colesevelam
Colesevelam (Welchol) is used to lower "bad" cholesterol in the blood in adults and children as young as 10 years old. It can also be used to lower blood sugar in adults with Type 2 diabetes. The medication should be used along with a balanced diet and exercise for it to work as best as possible. The dosage is typically taken once or twice per day. Common side effects include constipation and indigestion.
What is Colesevelam (Welchol)?
What is Colesevelam (Welchol) used for?
Add-on to diet and exercise for the treatment of:
High cholesterol in adults
High cholesterol in certain children 10 to 17 years with genetic cholesterol problems
Type 2 diabetes in adults
How Colesevelam (Welchol) works
Colesevelam (Welchol) is a bile acid sequestrant. It works by attaching to bile acid in your intestines to prevent it from being absorbed into your body. This causes your liver to turn the cholesterol in your body into bile acid to replace what couldn't get absorbed. As a result, the amount of cholesterol in your body drops.
Colesevelam (Welchol) can also help lower blood sugar in adults with Type 2 diabetes. It's not exactly known how it works. But it's thought to work by raising the levels of a protein called glucagon-like peptide 1 (GLP-1) that releases insulin.
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What are the side effects of Colesevelam (Welchol)?
Common Side Effects
- Constipation (11%)
- Indigestion (8%)
- Nausea (4%)
- Weakness (4%)
Other Side Effects
- Sore throat
- Flu-like symptoms
- Runny nose
- Muscle aches
- Accidental injury
Serious Side Effects
- Swelling of the pancreas (pancreatitis): nausea, vomiting, severe stomach pain that spreads to your back
- Stomach or intestine problems: severe constipation, severe stomach pain, blood in your stool
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Bowel blockage—stomach cramping, unable to have a bowel movement or pass gas, loss of appetite, vomiting
- Pancreatitis—severe stomach pain that spreads to your back or gets worse after eating or when touched, fever, nausea, vomiting
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Colesevelam (Welchol)
Pros
Good option for people with both high cholesterol and Type 2 diabetes
Good option for people who can't tolerate statins
Can take as a tablet or a packet of powder that's sprinkled into water, juice, or diet soft drinks
Available in a lower-cost generic form
Cons
Can cause constipation
Doesn't work as well as other cholesterol medications like statins
Can raise your triglycerides (a type of fat)
Shouldn't be used if you have stomach or intestinal problems like a history of stomach surgery, intestinal blockage, or gastroparesis (stomach can't empty itself properly)
Pharmacist tips for Colesevelam (Welchol)
Make sure to mark your calendar with your appointments to see your provider and to get any blood work done when you take colesevelam (Welchol). Your provider will check your cholesterol levels regularly while you're taking this medication. These follow-ups will help make sure the medication is safe and working well for you.
Take colesevelam (Welchol) with a meal and some liquid at about the same time every day.
For the colesevelam (Welchol) packets of powder: Empty the entire contents of one packet into a cup. Add 4 to 8 ounces (half a cup to 1 cup) of water, fruit juice, or diet soft drinks. Mix well and drink the entire glass.
Colesevelam (Welchol) commonly causes constipation. You can help prevent it by eating a high-fiber diet and staying well-hydrated. If you become constipated, there are several over-the-counter medications you can try, such as bismuth subsalicylate (Pepto-Bismol), docusate (Colace), or Miralax (polyethylene glycol). Talk to your provider if your constipation doesn't get better.
Make sure to tell your provider and pharmacist about all of the medications you're taking and planning to take during treatment with colesevelam (Welchol). It's generally recommended to take your other medications at least 4 hours before colesevelam (Welchol) because of possible drug interactions with colesevelam (Welchol). Your provider or pharmacist can help you come up with a dosing schedule that works best for you.
It's important that you eat a healthy and balanced diet low in fat and sugar and a maintain a regular exercise routine while taking colesevelam (Welchol). Doing so will help you get the most benefit out of the medication. Talk with your provider if you have questions about how to plan your meals and what kind of exercise is appropriate for you.
More on Colesevelam (Welchol) tips
Frequently asked questions about Colesevelam (Welchol)
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What are the risks and warnings for Colesevelam (Welchol)?
Colesevelam (Welchol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
High triglyceride levels and swelling of the pancreas (pancreatitis)
Risk factors: High triglycerides (TG) levels (e.g., 300 mg/dL to 500 mg/dL) | History of pancreatitis or diabetes
Colesevelam (Welchol) can make your blood triglyceride levels rise, which can lead to pancreatitis (swelling of the pancreas). This pancreas problem can cause symptoms like nausea, vomiting, and stomach pain that spreads to your back. Stop taking colesevelam (Welchol) and get medical help right away if you experience these symptoms during treatment.
