Meta Information
ID:bile-acid-sequestrants
Name:
Schema Version:AIM-2.0
Interactions
Target id:
/class/oral-medications-general
Target name:
All Other Oral Medications
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
1
Description:
Bile acid sequestrants are large, non-absorbable polymers that can physically bind to other drugs in the gut, preventing their absorption and reducing their effectiveness.
Actionable advice:
Take other oral medications at least 1 hour before or 4-6 hours after taking a bile acid sequestrant.
Target id:
/class/fat-soluble-vitamins
Target name:
Fat-Soluble Vitamins (A, D, E, K)
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
1
Description:
By binding bile acids, these drugs interfere with the formation of micelles necessary for absorbing fats and fat-soluble vitamins, potentially leading to deficiencies with long-term use.
Actionable advice:
Take fat-soluble vitamin supplements at least 1 hour before or 4-6 hours after the sequestrant dose.
Target id:
/intervention/levothyroxine_systemic_disease
Target name:
Levothyroxine
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
1
Description:
Bile acid sequestrants strongly bind to levothyroxine in the intestine, which can severely decrease its absorption and lead to hypothyroidism.
Actionable advice:
Separate levothyroxine and bile acid sequestrant doses by at least 4 hours.
Target id:
/class/anticoagulants-antiplatelets
Target name:
Anticoagulants (e.g., Warfarin)
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
1
Description:
These agents can bind to oral anticoagulants like warfarin, reducing their absorption and effectiveness. They can also impair Vitamin K absorption, further complicating anticoagulation control.
Actionable advice:
Separate doses by at least 4-6 hours and monitor INR closely when starting or stopping therapy.
Target id:
/intervention/digoxin
Target name:
Digoxin
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
1
Description:
Bile acid sequestrants bind to digoxin in the gut, significantly reducing its absorption and potentially leading to loss of therapeutic effect for heart conditions.
Actionable advice:
Administer digoxin at least 1 hour before or 4-6 hours after the bile acid sequestrant.
Target id:
/intervention/mycophenolate
Target name:
Mycophenolate
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
1
Description:
Co-administration with cholestyramine significantly reduces the absorption of the immunosuppressant mycophenolate, risking organ transplant rejection or autoimmune disease flare-ups.
Actionable advice:
Separate doses by at least 4-6 hours.
Target id:
/intervention/ursodiol
Target name:
Ursodiol (Ursodeoxycholic acid)
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
5
Hours after target:
2
Description:
Bile acid sequestrants bind ursodiol, a therapeutic bile acid, completely preventing its absorption and negating its medical effect for gallstone or liver conditions.
Actionable advice:
Separate ursodiol and sequestrant doses by at least 5 hours.
Target id:
/dietary/meal
Target name:
Meal
Severity:
major
Interaction type:
requirement
Nature:
temporal
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Bile acid sequestrants work by binding to bile acids released into the intestine in response to food. Taking them with a meal maximizes their efficacy and can improve gastrointestinal tolerance.
Actionable advice:
Always take bile acid sequestrants with a meal and a full glass of liquid.
Target id:
/condition/biliary-obstruction
Target name:
Complete Biliary Obstruction
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
These drugs work by sequestering bile acids in the intestine. If there is a complete biliary obstruction, bile acids are not reaching the intestine, rendering the drug ineffective and inappropriate.
Actionable advice:
Do not use if you have a complete biliary obstruction.
Target id:
/condition/hypertriglyceridemia
Target name:
High Triglycerides
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Bile acid sequestrants can cause a significant increase in serum triglyceride levels. This effect is most pronounced in individuals who already have elevated triglycerides.
Actionable advice:
Avoid use if fasting triglycerides are very high (>400 mg/dL) and use with caution if they are elevated.
Target id:
/condition/phenylketonuria
Target name:
Phenylketonuria (PKU)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Some formulations of bile acid sequestrants (e.g., cholestyramine light powder) contain phenylalanine as a sweetener, which must be avoided by individuals with PKU.
