Colesevelam

Colesevelam

Clinical data
Trade names	Welchol
AHFS/Drugs.com	monograph
MedlinePlus	a699050
Pregnancy cat.	B
Legal status	℞ Prescription only
Routes	Oral
Pharmacokinetic data
Bioavailability	N/A
Metabolism	Colesevelam is not absorbed and not metabolised.
Half-life	N/A (non-systemic drug)
Excretion	By intestines only, colesevelam is non-systemic.
Identifiers
CAS number	182815-44-7 Y
ATC code	C10AC04
PubChem	CID 160051
DrugBank	DB00930
ChemSpider	140701 Y
UNII	P4SG24WI5Q Y
KEGG	D03582 Y
ChEMBL	CHEMBL1201677 N
Chemical data
Formula	C31H67Cl3N4O
SMILES	eMolecules & PubChem
InChI InChI=1S/C13H27N.C12H27N2.C3H5ClO.C3H7N.2ClH/c1-3-5-6-7-8-9-10-11-13-14-12-4-2;1-5-10-13-11-8-6-7-9-12-14(2,3)4;4-1-3-2-5-3;1-2-3-4;;/h4,14H,2-3,5-13H2,1H3;5,13H,1,6-12H2,2-4H3;3H,1-2H2;2H,1,3-4H2;2*1H/q;+1;;;;/p-1 Y Key:VTAKZNRDSPNOAU-UHFFFAOYSA-M Y
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Colesevelam is a bile acid sequestrant administered orally. It is developed by Genzyme and marketed in the US by Daiichi Sankyo under the brand name WelChol and elsewhere by Genzyme under the tradename Cholestagel.

Clinical use

Colesevelam is indicated as an adjunct to diet and exercise to reduce elevated low-density lipoprotein cholesterol (LDL-C) in patients with primary hyperlipidemia as monotherapy and to improve glycemic control in adults with type 2 diabetes mellitus,^[1] including in combination with a statin. The expanded use of colesevelam in adults with type 2 diabetes mellitus is an example of drug repositioning.

Colesevelam is one of the bile-acid sequestrants, which along with niacin and the statins are the three main types of cholesterol-lowering agents. The statins are considered the first-line agents. This is because of side effects from the other two types, including bloating and constipation (bile-acid sequestrants) and skin flushing (niacin). These side effects often lead to low patient compliance.^[2]

Constituents

The constituents of the polymer colesevelam are:

N-prop-2-enyldecan-1-amine; trimethyl-[6-(prop-2-enylamino)hexyl]azanium; prop-2-en-1-amine; 2-(chloromethyl)oxirane; hydrogen chloride; chloride.

How it works

Colesevelam is part of a class of drugs known as bile acid sequestrants. Colesevelam hydrochloride, the active pharmaceutical ingredient in Welchol, is a non-absorbed, lipid-lowering polymer that binds bile acids in the intestine, impeding their reabsorption. As the bile acid pool becomes depleted, the hepatic enzyme, cholesterol 7-α-hydroxylase, is upregulated, which increases the conversion of cholesterol to bile acids. This causes an increased demand for cholesterol in the liver cells, resulting in the dual effect of decreasing transcription and activity of the cholesterol biosynthetic enzyme, HMG-CoA reductase, and increasing the number of hepatic LDL receptors. These compensatory effects result in increased clearance of LDL-C from the blood, resulting in decreased serum LDL-C levels. Serum TG levels may increase or remain unchanged.^[3]

It is not yet known how Colesevelam works to help control blood sugar in people with type 2 diabetes. However, it is clear that the drug works within the digestive tract, since it is not absorbed into the rest of the body.

Cholesterol

Since Colesevelam can lower total and LDL cholesterol levels (along with raising HDL - "good" cholesterol), taking it may decrease one's risk of developing certain health problems in the future.

Previous clinical research studies indicate individuals taking 3,800 mg to 4,500 mg of Colesevelam daily were able to:

• Reduce LDL cholesterol by 15 to 18 percent.
• Reduce total cholesterol by 7 to 10 percent.
• Raise HDL cholesterol by 3 percent.

The combination of Colesevelam with a HMG-CoA reductase inhibitor (known more commonly as a statin) can further lower cholesterol levels.^[4]

Side effects

In controlled clinical studies involving approximately 1,400 patients the following adverse reactions have been reported in patients treated with colesevelam. When reporting to the very common (≥ 1 / 10), common (≥ 1 / 100, 51/10), uncommon (≥ 1 / 1000, 51/100), rare (≥ 1/10.000, 51/1000) and distinction very rarely (51/10.000), including individual cases:

• Investigations Common: serum triglyceride increased; Uncommon: serum transaminase increases
• Nervous system disorders Common: headache
• Gastrointestinal disorders Very Common: flatulence, constipation; Common: vomiting, diarrhea, dyspepsia, abdominal pain, stool abnormalities, nausea
• Musculoskeletal and connective tissue disorders Uncommon: myalgia

The background incidence of flatulence and diarrhea was in patients in the same controlled clinical trials, the placebo were higher. Only constipation and dyspepsia were shown to occur in a higher percentage of patients who received Cholestagel, compared to the placebo reported. Side effects were generally mild or moderate in severity. In the application of colesevelam in combination with statins, no unexpected frequent side effects occurred.^[5]

References

1. ^ Colesevelam HCl Improves Glycemic Control and Reduces LDL Cholesterol in Patients With Inadequately Controlled Type 2 Diabetes on Sulfonylurea-Based Therapy
2. ^ Principles and Practice of Endocrinology and Metabolism, 2000, ed. Becker, chapter 163
3. ^ http://www.rxlist.com/welchol-drug.htm
4. ^ http://cholesterol.emedtv.com/welchol/welchol.html
5. ^ Fachinformation Cholestagel Stand März 2009

External links

• Cholestagel Product Website
• Welchol product website
• Prescribing Information