed to reduce levels of LDL (bad) cholesterol. Studies show that they lower LDL cholesterol by 15% to 20% in men and women with high cholesterol.67-71 Bile acid resins also slightly increase HDL (good) cholesterol by 3% to 8%. Colesevelam (WelChol) lowers LDL cholesterol more than cholestyramine or colestipol.72 Statins are the most effective cholesterol-lowering medications for reducing LDL cholesterol, so bile acid resins are used in people who cannot take statins because of side effects. Bile acid resins can also be combined with statins. Because bile acid resins may raise your triglyceride level slightly, you should not take them if you have high triglycerides (200 mg/dL or higher). Triglycerides are a type of lipid, or fat, that raises your risk of heart disease when present at a high level.
Do bile acid resins prevent heart disease and heart attacks?
There are no studies on the effectiveness of bile acid resins in preventing heart disease and heart attacks in women. Research in men with high cholesterol and/or heart disease found that bile acid resins reduce the risk of dying from a heart-related cause.73 In men with high cholesterol, bile acid resins reduced the risk of dying from heart disease by 24% and the risk of having a heart attack by 19%.70
Why do I need to take a bile acid resin and a statin?
Your healthcare provider may prescribe a bile acid resin in addition to a statin. This helps to lower your LDL cholesterol further while avoiding some complications that are associated with high doses of statins [link to Statins]. When the two medications are used together, LDL cholesterol levels go down an extra 12% to 16% compared with taking a statin alone.74, 75 Doubling the statin dose generally leads to an extra 6% to 9% reduction in LDL cholesterol, and the risk of side effects increases with higher statin doses.31
What are the risks and side effects of bile acid resins?
The main side effects for bile acid resins are gastrointestinal complaints, particularly constipation. The biggest drawback to these medications is the large amount that you have to take. This is either in the form of a large tablet, chewable bar, or in a powder that can be mixed with water or juice (often these powders don't taste good). Colesevelam seems to have fewer side effects than the other bile acid resins, and it does not affect the absorption of other medications you may be taking.72 For bile acid resins other than colesevelam, you will have to take additional medications one hour before or four hours after your bile acid resin.