THE EFFECT OF CHOLESTYRAMINE ("MK 135") ON THE SERUM CHOLESTEROL LEVEL IN MAN

Interaction by cholestyramine on the uptake of hydrocortisone in the gastrointestinal tract

An absolute reduction of the plasma cortisol levels and a delay of the peak concentrations were recorded in 10 healthy subjects, when a bile-sequestering anionic exchange resin, cholestyramine, was given prior to a single oral hydrocortisone dose, indicating that the resin interferes with the uptake of a neutral sterol in the human gastrointestinal tract. The possibility of a direct binding of drug to resin is supported by the affinity of hydrocortisone to cholestyramine in vitro, which was uninfluenced by the presence of sodium taurocholate. Cholestyramine significantly delayed the gastric emptying of a glucose solution, indicating that the resin not only decreases but also delays hydrocortisone absorption. Careful supervision is recommended when treatment with cholestyramine is given concomitant to neutral sterol drugs.

Use of cholestyramine in treatment of children with familial hypercholesterolaemia

19 children with heterozygous familial hypercholesterolaemia have been treated with cholestyramine administered twice daily in a total dosage of 8 to 24 g/day (0·3 to 1·1 g/kg body weight per day). Serum cholesterol concentration was reduced by a mean of 36% (range 27 to 47%). The therapeutic effect was similar whether or not dietary fat was restricted, and the reduction in serum cholesterol has been maintained for periods of up to 20 months. Side effects of cholestyramine have been confined to the gastrointestinal tract. Absorption of fat was impaired in some patients, but has not been associated with diarrhoea. Serum folate levels have decreased in all patients, and 6 out of 12 tested have had subnormal red blood cell folate. There has been no evidence of malabsorption of other vitamins or of minerals. Growth rate has been normal in all children.