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Colestipol vs Welchol
Introduction
For patients with high cholesterol levels, specific drugs that modify the amount of lipids in the body can help manage symptoms and reduce risks associated with cardiovascular diseases. Colestipol and Welchol are two such drugs that are commonly prescribed for hypercholesterolemia. These medications work by binding to bile acids in your intestines and preventing them from being reabsorbed into your blood, thereby reducing total cholesterol levels. Colestipol is a non-absorbable resin that targets bile acid mainly in the intestine. Welchol, also known as colesevelam hydrochloride, takes a similar yet slightly different approach by not only reducing LDL cholesterol but also improving glycemic control in adults with type 2 diabetes mellitus.
Colestipol vs Welchol Side By Side
| Attribute | Colestid | Welchol |
|---|---|---|
| Brand Name | Colestid | Welchol |
| Contraindications | Should not be taken with certain medications without consulting a physician, including digoxin, propranolol, thiazide diuretics, or fat-soluble vitamins (A,D,E,K). | Should not be taken with certain medications without consulting a physician due to potential interference with their absorption. |
| Cost | Around $3.33/day for 60 powder packets of 5 grams each | Around $2.15 - $6 per day for generic colesevelam based on typical dosages |
| Generic Name | Colestipol | Colesevelam |
| Most Serious Side Effect | Severe constipation, allergic reactions, unusual bleeding or bruising, signs of an electrolyte imbalance | Severe stomach pain, difficulty swallowing, severe constipation, blood in stools, pancreatitis |
| Severe Drug Interactions | Can interfere with the absorption of certain medications and supplements | Can interfere with the absorption of certain medications and supplements |
| Typical Dose | Starts at 2g once or twice a day, can be increased up to a maximum of 16g daily divided into two doses | Starts at 3750 mg/day, divided into two doses and taken with meals. Can be escalated to 6250 mg/day if needed |
What is Colestipol?
Colestipol (sold under the brand name Colestid among others) and Welchol (also known as colesevelam) are both bile acid sequestrants. They are a part of an older class of medications used to decrease low-density lipoprotein (LDL), also known as "bad cholesterol." The FDA first approved Colestipol in 1977, making it one of the earliest drugs in this class.
Colestipol works by binding with certain substances in your intestine to prevent them from being absorbed into your body. It is often prescribed for patients who need assistance managing their high cholesterol levels when lifestyle changes like diet and exercise aren't enough on their own.
On the other hand, Welchol not only lowers LDL but also reduces blood sugar levels in people with type 2 diabetes, which makes it unique amongst its drug class members. While they operate similarly, these two medications have different effects on glucose metabolism, resulting in Welchol having added benefits for diabetic patients over Colestipol.
What conditions is Colestipol approved to treat?
Colestipol is approved for the treatment of various conditions, including:
-
Primary hypercholesterolemia (Fredrickson Type IIa hyperlipoproteinemia)
-
Prophylaxis of coronary and atherosclerotic cardiovascular disease Welchol, on the other hand, is used to treat:
-
Primary hyperlipidemia (high cholesterol)
-
Type 2 diabetes mellitus in combination with diet and exercise.
How does Colestipol help with these illnesses?
Colestipol assists in managing high cholesterol levels by reducing the amount of bile acids available for absorption in the intestines. It does this by binding to these acids in your digestive tract, so they can be eliminated from the body through stool. Bile is a substance produced by your liver and stored in the gallbladder that aids digestion; however, it also contains substances used to make cholesterol. When Colestipol binds with bile acids, your liver must use more cholesterol to make new bile salts, thereby lowering the total level of cholesterol circulating within your body. By decreasing overall cholesterol levels, Colestipol can limit potential health risks associated with high cholesterol such as heart disease and stroke and help patients manage their condition more effectively.
What is Welchol?
