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Bile acid sequestrants are FDA-approved to manage hypercholesterolemia. They can be used in combination with HMG-CoA reductase inhibitors (statins) or as monotherapy. Often, bile acid sequestrants are used as adjuvant therapy to complement exercise and dietary modifications. This activity discusses their indications, mechanism of action, adverse effects, contraindications, and administration to lower LDL cholesterol. Objectives: Identify the mechanism of action of bile acid sequestrants. Assess the adverse effects of bile acid sequestrants. Evaluate the appropriate monitoring and contraindications of bile acid sequestrants. Communicate interprofessional team strategies for improving care coordination to improve outcomes when using bile acid sequestrants. Access free multiple choice questions on this topic.

Overdosage of cholestyramine (150% of the maximum recommended daily dosage) has been reported in patients taking it for several weeks. No adverse effects were reported. Excessive doses of colesevelam hydrochloride might cause more severe local gastrointestinal effects (eg, constipation). If overdosage occurs, the primary potential problem would be obstruction of the gastrointestinal tract. At this time, the degree of possible obstruction, the location of such obstruction,  and the absence or presence of normal gut motility would determine its treatment.

Primary care providers are often the first to identify hypercholesterolemia in their patients and typically recommend bile acid sequestrants for their patients. Still, therapy requires an interprofessional healthcare team for optimal results. Nutritionists and diabetes educators can also consult on the case to help educate patients on appropriate lifestyle modifications to support patients who need to make these changes while on bile acid sequestrants. Endocrinologists or cardiologists may offer consultation when patients have a complex presentation, are unresponsive to bile acid sequestrants, or have severe complications from bile acid sequestrants. Nurses will be on hand to counsel patients, provide administration instructions, and monitor adherence and treatment results on subsequent visits. Importantly, pharmacists play a critical role in evaluating proper bile acid sequestrants administration and preventing polypharmacy in patients who are often taking multiple medications, checking for drug interactions, verifying dosing, reporting all findings to the rest of the team. An interprofessional team approach, including physicians, specialists, specialty-trained nurses and educators, and pharmacists conversing across disciplines to optimize patient-specific management, is critical in utilizing bile acid sequestrants.