Effect of colestimide on intestinal absorption of ursodeoxycholic acid in men

Colestimide is a new anion-exchange resin which is used to lower serum cholesterol levels in Japan. Because of its excellent compliance, colestimide can replace cholestyramine in the treatment of pruritus. However, there may be an interaction in cholestatic patients undergoing treatment with ursodeoxycholic acid (UDCA). Therefore, we studied the effect of colestimide on the absorption of UDCA in men. Five healthy men took two 100 mg tablets of UDCA after a test meal following an overnight fast, and blood samples were collected every 30 min for 3 h. Two weeks later, the same study was repeated just after taking colestimide granules (1.5 g). Bile acid subfractions in serum were measured by HPLC. Serum UDCA levels after 30 min (mainly unconjugated), which reflect the initial absorption, were decreased > 50% by colestimide in 4 out of 5 subjects. Serum total bile acid levels after 30 min, which reflect the initial absorption of bile acids due to postprandial bile secretion, were decreased by colestimide in all subjects. These results indicate that colestimide administration before the meal inhibits UDCA absorption.