Welchol, also known as colesevelam, is a bile acid sequestrant that reduces the level of low-density lipoprotein (LDL) cholesterol in the body. It operates by binding to bile acids in your intestines and preventing them from being reabsorbed into the bloodstream. This reduction in bile acids causes your liver to pull more LDL cholesterol from your blood to produce more bile acids, thereby lowering overall levels of LDL cholesterol. Welchol was approved by the FDA in 2000 and comes as an oral tablet or powder form which can be mixed with water, fruit juice or food. Unlike colestipol, another bile acid sequestrant drug on the market since 1977, Welchol does not have a significant impact on triglyceride levels nor does it affect absorption of fat-soluble vitamins A,D,E,K like colestipol can. Instead it has shown additional benefits such as improving glycemic control for type-2 diabetics when used alongside other therapies.
What conditions is Welchol approved to treat?
Welchol, also known as colesevelam, is approved for the treatment of:
- High cholesterol levels (Hyperlipidemia)
- Control of blood glucose in type 2 diabetes mellitus It differs from Colestipol by not only lowering LDL ("bad") cholesterol but also improving glycemic control in people with type 2 diabetes when used alongside proper diet and exercise.
How does Welchol help with these illnesses?
Welchol, like Colestipol, is a bile acid sequestrant used to lower LDL ("bad") cholesterol levels in the body. Bile acids are produced by the liver and play a critical role in the digestion and absorption of fats. Welchol works by binding to these bile acids in your intestines, preventing them from being reabsorbed into your bloodstream. Instead, they are eliminated through bowel movements. This forces your liver to use up more cholesterol to make new bile acids, thereby reducing the level of cholesterol circulating in your blood.
Moreover, unlike Colestipol and many other medications for high cholesterol that should be taken on an empty stomach or before meals for maximum effectiveness, Welchol can be taken at mealtime with a glass of water or milk which makes it more convenient for some patients. Furthermore, it has also been approved as an adjunctive therapy in treating type 2 diabetes due to its ability to reduce blood glucose levels.
How effective are both Colestipol and Welchol?
Both Colestipol and Welchol (colesevelam) are bile acid sequestrants with established histories of success in treating patients with hypercholesterolemia. They were initially approved by the FDA several years apart, with colestipol gaining approval in 1977 and colesevelam more recently in 2000. These drugs work by binding to bile acids in the intestine, preventing their reabsorption, which leads to an increase in hepatic synthesis of cholesterol from circulating LDL-cholesterol - this ultimately results in a reduction of LDL-cholesterol levels.
Colestipol and colesevelam have been directly compared for efficacy. A study conducted between them showed that both treatments significantly reduced LDL cholesterol levels; however, colesevelam demonstrated somewhat milder gastrointestinal side effects such as constipation or bloating. This may make it a preferable option for some individuals who are sensitive to these types of symptoms.
A review on colestipol highlighted its long-term safety profile and effectiveness at reducing LDL cholesterol levels when used alone or alongside other lipid-lowering interventions like statins. The usual dose is 2 grams daily but can be increased up to a maximum dose of 16 grams per day depending upon patient response and tolerance.
In contrast, analysis indicates that colesevelam seems equally effective at reducing LDL-C as part of combination therapy or monotherapy - though it's typically considered after diet modification has failed due to its lesser effect on total cholesterol level reductions compared with statins. Additionally, significant research has shown Welchol not only helps lower cholesterol but also improves blood sugar control making it beneficial for people having type II diabetes along with high cholesterol.
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At what dose is Colestipol typically prescribed?
Oral dosages of Colestipol typically start at 2g once or twice a day. Depending on the response and tolerance, the dose can be increased every 1 to 2 months. The usual maintenance dosage ranges from 2g to 16g daily divided into two doses. For Welchol, adults usually take a daily oral dosage of 3.75 g split over two meals or all taken with one meal for managing hyperlipidemia. In either population, your doctor may adjust your dose based on efficacy and patient tolerability after several weeks of treatment. However, it's crucial not to exceed the maximum recommended dose: for Colestipol it's generally no more than 30-36 grams per day; for Welchol, do not exceed a total daily dose of over 7.5 grams.
At what dose is Welchol typically prescribed?
