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Dyslipidemia
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
The bile acid sequestrants block reabsorption of intestinal bile acid. This forces the up-regulation of liver LDL receptors to recruit the circulating cholesterol and synthesize bile. These sequestrants reduce cardiovascular-related deaths. They are usually used along with statins or nicotinic acid. The sequestrants are the medications of choice for women planning to become pregnant, or who are already pregnant. Though safe, the sequestrants cause bloating, constipation, cramping, and nausea. They can also increase triglycerides, so they cannot be used if hypertriglyceridemia is present. The drugs called cholestyramine and colestipol interfere with absorption of thiazides, beta-blockers, digoxin, thyroxine, and warfarin. Colesevelam also interferes with these, but not as much. The interference between the drugs can be reduced by administration that is 4 or more hours before or 1 hour after. Bile acid sequestrants are more effective if they are taken during a meal.
Do I Have IBS?
Published in Melissa G. Hunt, Aaron T. Beck, Reclaim Your Life From IBS, 2022
Melissa G. Hunt, Aaron T. Beck
The good news is that there is a very effective treatment for bile acid diarrhea. You take a medication called a bile acid sequestrant (cholestyramine, colestipol, or colesevelam). The medicine binds to the bile acid and keeps it from pulling so much water into the large intestine. A positive response to a bile acid sequestrant is usually a pretty good sign that excess bile acid was causing diarrhea, to begin with. Unfortunately, there are two downsides to the treatment. First, the medicine is a little hard to take. The medications come in two forms – resinous powder that needs to be mixed with food (like apple sauce or yogurt) or pills. The powder doesn’t taste great and it’s got a weird gritty texture that most people find pretty unappealing. The pills are quite large and hard to swallow, and you usually have to take at least 4 of them a day to get any benefit. (If you try them, be sure to ask the pharmacist to give you the brand name drug, not the generic. The generic pills are even harder to swallow.) The other downside is that the medications interfere with the absorption of lots of other medications, so you have to take it two hours after or four hours before you take anything else. That can make it hard to time them and hard to remember to take them. On the other hand, if your symptoms are really the result of bile acid diarrhea, and not IBS, then taking one of these medications may solve your symptoms completely.
Irritable Bowel Syndrome
Published in Nicole M. Farmer, Andres Victor Ardisson Korat, Cooking for Health and Disease Prevention, 2022
It has been reported that up to 1/3 of people with IBS-D have bile acid malabsorption. Bile is made by the liver, stored in the gall bladder, and used to emulsify fats to help with absorption along the small intestine. Normally, the bile should be reabsorbed in the last section of the small intestine, the terminal ileum. In fact, in a healthy working digestive tract, it is estimated that 95% of the bile is reabsorbed. When this doesn’t happen, the bile acids make their way into the large intestine where they can cause diarrhea by various mechanisms. Removal of, or disease activity in, the terminal ileum can of course cause issues here, but this is less likely a cause of bile acid malabsorption in people with functional bowel disease like IBS. While there are tests for this, usually physicians will prescribe a therapeutic trial of bile acid sequestrants like colestipol to see if this improves the patient’s diarrhea (Camilleri 2015).
Consideration of quality of life in the treatment decision-making for patients with advanced gastroenteropancreatic neuroendocrine tumors
Published in Expert Review of Anticancer Therapy, 2023
Boris G. Naraev, Josh Mailman, Thorvardur R. Halfdanarson, Heloisa P. Soares, Erik S. Mittra, Julie Hallet
NET-related diarrhea is one of the most common and impactful symptoms affecting patient QoL [24,62]. There are several symptomatic treatments depending on the underlying pathophysiology: carcinoid syndrome, steatorrhea, short GI transit time, or excessive bile acids. For diarrhea due to carcinoid syndrome, SSA therapy is beneficial [72]. However, some patients with serotonin-producing tumors experience diarrhea that is inadequately controlled by SSAs. In these patients, telotristat ethyl should be considered as add-on therapy based on results from TELESTAR. Patients with poorly controlled diarrhea due to carcinoid syndrome may also benefit from RLT. Chronic SSA use may cause pancreatic insufficiency and steatorrhea [62,73], which can be addressed with pancreatic enzyme therapy and dietary adjustments. Additionally, patients with NETs who have undergone small bowel resection can develop diarrhea resulting from shortened GI transit time or decreased bile acid resorption [74]. Diarrhea resulting from short GI transit time can be improved with dietary adjustments, adjustment of fluid consumption, and certain medications. Bile acid sequestrants can address bile acid malabsorption. More generally, nutritional assessments and dietary modifications have the potential to improve patient symptoms (including but not limited to diarrhea) and QoL [75].
Managing dyslipidemia in patients with Type 2 diabetes
Published in Expert Opinion on Pharmacotherapy, 2021
Brian Tomlinson, Nivritti Gajanan Patil, Manson Fok, Christopher Wai Kei Lam
Bile acid sequestrants are one of the earliest groups of lipid-lowering therapies, but nowadays, they are rarely used because of poor tolerability with frequent gastrointestinal adverse effects [50]. Colesevelam may be better tolerated than cholestyramine and colestipol, and it can lower glucose levels and does have the indication for T2DM as well as hypercholesterolemia [108]. The bile acid sequestrants, and particularly colesevelam, can be taken in combination with statins and other lipid-modifying drugs in patients with T2DM to help achieve LDL-C and non-HDL-C targets, but they may result in an increase in triglyceride levels in some patients [50]. A meta-analysis of 15 studies with bile acid sequestrants found that therapy significantly improves HDL-C, LDL-C, and glycemic markers including fasting blood glucose and HbA1c levels [109,155].
Choosing an ideal pharmacotherapeutic strategy for dyslipidemia in children
Published in Expert Opinion on Pharmacotherapy, 2019
Dragana Nikolic, Andreea Corina, Peter. P. Toth, Lubna Hammad, Manfredi Rizzo
There is an urgent need for diagnosing pediatric dyslipidemia. It is important to increase awareness and to offer better education of young FH subjects and their parents. In secondary dyslipidemia, first line treatment must be changes in lifestyle. If despite 6 months of lifestyle intervention LDL cholesterol levels do not improve in children over 8–10 years of age, pharmacologic treatment should be considered. Statins and ezetimibe are well tolerated in children and adolescents. Bile acid sequestrants can also be considered. A new class of drugs, PCSK9 inhibitors, is the most promising therapy in children with homozygous FH. The biggest challenge is to institute adequate treatment for children with HeFH and nonFH and to evaluate the cost-effectiveness of treatment. To this end, long-term, well-design, randomized clinical trials are needed.