- Company Name: Bristol Mayer Squibb.
- Trade Name: Questran Powder
- Generic Name: Cholestyramine
- Composition: 4 gm/sachet Cholestyramine
- Pharmaceutical Form: Powder
Pharmacological Action
Cholestyramine, the active ingredient of Questran, is the chloride salt of a basic anion-exchange.resin.
In the small intestine, cholestyramine binds bile acids forming an insoluble complex which prevents intestinal reabsorption of bile acids and promotes their fecal excretion.
As a result, the rate of hepatic conversion of cholesterol to bile acids is increased causing depletion of the hepatocytes cholesterol contents with a subsequent increase in hepatic low-density lipoprotein (LDL) receptor activity.
These changes enhance the clearance of LDL from plasma and, in turn, reduce elevated plasma cholesterol levels.
Questran is also of therapeutic value for the relief of pruritus, due to partial biliary obstruction, and diarrhea caused by increased concentrations of bile acids in the colon.
Questran, in addition, is capable of binding oxalic acid and other negatively charged molecules within the lumen of the GIT, a property which broadens the therapeutic spectrum of Questran
Pharmacokinetics
Cholestyramine is not absorbed from the digestive tract.
Indications
Questran is used for:
- Primary prevention of coronary heart disease in men between 35 and 59 years of age and with primary hypercholesterolaemia who have not responded to diet and other appropriate measures.
- Reduction of plasma cholesterol in hypercholesterolaemia, particularly in those patients, who have been diagnosed as Fredrickson’s Type 2 (high plasma cholesterol with normal or slightly elevated triglycerides.
- Relief of pruritus associated with partial billiary obstruction and primary biliary cirrhosis
- Relief of diarrhea associated with ileal resection, Crohn’s disease, vagotomy and diabetic vagal neuropathy.
- Management of radiation-induced diarrhea.
Dosages
Adults:
1- For primary prevention of coronary heart disease and to reduce cholesterol: After initial introduction over a three to four week period, 3 to 6 Questran sachets per day, administered either as a single daily dose or in divided doses up to four times daily, according to dosage requirements and patient acceptability.
Dosage may be modified according to response and can be increased to 9 sachets per day if necessary.
Occasional slight gastro-intestinal upsets, e.g. constipation, may occur on starting Questran. These usually pass with continued usage of Questran and are minimised by starting therapy gradually (see Table below)
| Final dose required | Week 1 | Week 2 | Week 3 | Week 4 |
| Sachets per day | ||||
| 3 | 1 | 2 | 3 | 3 |
| 4 | 1 | 2 | 3 | 4 |
| 6 | 1 | 2 | 3 | 5 |
2- To relieve pruritus: One or two sachets daily are usually sufficient.
3- To relieve diarrhea: As for reduction of cholesterol but it may be possible to reduce this dosage. In all patients presenting with diarrhoea induced by bile acid malabsorption, if a response is not seen within 3 days, then alternative therapy should be initiated.
Children:
Children 6-12 years: 80 mg/kg body weight. 3 times daily,
Infants and children under 6 years: the dosage has not been established.
Elderly:
No dosage adjustment is necessary.
Preparation and administration:
Questran should not be taken in dry form. The dose is prepared by adding the contents of one sachet to a glass of water (about 150 ml).
Allow to stand without stirring for 1-2 minutes, then stir and mix thoroughly to obtain a homogeneous suspension, Questran may also be taken with juices or other fluids.
Contraindications
In patients with complete biliary obstruction, since Questran cannot be effective where bile is not secreted into the intestine.
Side effects
Since Questran may interfere with the absorption of fat soluble vitamins, the diet may require supplementation with Vitamins A,D and K during prolonged high dose administration.
Chronic use of Questran may be associated with increased bleeding tendency due to hypoprothrombinaemia associated with Vitamin K deficiency. This will usually respond promptly to parenteral Vitamin K administration; recurrences can be prevented by oral administration of Vitamin K.
Hyperchloraemic acidosis has occasionally been reported following the prolonged use of anion exchange resins.
Gastro-intestinal side effects are those most frequently reported. The principal complaint is constipation which may be controlled with the usual remedies, and frequently disappears on continued usage of Questran.
Large doses of Questran can cause diarrhoea.
Drug Interactions
Questran may delay or reduce the absorption of certain drugs (such as digitalis, tetracycline, chlorothiazide, warfarin and thyroxine).
The response to concomitant medication should be closely monitored and appropriate adjustments made if necessary.
Questran may interfere with the pharmacokinetics of drugs that undergo enterohepatic recirculation. Patients should take other drugs at least one hour before or 4-6 hours after Questran to minimize possible interference with their absorption.
Reference files and articles related to Questran sachets
Ch0lestran powder PIL – Arabic / PDF file.
Ch0lestran powder PIL – English/Medical Professions – PDF.
Cholestyramine – Brand names of medicines available in the countries of the Middle East and North Africa
The following list contains a list of the trade names of medicines containing cholestyramine at a concentration of 4 grams (4000 milligrams) in each sachet. All the pharmaceutical products mentioned later are considered equivalent products, and any of them replaces the other in the event that it is not available:
- Ch0lestran sachets – Pharco Pharmaceutical Company / Egypt.
- Quantamash Bags – Mash Premier Company/ Egypt.
- Qustran sachets – Bristol-Myers Squibb / Multinational Company
- Trade name: Questran powder for oral suspension preparation.
- Pharmaceutical form: sachets containing 4 grams of powder.
- Package description: A package containing 50 sachets.
- Scientific name: cholestyramine.
- Producing Company: Bristol Mayer Squibb (BMS)
- Price: It ranges between 55 to 60 USD or its equivalent in the local currency of your country of residence.
- Availability: Egypt, and some countries in the Middle East, North and Central Africa
- Common Uses: Increased cholesterol in the blood – Itching associated with jaundice
- Legal description: dispensed by prescription
- Therapeutic group: Blood lipid modulators.
- Therapeutic subclass: bile acid sequestrants.
- Therapeutic and Anatomical Classification Code: C10AC01.