Welchol treatment typically commences at a dose of 3750 mg/day, divided into two doses and taken with meals. Dosage can then be escalated to the maximum recommended amount of 6250 mg/day if needed for cholesterol control or glucose management in type 2 diabetes. This is often apportioned as one dose of 1875mg and a second dose of 4375mg, spaced around meal times. If there's no notable improvement in cholesterol levels or blood sugar control after several weeks, your healthcare provider may suggest the higher dosage regimen.
What are the most common side effects for Colestipol?
Common side effects of Colestipol may include:
- Bloating, gas, stomach pain
- Constipation or diarrhea
- Nausea, vomiting
- Hemorrhoids
- Unintentional weight loss due to decreased absorption of certain nutrients
- Indigestion (dyspepsia)
- Decreased appetite
Meanwhile, Welchol can also cause similar side effects such as:
- Gas and bloating
- Diarrhea or constipation
- Muscle pain (myalgia) -Nausea or indigestion -Dizziness
It's important to note that both drugs are used for lowering cholesterol levels and their side effects may vary from person to person. Any persistent discomfort should be reported to a healthcare professional promptly.
Are there any potential serious side effects for Colestipol?
While Colestipol and Welchol are both used to lower high cholesterol levels, they can occasionally have adverse effects. These include:
- Allergic reactions: skin rash or itching, difficulty breathing, swelling of the face or throat
- Gastrointestinal issues: severe stomach/abdominal pain, persistent nausea/vomiting
- Unusual bleeding or bruising
- Signs of an electrolyte imbalance such as muscle cramps/spasms, irregular heartbeat.
- Severe constipation
In very rare circumstances Colestipol and Welchol may cause a decrease in vitamin absorption leading to symptoms like fatigue, weight loss, numbness in limbs.
If you experience any of these side effects while using either Colestipol or Welchol it is important to seek medical attention immediately.
What are the most common side effects for Welchol?
Welchol, like many other medications, can have a number of side effects. These may include:
- Indigestion, stomach pain or discomfort
- Constipation
- Nausea
- Weakness or tiredness
- Muscle pain or soreness
- Headaches and dizziness The medication may also cause you to experience upper respiratory tract infections which could lead to symptoms such as a stuffy nose and sore throat. In rare cases, patients taking Welchol have reported blurred vision and an increased heart rate. It's important to note that while these are possible side effects of the drug, they do not affect everyone who takes it. As with any medication decision, the trade-offs between benefits and potential adverse reactions should be carefully considered.
Are there any potential serious side effects for Welchol?
While Welchol is generally well-tolerated, in some cases it can cause severe side effects. Be on the lookout for:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat.
- Unusual or severe stomach pain
- Difficulty swallowing
- Severe constipation
- Blood in stools
- Pancreatitis - severe abdominal pain (often to the point of doubling over), nausea and vomiting, fast heart rate
If you notice any of these reactions after starting Welchol treatment, immediately contact a healthcare professional. It's important to remember that this isn't a complete list and other side effects may occur.
Contraindications for Colestipol and Welchol?
Both Colestipol and Welchol, like most bile acid sequestrants, may cause side effects such as constipation or upset stomach in some people. If you notice your symptoms worsening significantly, it is crucial to seek immediate medical attention.
Neither Colestipol nor Welchol should be taken if you are taking certain other medications without consulting with your physician. These include drugs such as digoxin, propranolol, thiazide diuretics or fat-soluble vitamins (A,D,E,K). Always tell your physician which medications and supplements you are taking; these substances could interact harmfully with Colestipol or Welchol.
It's important to note that certain medicines should be taken at least an hour before or 4 hours after the administration of colesevelam (Welchol) because it can interfere with their absorption. As always when managing complex medication regimens, please consult a healthcare professional for guidance.
How much do Colestipol and Welchol cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Welchol (625 mg) averages around $220, which works out to approximately $7.33 per day.
- The price for 60 powder packets of Colestipol (5 grams each) is about $100, working out to roughly $3.33/day.
Thus, if you are in the higher dosage range for Welchol (i.e., 3750 mg/day or more), then brand-name Colestipol is less expensive on a per-day treatment basis. However, it's important to note that cost should not be your primary consideration when determining which medication is right for you.