Blockage of your digestive tract
Risk factors: Swallowing problems | Changes to the anatomy of your digestive tract | Digestive tract problems, including severe constipation
Some people taking colesevelam (Welchol) have experienced stomach or intestinal blockage. Ask your provider whether colesevelam (Welchol) is right for you if you have constipation or other digestive tract problems. Since the tablets are quite big, it might be safer to use the powder for suspension if you have trouble swallowing to lower your risk of choking. Let your provider know right away if you have severe stomach pain, new or worsening constipation, blood in your stool, vomit that looks like coffee grounds, or other severe gut symptoms while you're taking colesevelam (Welchol).
Low levels of vitamin A, D, E, and K
Colesevelam (Welchol) might lower how well your body absorbs certain vitamins (A, D, E, and K). Your provider might recommend that you take supplements to keep your vitamin levels healthy. But make sure you take them at least 4 hours before colesevelam (Welchol) so the medication doesn't interfere with the vitamins.
Must separate from other medications
Colesevelam (Welchol) can lower how well your body absorbs other medications. It's possible that this can affect how well these other medications work for you. These medications can include birth control pills and thyroid medications. Make sure to take other medications by mouth at least 4 hours before you take colesevelam (Welchol) to avoid interactions.
Caution use in people with phenylketonuria (PKU) - powder for oral suspension only
Powder packets of colesevelam (Welchol) from certain manufacturers can contain phenylalanine, a component of the artificial sweetener aspartame. If you have a genetic condition called phenylketonuria (PKU), taking this form of the medication can be dangerous for you. Ask your pharmacist if you're not sure whether the powder packets from the manufacturer you have is safe for you. There are other manufacturers that make the medication in a formulation that might be safer for you.
Colesevelam (Welchol) dosage forms
Typical dosing for Colesevelam (Welchol)
Tablets: The typical dose is 3.75 grams by mouth per day. This dose is given as either six 625 mg tablets once a day or three 625 mg tablets twice a day.
Powder for oral suspension: The typical dose is 3.75 grams by mouth per day. This dose is given as either one 3.75-gram packet once a day or two 1.875-gram packets twice per day.
Colesevelam (Welchol) should be taken with food.
How much does Colesevelam (Welchol) cost?
Colesevelam (Welchol) contraindications
Blood triglyceride levels that are greater than 500 mg/dL
History of pancreatitis due to high triglycerides
History of stomach or intestinal blockage
What are alternatives to Colesevelam (Welchol)?
Add-on to diet and exercise for the treatment of:
High cholesterol in adults
High cholesterol in certain children 10 to 17 years with genetic cholesterol problems
Type 2 diabetes in adults
High cholesterol (in combination with diet)
Itching caused by bile duct blockage
High cholesterol in adults; added onto a heart-healthy diet and exercise
What is the latest news about Colesevelam (Welchol)?
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References
Best studies we foundAscend Laboratories, LLC. (2023). Colesevelam hydrochloride powder, for suspension [package insert]. DailyMed.
Camilleri, M., et al. (2015). Effect of colesevelam on faecal bile acids and bowel functions in diarrhoea-predominant irritable bowel syndrome. Alimentary Pharmacology & Therapeutics.
Glenmark Pharmaceuticals Inc., USA. (2023). Colesevelam hydrochloride- colesevelam hydrochloride tablet, film coated [package insert]. DailyMed.
Glenmark Pharmaceuticals Inc., USA. (2023). Colesevelam hydrochloride powder, for suspension [package insert]. DailyMed.
National Human Genome Research Institute. (2014). About phenylketonuria.
National Institute of Diabetes and Digestive and Kidney Disease. (2017). Symptoms & causes of pancreatitis.
National Research Council (US) Committee on Diet and Health. (1989). 11: Fat-soluble vitamins. Diet and Health: Implications for Reducing Chronic Disease Risk.
Nwose, O. M., et al. (2013). Atypical mechanism of glucose modulation by colesevelam in patients with type 2 diabetes. Clinical Medicine Insights: Endocrinology and Diabetes.
Onorato, A., et al. (2016). Heterozygous familial hypercholesterolemia. Circulation.
Radosh, L. (2005). Colesevelam (WelChol) for reduction of LDL cholesterol. American Family Physician.
Staels, B., et al. (2009). Bile acids and metabolic regulation: Mechanisms and clinical responses to bile acid sequestration. Diabetes Care.
You and Your Hormones. (2021). Glucagon-like peptide 1.
You and Your Hormones. (2021). Insulin.
Zema, M. J. (2012). Colesevelam hydrochloride: Evidence for its use in the treatment of hypercholesterolemia and type 2 diabetes mellitus with insights into mechanism of action. Core Evidence.
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