A bile acid sequestrant
Colestipol
A medicine that lowers cholesterol by binding bile acids in the gut, often used when other options are unsuitable.
What is Colestipol?
Colestipol is a cholesterol-lowering medicine that works inside the gut. It binds bile acids so the body makes more from cholesterol, which lowers cholesterol in the blood. It commonly causes constipation and bloating, and because it can bind other medicines and fat-soluble vitamins in the gut, these should be taken at a different time. It is often used when statins are unsuitable or as an add-on. In the UK it is known by the brand Colestid.
Education and reference only. This is a plain-language guide to Colestipol — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Colestipol is a cholesterol-lowering medicine that belongs to a group called bile acid sequestrants. Rather than being absorbed into the blood, it stays in the gut and works there. It is taken as a powder mixed with liquid, or sometimes as granules or tablets. It is used to lower high cholesterol, often in people who cannot take statins, who need an additional medicine, or in certain situations such as relieving itch caused by bile build-up.
How it works
Bile acids are made by the liver from cholesterol and released into the gut to help digest fat. Colestipol binds these bile acids so they are passed out in the stool instead of being reabsorbed. To replace them, the liver uses up more cholesterol to make new bile acids, which lowers the amount of cholesterol in the blood. Because it acts entirely within the gut, its side effects are mostly digestive, and it can also trap other medicines passing through.
Company & origin
Originated / developed by: Generic (long-established).
A long-established cholesterol-lowering medicine used in the UK that works inside the gut rather than in the bloodstream.
What it treats
Conditions Colestipol is used for
Practical use
How to take Colestipol
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Mix the powder thoroughly with water, juice or soft food and never swallow it dry.
- Take your other medicines either an hour or so before, or several hours after, colestipol, as it can reduce their absorption.
- Drink plenty of fluids and eat more fibre to help with the constipation and bloating it can cause.
- Build the dose up gradually if advised, which makes the digestive effects easier to tolerate.
- Tell your pharmacist about all your medicines and supplements so the timing can be arranged safely.
Weighing it up
Advantages & disadvantages of Colestipol
Advantages
- Lowers cholesterol without being absorbed into the body, working only in the gut.
- A useful option when statins are unsuitable, or as an add-on treatment.
- Can also relieve itching caused by a build-up of bile acids.
Disadvantages
- Commonly causes constipation, bloating and wind.
- Binds many other medicines and fat-soluble vitamins, so doses must be carefully separated in time.
- The powder must be mixed and taken with liquid, which some people find inconvenient.
Practical use
Good to know
The most important practical point with colestipol is timing. Because it binds substances in the gut, it can reduce the absorption of many other medicines and of fat-soluble vitamins, so other tablets are usually taken either well before or several hours after it. Tell your pharmacist about everything you take so the timing can be sorted out. It commonly causes constipation, bloating and wind, which can often be eased by drinking plenty of fluids, eating more fibre and building the dose up slowly. The powder must be mixed thoroughly with water, juice or soft food and never taken dry. It lowers cholesterol steadily over time and does not make you feel any different day to day.
Who should not take it / use with caution
- It should not be used in people with a complete blockage of the bile ducts.
- It is used with caution in people prone to severe constipation or with bowel problems.
- Care is needed in those with very high triglycerides, which it can raise.
Monitoring
- Blood tests to check cholesterol is falling and to keep an eye on triglycerides.
- Reviewing bowel symptoms and whether fibre and fluids are helping.
- Considering fat-soluble vitamin levels with long-term use.
Side effects
- Constipation, bloating, wind and tummy discomfort are the most common.
- Nausea and, less often, diarrhoea.
- With long-term use it can lower fat-soluble vitamin levels and may raise triglycerides.
Key interactions
- Reduces absorption of many medicines, such as some thyroid, heart and water tablets, so separate the timing.
- Can reduce uptake of fat-soluble vitamins, which may need monitoring with long-term use.
- Tell your prescriber about all your medicines so doses can be spaced correctly.
Available as: Powder for mixing with liquid, and granules or tablets, taken by mouth.
Answers
Colestipol: frequently asked questions
How does colestipol lower cholesterol?
It binds bile acids in the gut so they are passed out, prompting the liver to use more cholesterol to make new bile acids, which lowers cholesterol in the blood.
Why do I have to separate it from my other tablets?
Because it can bind other medicines in the gut and reduce their absorption, so other tablets are usually taken well before or several hours after it.
Will it make me constipated?
Constipation, bloating and wind are common; drinking plenty of fluids, eating more fibre and building the dose up slowly can help.
Can I take the powder dry?
No. The powder should always be mixed thoroughly with water, juice or soft food and never swallowed dry.
Does it affect my vitamins?
With long-term use it can reduce the absorption of fat-soluble vitamins, so this may be monitored and supplements taken at a separate time if needed.
The wider class
About Bile acid sequestrant
Colestipol belongs to the bile acid sequestrant class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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