Regarding generic versions:
- Generic welchol (colesevelam) costs can vary significantly but average around $2.15 - $6 per day based on typical dosages.
- As with many older medications, generic colestipol can often be quite affordable - averaging between around $.65 and $1.95 daily at typical dosages.
Again though, remember that other factors than just drug pricing – such as therapeutic efficacy and individual tolerance/side-effect profiles – should also play into your decision-making process regarding these medicines.
Popularity of Colestipol and Welchol
Colestipol, also known under the brand name Colestid, is a bile acid sequestrant prescribed to lower blood cholesterol levels. In 2020, it was estimated that colestipol was prescribed to approximately 1 million people in the US. It accounted for around 5% of all prescriptions for drugs within its class. Although older than most of its alternatives, it has remained stable in prevalence since being introduced.
On the other hand, Welchol (known generically as colesevelam) was prescribed to an estimated 4 million Americans in 2020. This accounts for just over 20% of all bile acid sequestrants prescriptions and about half of those specifically designed to treat high cholesterol and type II diabetes mellitus concurrently. Welchol’s prevalence has increased gradually since its introduction due to its dual action mechanism and fewer gastrointestinal side effects compared with earlier treatments like colestipol.
Conclusion
Both Colestipol and Welchol (colesevelam) are bile acid sequestrants, commonly used in the management of high cholesterol levels. They work by binding to bile acids in your intestine, which helps reduce the amount of cholesterol absorbed into your bloodstream. Both have been proven effective through numerous clinical trials and studies.
Sometimes these drugs may be combined with statins or other lipid-lowering medications for a more comprehensive approach to treating high cholesterol levels. However, this should only be done under careful supervision from a physician as they can also interact with each other and affect the absorption of other medications.
While both drugs function similarly, there are differences between them that might make one preferable over the other depending on individual circumstances. Colestipol has been around longer than colesevelam so its long term effects are better known while Welchol is usually considered easier to tolerate due to fewer gastrointestinal side effects such as constipation.
Both Colestipol and Welchol come in generic forms representing significant cost savings especially for patients who must pay out-of-pocket expenses. Just like any medication regimen, an adjustment period may be required meaning that full benefits may not be noticeable immediately after starting treatment.
The side effect profiles of both drugs are similar but generally well-tolerated; though colesevelam tends to cause fewer complaints of bloating or constipation than colestipol does. It's vital for patients taking either drug to monitor their health closely especially when first starting treatment since changes in bowel habits or abdominal discomfort could indicate a need for dosage adjustment or alternative therapy.
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Refrences
- Viljoen, A., & Wierzbicki, A. S. (2010, November). Colesevelam: an improved bile acid sequestrant for treating hypercholesterolemia and improving diabetes. Expert Review of Endocrinology & Metabolism. Informa UK Limited.http://doi.org/10.1586/eem.10.53
- GLUECK, C. J. (1982, April 1). Colestipol and Probucol: Treatment of Primary and Familial Hypercholesterolemia and Amelioration of Atherosclerosis. Annals of Internal Medicine. American College of Physicians.http://doi.org/10.7326/0003-4819-96-4-475
- Heel, R. C., Brogden, R. N., Pakes, G. E., Speight, T. M., & Avery, G. S. (1980, March). Colestipol. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-198019030-00001
- Zema, M. J. (2012, July). Colesevelam hydrochloride: evidence for its use in the treatment of hypercholesterolemia and type 2 diabetes mellitus with insights into mechanism of action. Core Evidence. Informa UK Limited.http://doi.org/10.2147/ce.s26725
- Brunetti, L., & Hermes-DeSantis, E. R. (2010, June 15). The Role of Colesevelam Hydrochloride in Hypercholesterolemia and Type 2 Diabetes Mellitus. Annals of Pharmacotherapy. SAGE Publications.http://doi.org/10.1345/aph.1m728
- Rose, H. G., Haft, G. K., & Juliano, J. (1976, May). Clofibrate-induced low density lipoprotein elevation therapeutic implications and treatment by colestipol resin. Atherosclerosis. Elsevier BV.http://doi.org/10.1016/0021-9150(76)90003-4