The effect of cholestyramine on intestinal absorption

Area of Science:

• Pediatric Endocrinology
• Clinical Pharmacology

Background:

• Familial hypercholesterolemia (FH) is a genetic disorder leading to high cholesterol levels.
• Cholestyramine, an anion exchange resin, is used to treat hypercholesterolemia by binding bile acids.

Purpose of the Study:

• To evaluate the long-term effects of cholestyramine in children with familial hypercholesterolemia.
• To assess potential nutrient deficiencies and other side effects associated with cholestyramine therapy.

Main Methods:

• 18 children with FH received cholestyramine (0.6 g/kg/day) for 1-2.5 years.
• Serum and red cell folate levels were monitored, along with vitamins A, E, prothrombin time, and inorganic phosphorus.
• Faecal fat excretion was assessed in a subset of patients.

Main Results:

• Prolonged cholestyramine treatment led to folate deficiency (serum folate decreased from 7.7 to 4.4 ng/ml).
• Oral folic acid supplementation (5 mg daily) corrected folate depletion.
• Decreases in serum vitamins A and E, and inorganic phosphorus were observed, though values remained within normal limits.
• Faecal fat excretion increased in most children, but growth and prothrombin time remained normal.

Conclusions:

• Long-term cholestyramine therapy in children with FH necessitates folic acid supplementation to prevent deficiency.
• Monitoring of fat-soluble vitamins and prothrombin time is advisable, though routine supplementation may not be necessary.
• Cholestyramine is generally well-tolerated in children, with normal growth and no significant gastrointestinal issues like diarrhea.