Reviewed on 5/22/2023

What Is Cholestyramine and How Does It Work?

Cholestyramine is a prescription medication used to treat Hyperlipidemia.

What Are Dosages of Cholestyramine?

Adult dosage


  • 4g

Powder for Oral Suspension

Adult dosage

  • 4g/dose (231g)
  • 4g/dose (378g)
  • 4g/dose (210g)

Pediatric dosage

  • 4g resin/5g powder
  • 4g resin/5.5g powder
  • 4g resin/5.7g powder
  • 4g resin/6.4g powder
  • 4g resin/9g powder 


Adult dosage

  • 4 g orally every 12-24 hours; increase gradually over 1-month intervals
  • Maintenance: 8-16 g/day orally divided every 12 hours; not to exceed 24 g/day

Pediatric dosage

  • 240 mg/kg/day orally divided every 8-12 hours; generally not to exceed 8 g/day

Dosage Considerations – Should be Given as Follows: 

  • See "Dosages."

What Are Side Effects Associated with Using Cholestyramine?

Common side effects of Cholestyramine include:

  • mild constipation, 
  • diarrhea, 
  • stomach pain, 
  • nausea, 
  • loss of appetite, 
  • bloating or gas, 
  • irritation of the tongue, and
  • itching or irritation around your rectal area

Serious side effects of Cholestyramine include:

  • hives, 
  • difficulty breathing, 
  • swelling of the face, lips, tongue, or throat, 
  • ongoing or worsening constipation, 
  • severe stomach pain, 
  • blood in the urine
  • black, bloody, or tarry stools, 
  • easy bruising, and 
  • unusual bleeding

Rare side effects of Cholestyramine include:

  • none 
This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

What Other Drugs Interact with Cholestyramine?

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

What Are Warnings and Precautions for Cholestyramine?


  • Hypersensitivity to bile-sequestering resins. 
  • Complete biliary obstruction. 

Effects of drug abuse

  • None

Short-Term Effects

  • See “What Are Side Effects Associated with Using Cholestyramine?”

Long-Term Effects

  • See “What Are Side Effects Associated with Using Cholestyramine?”


  • Use with caution in renal impairment
  • Volume depletion
  • Concomitant spironolactone therapy
  • Not for use with baseline fasting triglyceride levels over 300 mg/dL or type III hyperlipoproteinemia; use with caution in patients with triglyceride levels 250-299 mg/dL; perform fasting lipid panel in 4-6weeks after initiation; discontinue use if triglycerides are over 400 mg/dL; secondary causes of hyperlipidemia must be ruled out before therapy is initiated
  • Not to be used as monotherapy in hypertriglyceridemia
  • With prolonged use, increased risk of bleeding because of hypoprothrombinemia from vitamin K deficiency
  • May interfere with fat absorption and decrease absorption of fat-soluble vitamins (A, D, E, K)
  • May exacerbate preexisting constipation (initiate therapy at lower dosage in patients with history of constipation)
  • Special care must be taken to avoid constipation in patients with symptomatic coronary heart disease
  • Always mix with water or fluids; never ingest dry powder
  • Some formulations contain phenylalanine
  • Because of large quantities of chloride ion released from resin (which may lead to hyperchloremic acidosis and increase urinary calcium excretion on prolonged use), it may be advisable to reduce chloride intake
  • Take other drugs at least 1 hour before or 4-6 hours after taking cholestyramine to minimize possible interference with absorption

Pregnancy and Lactation

  • Use with caution if benefits outweigh risks during pregnancy.
  • Lactation: Drug does not enter breast milk; use with caution because of potential vitamin loss in the mother. 
Medscape. Cholestyramine.

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