Colesevelam - a lipid-lowering medicine (Cholestagel)

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Take colesevelam tablets after some food, such as a snack or meal. Swallow the tablets with a drink of water.

Colesevelam can stop the absorption of many other medicines. Take the other medicines four hours before colesevelam, or wait until at least four hour afterwards. If you have any problems planning when to take your medicines speak with your doctor or pharmacist for advice.

The main side-effects of colesevelam are wind and constipation.

Type of medicineA bile acid binder (sequestrant)
Used forLowering cholesterol
Also calledCholestagel®
Available asTablets

Colesevelam works in the body as a bile acid sequestrant. This means that it binds to bile acids in your digestive system. It prevents the bile acids from being recycled (reabsorbed) into your body. This action can be useful for people who have higher than normal levels of cholesterol in their blood.

Cholesterol is a type of lipid, or fat. Lipids are easily stored in your body and serve as a source of energy. They are made naturally in your body from the food you eat. When the concentration of cholesterol in your blood is too high, it is called hypercholesterolaemia. By taking colesevelam, it prevents your bile acids from being reabsorbed and as a consequence your liver has to make more bile acids. It does this by using cholesterol from your blood. This lowers the amount of cholesterol in your blood and reduces your risk of heart and blood vessel disease.

Colesevelam may be prescribed on its own to treat high cholesterol, or you may also be given other lipid-lowering medicines to take alongside it.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking colesevelam it is important that your doctor knows:

  • If you are pregnant, trying for a baby or breast-feeding.
  • If you have a condition which blocks the flow of bile from your liver.
  • If you have any bowel problems such as a blockage, an inflammatory bowel disease, bowel movement problems, or if you have recently had any bowel surgery.
  • If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • If you have ever had an allergic reaction to a medicine.
  • Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about colesevelam and will provide you with a full list of the side-effects which you may experience from taking it.
  • Take the tablets exactly as your doctor tells you to. It is usual to be prescribed 4-6 tablets a day, taken in either one or two doses. Take colesevelam tablets with some food such as a snack, or straight after a meal. Swallow the tablets with a drink of water.
  • Colesevelam tablets can stop the absorption of many other medicines. If you are taking other medicines, these should be taken four hours before you take colesevelam or 4-6 hours afterwards. This is particularly important if you are taking the combined oral contraceptive 'pill'. If, however, you are taking a statin medicine or a medicine called ezetimibe to help reduce your cholesterol, these medicines can be taken at the same time as colesevelam. If you have any problems planning when to take your medicines speak with your doctor or pharmacist.
  • If you forget to take a dose, take it as soon as you remember. Try to take the correct number of tablets each day.
  • Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress. You will need to have blood tests from time to time to measure your cholesterol level.
  • Taking colesevelam over a period of time can reduce your body's absorption of fat-soluble vitamins (vitamins A, D and K) and folic acid. Your doctor may advise you to take a supplement containing these vitamins.
  • Your doctor may give you advice about lifestyle changes that could help you get the most out of your treatment. This may include reducing the amount of salt in your diet, stopping smoking, losing weight, reducing the amount of alcohol you drink, and taking regular exercise. Following this advice will help you to reduce your risk of developing heart and blood vessel disease in the future.
  • If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.
  • If you buy any medicines 'over-the-counter', check with a pharmacist that they are suitable for you to take.
  • Treatment with colesevelam is usually long-term.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with colesevelam. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Common colesevelam side-effectsWhat can I do if I experience this?
ConstipationTry to eat a well-balanced diet and drink plenty of water
Headache, muscle aches or painsAsk your pharmacist to recommend a suitable painkiller
Wind (flatulence), indigestion, stomach upsetStick to simple meals - avoid rich or spicy food
Changes to some blood test resultsYour doctor will check for these

If you experience any other symptoms which you think may be due to the tablets, speak with your doctor or pharmacist for further advice.

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Further reading & references

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Helen Allen
Current Version:
Peer Reviewer:
Dr Helen Huins
Document ID:
13851 (v2)
Last Checked:
Next Review:
The Information Standard - certified member

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