Cholestyramine for Itching Linked to Partial Biliary Obstruction

Cholestyramine is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to relieve itching caused by a partial blockage of bile flow.

How Cholestyramine Works and How It’s Taken

Cholestyramine is a type of bile acid binder. It attaches to bile acids in the intestines. The bile acids then leave the body in stool.

In people with a partial blockage of bile flow, cholestyramine can lower bile acid levels. This may reduce bile acids that collect in the skin and cause itching.

Cholestyramine comes as a powder taken by mouth. To start, it is taken once or twice a day. It may be taken around mealtime, but the timing may be changed to avoid affecting other medicines.

Typical Dosing

The recommended starting dose of cholestyramine is 1 pouch or 1 level scoopful once or twice a day.

The recommended maintenance dose is 2 to 4 pouches or scoopfuls each day, divided into two doses.

Your doctor may increase the dose gradually. The maximum recommended dose is 6 pouches or scoopfuls each day.

This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Cholestyramine Side Effects

In clinical studies of cholestyramine the most common side effects occurred include:

Constipation
Abdominal (stomach) discomfort or pain
Flatulence (gas)
Nausea
Vomiting
Diarrhea

Serious Side Effects and Warnings

Cholestyramine can cause serious side effects that may require immediate medical attention. These include:

Bleeding problems from low vitamin K — This may show up as easy bruising, bleeding, or a prolonged prothrombin time, a blood test related to clotting.
Vitamin deficiencies — Long-term use can lower some vitamin levels, including vitamins A and D. Vitamin A deficiency has been linked to night blindness in a reported case.
Low folate — Low levels of this type of B vitamin can happen with long-term use.
Severe constipation or fecal impaction — Hard stool blockages can be serious.
Intestinal obstruction — A blockage in the intestines may happen.
Hyperchloremic acidosis — A serious blood acid-base imbalance can occur, reported especially in younger and smaller people.
Allergic reactions — Reactions such as hives, asthma, wheezing, or shortness of breath can occur.

Get medical help right away if you think you are having a serious reaction.

What To Know Before Taking Cholestyramine

Before starting cholestyramine, your doctor will check that you do not have complete biliary obstruction. Do not take cholestyramine if you have a complete blockage of bile flow. This means bile is not reaching the intestine.

Do not take cholestyramine if you are allergic to any of its ingredients.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements. Cholestyramine can reduce how well some oral medicines are absorbed.

Cholestyramine is also FDA-approved for use with diet to lower high cholesterol in people with primary hypercholesterolemia who do not respond well enough to diet alone.

If you are pregnant, planning to become pregnant, or breastfeeding while taking cholestyramine, talk with your doctor about the risks and benefits.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is cholestyramine to relieve itching?

Cholestyramine is used to relieve itching linked to a partial blockage of bile flow. It works by binding bile acids in the intestine. This lowers the amount of bile acids that can build up in the skin and cause itching.

The prescribing information says cholestyramine can reduce this type of itching. It does not give exact study percentages for how many people improve.

Can cholestyramine cause constipation in people taking it for primary biliary cholangitis?

Yes. Constipation is the most common side effect of cholestyramine.

The risk may be higher with larger doses and in people older than 60. Most cases are mild and do not last long. Some people may need a lower dose or may need to stop treatment for a short time.

Can cholestyramine be used with other medicines for primary biliary cholangitis?

Cholestyramine can reduce how well some oral medicines are absorbed.

Take other medicines at least one hour before cholestyramine or four to six hours after it. Keep the doses as far apart as possible.

This may matter for medicines such as warfarin, thyroid medicines, digitalis, tetracycline, penicillin G, propranolol, estrogens, and progestins. Always ask your healthcare provider how to time your medicines.