Cholesterol-lowering medications - bile acid sequestrants

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Medications

Bile acid sequestrants include:

  • Cholestyramine (Questran, Questran Light, Prevalite, Cholestyramine Light)
  • Colestipol (Colestid, Colestid Flavored)
  • Colesevelam (Welchol)

Depletions

Taking bile acid sequestrants may deplete vitamins A, D, E and K.

Vitamin A (Retinol)

Low levels of vitamin A may cause:

  • Night blindness
  • Rough and dry skin
  • Itchy skin
  • Dull hair
  • Broken nails
  • Increased risk of infections

Vitamin D

Vitamin D, along with calcium, keeps your bones strong and healthy.

Low levels of vitamin D may cause:

  • Increased risk of osteoporosis
  • Softening of the bones, called rickets in children and osteomalacia in adults
  • Fractures even on minor injury
  • Muscle cramps
  • Seizures
  • Numbness or tingling in toes and feet
  • Poor immune response and some medical experts even suggest an increased risk of cancer

Vitamin E

It's rare to be deficient in vitamin E. Low levels of vitamin E may cause:

  • Diseases of the retina
  • Loss of coordination
  • Bone weakness
  • Unsteady way of walking

Vitamin K

Low levels of vitamin K may cause:

  • Poor clotting ability which can lead to bruising or possibly serious bleeding including potentially internal bleeding
  • Bone weakness

Taking cholestyramine may deplete vitamin B9.

Vitamin B9 (Folic Acid)

Low levels of folic acid in the body may be linked to:

  • Anemia
  • Heart disease
  • Birth defects

Symptoms may include:

  • Weakness
  • Mouth sores
  • Swollen tongue
  • Depression
  • Poor growth

Editorial Note

The information presented here covers some of the nutrients that may be affected when you take certain medicines. If you have any of these signs and symptoms, it does not always mean you have low levels of these nutrients.

Factors that affect the level of nutrients are:

  • Your medical history
  • Diet
  • Lifestyle
  • How long you have been taking the medicine

Please talk to your health care provider. They can best address your health care needs and see if you are at risk for low levels of any nutrients.

Supporting Research

Asiedu DK. Vitamin D deficiency. In: Ferri FF, ed. Ferri's Clinical Advisor 2017. Philadelphia, PA: Elsevier; 2017:1357-1358.

Asiedu DK. Vitamin deficiency (Hypovitaminosis). In: Ferri FF, ed. Ferri's Clinical Advisor 2017. Philadelphia, PA: Elsevier; 2017:1359-1360.

Dominiczak MH, Broom JI. Vitamins and minerals. In: Baynes JW, Dominiczak MH, eds. Medical Biochemistry. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 11.

Gold Standard Drug Database. Drug Monograph: Colestipol, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-148. Accessed July 5, 2016.

Gold Standard Drug Database. Drug Monograph: Colesevelam, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-2295. Accessed July 12, 2016.

Gold Standard Drug Database. Drug Monograph: Cholestyramine, 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-124. Accessed July 5, 2016.

Goldberg AC. Bile acid sequestrants. In: Ballantyne CA, ed. Clinical Lipidology: A Companion to Braunwald's Heart Disease. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 22.

Greenbaum LA. Vitamin E deficiency. In: In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 52.

Greenbaum LA. Vitamin K deficiency. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 53.

James WD, Berger TG, Elston DM. Nutritional diseases. In: James WD, Berger TG, Elston DM, eds. Andrews' Diseases of the Skin. 12th ed. Philadelphia, PA: Elsevier; 2016:chap 22.

Sachdev HPS, Shah D. Vitamin B complex deficiencies and excess. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 49.

Shenkin A, Roberts NB. Vitamins and trace elements. In: Burtis CA, Ashwood ER, Bruns DE, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th ed. St. Louis, MO: Elsevier Saunders; 2012:chap 31.

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