Choltran (cholestyramine) is a medication which prevents bile from being reabsorbed into the bloodstream after digestion, causing it to be excreted as waste instead. It is predominantly used to reduce levels of cholesterol in the blood, but also sees use in alleviating the severe itching associated with certain liver problems, alleviate diarrhea, and to encourage rapid elimination of other medications.

In other words, Choltran is used to:

• Lower cholesterol - The liver utilizes cholesterol to produce bile; removing bile from the system forces the liver to utilize more cholesterol, thus reducing overall levels in the blood.
• Sooth itching - Excess bile build up in the body may occur when the liver is unable to process reabsorbed bile correctly, causing severe itching; eliminating the excess bile reduces the itching.
• Reduce diarrhea - Bile in the intestine attracts water, which causes diarrhea. Patients who suffer chronic diarrhea after certain surgeries, such as gallbladder removal, or with certain conditions, such as irritable bowel syndrome, may find relief from symptoms by expelling excess bile.
• Eliminate medications - Choltran can also prevent reabsorption of certain medications, most commonly leflunomide, which may remain in the body for years after treatment stops. It may also be used in cases of overdose with some medications.

While very useful at what it treats, patients should have the condition evaluated by a doctor prior to starting treatment with Choltran. The medication will have no effect if reabsorption of bile is not contributing to the condition.

Likewise patients who have diabetes, a thyroid disorder, kidney or liver disease, chronic vitamin deficiency, or chronic constipation should discuss risks with a doctor prior to taking Choltran.

Taking Choltran

Choltran is most widely available as a powder; either individual sachets or a canister with a scoop. One sachet or one scoop represents one dose; the number of doses taken varies according to the condition being treated and patient response.

Powdered doses should be mixed in a non-carbonated beverage or high-liquid content food; water, juice, tea, soup, applesauce, and so forth are all viable options. Once mixed in, the beverage or food should be consumed immediately and in entirety.

Ideally a doctor will help a patient individualize treatment. Very rough treatment guidelines are:

• Treatment typically starts at low doses, 2 to 4 grams per day.
• Dosage is gradually increased, if needed, up to 24 grams per day.
• Small doses of 2 to 4 grams may be taken once per day.
• Higher doses of 5+ grams per day are typically divided into two or more smaller doses, taken throughout the day.

Detailed instructions are included with each package of Choltran. Some additional tips to ensure treatment goes well:

• Each scoop or sachet should be mixed with 2 to 6 ounces of fluid or food.
• Do not consume dry powder.
• Do not hold the medicated fluid or food in the mouth; this can result in tooth discoloration.
• Drink plenty of fluids throughout treatment to ensure hydration and prevent constipation.
• Do not exceed the daily prescribed dose---doing so may result in severe constipation.

Additional dietary changes are often recommended along with Choltran, to further enhance the medication's effects and minimize side effects, as well as further control the underlying condition.

Potential Complications

Choltran binds with bile in the digestive tract, and binds to many other substances that might otherwise bind to bile. This can cause a range of complications as far as absorbing nutrients and other medications, particularly if used long term.

If the medication is used for more than a couple of weeks, patients may start to experience depletion of vitamins A, D, E, and K. These patients may be prescribed a multivitamin to compensate, which should be taken several hours before or after a dose of Choltran.

Other medications should also be taken several hours before or after a dose of Choltran, though this may not be enough in all cases. Double-check with a doctor regarding all other medications taken during treatment, particularly vital medications.

Women who are pregnant or breastfeeding should avoid this product if at all possible due to nutrient deficiency concerns.

The most common side effect associated with Choltran is constipation. Increasing fluid intake is the best way to prevent this from happening. Consult a doctor if it becomes severe.

Other side effects are rare and most are harmless, including mild constipation or diarrhea, mild stomach upset, bloating, and itching around the anus. Very rarely more serious reactions occur, which call for emergency medical attention:

• Blood in urine or stools
• Severe constipation
• Severe stomach pain
• Difficulty breathing

Regular doctor check-ups are advisable for all patients taking Choltran, to ensure it is working as intended and to monitor any possible subtle side effects, such as vitamin deficiency.