[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Bile acid sequestrants](https://durgical.com/en/pharmacology/classes/bile-acid-sequestrants/) › Colesevelam

[Pharmacology](https://durgical.com/en/pharmacology/) · [Bile acid sequestrants](https://durgical.com/en/pharmacology/classes/bile-acid-sequestrants/)

# Colesevelam

A bile acid sequestrant that lowers LDL and also modestly lowers glucose in type 2 diabetes. Fewer drug-binding problems than colestyramine.

Updated 2026-11-01

- Class: [Bile acid sequestrants](https://durgical.com/en/pharmacology/classes/bile-acid-sequestrants/)
- Target: Bile acids in the gut lumen
- ATC code: C10AC04

## Mechanism of action

Colesevelam is a non-absorbed polymer with a high affinity for bile acids. It holds them in the gut so they are lost in the stool; the liver uses more cholesterol to make new bile acids and raises its LDL receptors, which lowers LDL. It also lowers HbA1c in type 2 diabetes, by mechanisms not fully understood.

- Polymer binds bile acids in the gut
- Bile acids are lost in the stool
- Liver converts cholesterol to bile acids and adds LDL receptors
- LDL falls; HbA1c falls modestly in type 2 diabetes

## Pharmacokinetics

**Absorption**
Not absorbed systemically.

**Elimination**
In the stool.

## Indications

- Primary hyperlipidemia (high LDL), alone or with a statin [Atherosclerosis and dyslipidaemia →](https://durgical.com/en/conditions/atherosclerosis-and-dyslipidaemia/)
- Heterozygous familial hypercholesterolemia in children and adolescents [Familial hypercholesterolemia →](https://durgical.com/en/conditions/familial-hypercholesterolemia/)
- Type 2 diabetes, to improve glucose control as an adjunct [Type 2 diabetes mellitus →](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)

## Adverse effects

### Common

- Constipation
- Dyspepsia, nausea
- Rise in triglycerides

### Serious (rare, important)

- Bowel obstruction; dysphagia or esophageal obstruction from the large tablets
- Pancreatitis from very high triglycerides
- Vitamin K and other fat-soluble vitamin deficiency

## Contraindications

- Very high serum triglycerides
- History of pancreatitis caused by hypertriglyceridemia
- History of bowel obstruction

## Key interactions

**Levothyroxine, oral contraceptives, glyburide and other sulfonylureas, phenytoin, cyclosporine, warfarin**
Exposure may fall; these drugs are taken at least 4 hours before colesevelam and levels or effects are watched.

**Metformin extended-release**
Exposure rises; glucose response is monitored.

**Fat-soluble vitamins**
May reduce absorption of vitamins A, D, E and K; supplements are taken at least 4 hours before.

## What is monitored

- Lipid panel including triglycerides before and during treatment
- HbA1c and glucose in diabetes
- Bowel habits and swallowing

## Administration and safety

- Tablets are large: taken with a meal and plenty of liquid; the oral suspension is used if swallowing is difficult.
- Interacting drugs (for example levothyroxine and oral contraceptives) are taken at least 4 hours before.
- Avoided in gastroparesis, other motility disorders and after major gut surgery.

## Nursing care

- Before: lipid panel with triglycerides, bowel and swallowing history, full medication list.
- Teach to report severe stomach pain (pancreatitis) or severe constipation.
- Watch glucose in patients on antidiabetic drugs.
- Plan medication timing to keep the 4-hour gap.

## Pregnancy and breastfeeding

Not absorbed systemically, so fetal exposure is not expected; it may reduce absorption of fat-soluble vitamins.

## Memory aid

«Colesevelam = Cole-SEVEN-lam»: the sequestrant with a second job, lowering both LDL and HbA1c.

## Test yourself

Think of the answer, then tap the question to see it.

## Which additional indication does colesevelam have besides LDL lowering?

Improving glucose control in type 2 diabetes, as an adjunct.

## Which triglyceride situation contraindicates colesevelam?

Very high triglycerides or a history of pancreatitis caused by hypertriglyceridemia.

## A patient takes levothyroxine and starts colesevelam. What timing applies?

Levothyroxine is taken at least 4 hours before colesevelam, and thyroid tests are monitored.

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## Related drugs

- [Colestyramine](https://durgical.com/en/pharmacology/colestyramine/)
- [Ezetimibe](https://durgical.com/en/pharmacology/ezetimibe/)

## Related conditions

- [Atherosclerosis and dyslipidaemia](https://durgical.com/en/conditions/atherosclerosis-and-dyslipidaemia/)
- [Familial hypercholesterolemia](https://durgical.com/en/conditions/familial-hypercholesterolemia/)
- [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)

[← Back to the class: Bile acid sequestrants](https://durgical.com/en/pharmacology/classes/bile-acid-sequestrants/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Colesevelam: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a699050.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [DailyMed - COLESEVELAM HYDROCHLORIDE tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4aa52225-9214-59dc-e063-6294a90a5f75) (DailyMed (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=C10AC04) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/colesevelam/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/colesevelam/