When you hear cholestyramine, a bile acid sequestrant used to lower LDL cholesterol and relieve itching caused by liver conditions. Also known as Questran, it doesn’t get absorbed into your bloodstream—it works right in your gut to bind bile acids and pull them out of your body. This forces your liver to make more bile, which uses up cholesterol, and that’s how it lowers your blood cholesterol levels. Unlike statins, it doesn’t touch your liver enzymes directly, but it can still mess with how other meds work.
Cholestyramine is part of a group called bile acid sequestrants, oral resins that trap bile acids in the intestines to reduce cholesterol reabsorption. Other drugs in this class include colesevelam and colestipol, but cholestyramine is the oldest and most commonly used. It’s often prescribed when statins aren’t enough, or when someone can’t tolerate them. It’s also used for itching from cholestasis—when bile flow from the liver gets blocked. That’s why you’ll see it pop up in posts about liver health and drug interactions, like those involving liver enzymes, proteins that help process medications and toxins in the liver. Even though cholestyramine doesn’t harm the liver, it can block absorption of other drugs that rely on those enzymes, like thyroid meds, warfarin, or even some antibiotics.
You can’t just take cholestyramine with your other pills. It binds to everything in your gut—good and bad. That means if you take it at the same time as your blood pressure pill or vitamin D, you might not absorb any of it. The rule? Take cholestyramine at least one hour before or four hours after any other medication. This isn’t just a suggestion—it’s how you avoid making your other meds useless. People who take it long-term often end up with low levels of fat-soluble vitamins (A, D, E, K), so doctors sometimes recommend supplements. And yes, it’s gritty. It comes as a powder you mix with water or juice. Some people hate the texture, but if it’s working, most learn to live with it.
What you’ll find in the posts below isn’t just a list of facts—it’s real-world guidance. You’ll see how cholestyramine plays into bigger topics like drug interactions with macrolides, how liver metabolism affects medication safety, and why knowing what’s in your medicine cabinet matters. Whether you’re managing high cholesterol, dealing with bile-related itching, or just trying to avoid dangerous combos, this collection gives you the straight talk you need.
Cholestatic pruritus is a severe, non-histamine-related itching caused by liver bile buildup. Bile acid resins like cholestyramine are first-line, but newer drugs like maralixibat offer better tolerability and effectiveness. Learn what works, what doesn't, and what's coming next.