Colesevelam hydrochloride, Colestipol hydrochloride, Colestyramine
Issues for Surgery
For hyperlipidaemia – increase in cholesterol if omitted for prolonged period.
For diarrhoea associated with Crohn’s disease, ileal resection, vagotomy, diabetic vagal neuropathy or radiation – exacerbation of symptoms if omitted.
For pruritus associated with partial biliary obstruction and primary biliary cirrhosis – exacerbation of symptoms if omitted.
Potential for reduced bioavailability of other oral medicines if continued – see Interaction(s) with Other Common Medicines in the Perioperative Period.
Potential risk of increased bleeding tendency, secondary to reduced vitamin K absorption – see Further Information.
Advice in the Perioperative period
Elective and Emergency Surgery
Consider checking clotting screen pre-operatively in patients who have been taking bile acid sequestrants long-term and who are undergoing major surgery – see Further Information.
Ensure administration of bile acid sequestrant is separated from other oral medications to minimise effect on absorption (see Interaction(s) with Other Common Medicines in the Perioperative Period).
Patients undergoing Biliary Surgery
Patients undergoing Major Gastrointestinal Surgery
Interaction(s) with Common Anaesthetic Agents
None1, 2, 3, 4, 5.
Interaction(s) with other Common Medicines used in the Perioperative Period
Bile acid sequestrants may affect the bioavailability of other medicines; to limit this, bile acid sequestrant administration should be separated from other oral medicines (see figure 1 below).
Figure 1: Recommended time to administer other oral medications in relation to bile acid sequestrants1, 2, 3, 4, 5
Increased bleeding tendency