Actionable advice:
Check the specific product formulation and avoid any containing phenylalanine if you have PKU.
Target id:
/biomarker/lipid-panel
Target name:
Lipid Panel
Severity:
major
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
null
Description:
The primary purpose of this medication is to lower LDL cholesterol, but it can also increase triglyceride levels. Regular monitoring of the full lipid panel is essential to assess efficacy and safety.
Actionable advice:
Monitor your lipid panel regularly to track LDL reduction and check for increases in triglycerides.
Target id:
/intervention/folate
Target name:
Folate (Vitamin B9)
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
1
Description:
Bile acid sequestrants can bind to dietary and supplemental folate in the intestine, reducing its absorption and potentially leading to deficiency over time.
Actionable advice:
Take folate supplements at least 1 hour before or 4-6 hours after the sequestrant dose.
Target id:
/intervention/iron
Target name:
Iron Supplements
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
1
Description:
These medications can bind to iron in the gastrointestinal tract, impairing its absorption and potentially worsening or causing iron deficiency.
Actionable advice:
Separate iron supplements from bile acid sequestrants by at least 4 hours.
Target id:
/class/statins
Target name:
Statins
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
1
Description:
Bile acid sequestrants can bind to some statins (especially pravastatin and fluvastatin), reducing their absorption and cholesterol-lowering effect.
Actionable advice:
Take statins at least 1 hour before or 4 hours after the bile acid sequestrant.
Target id:
/intervention/ezetimibe
Target name:
Ezetimibe
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
2
Description:
Cholestyramine can decrease the absorption of ezetimibe, reducing its effectiveness. The effect is less pronounced with colesevelam.
Actionable advice:
Take ezetimibe at least 2 hours before or 4 hours after cholestyramine.
Target id:
/class/diuretics
Target name:
Thiazide and Loop Diuretics
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
1
Description:
The absorption of diuretics like hydrochlorothiazide and furosemide can be significantly reduced by co-administration, lessening their effect on blood pressure and fluid retention.
Actionable advice:
Administer diuretics at least 1 hour before or 4-6 hours after the sequestrant.
Target id:
/class/antidiabetic-medications
Target name:
Oral Diabetes Medications
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
1
Description:
Absorption of oral antidiabetic drugs, such as sulfonylureas (glipizide, glyburide), can be delayed or reduced, potentially affecting blood glucose control.
Actionable advice:
Separate doses by at least 4 hours and monitor blood glucose levels closely.
Target id:
/class/estrogens
Target name:
Oral Estrogens & Progestins
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
1
Description:
Bile acid sequestrants can interfere with the absorption of oral contraceptives and hormone replacement therapy, potentially reducing their efficacy.
Actionable advice:
Take oral hormones at least 1 hour before or 4-6 hours after the sequestrant.
Target id:
/class/chelating-antibiotics
Target name:
Tetracycline and Quinolone Antibiotics
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
2
Description:
Bile acid sequestrants can bind to antibiotics like tetracycline and doxycycline, reducing their absorption and potentially leading to treatment failure for infections.
Actionable advice:
Take these antibiotics at least 2 hours before or 4-6 hours after the sequestrant.
Target id:
/condition/chronic-constipation
Target name:
Chronic Constipation or Gastroparesis
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Constipation is a very common and potentially severe side effect of bile acid sequestrants. They can worsen pre-existing constipation, gastroparesis, or other motility disorders.
Actionable advice:
Use with extreme caution and ensure adequate fluid and fiber intake if you have a history of constipation.
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
Although not absorbed systemically, these drugs can interfere with the absorption of essential fat-soluble vitamins and folate, which are critical for fetal development.
Actionable advice:
Consult a physician before using during pregnancy; vitamin supplementation may be required.
Target id:
/biomarker/prothrombin-time-inr
Target name:
Prothrombin Time (PT/INR)
Severity:
moderate
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
null
Description:
Long-term use can impair Vitamin K absorption, which is essential for blood clotting. This can affect PT/INR levels, especially in patients on warfarin.
Actionable advice:
Periodically monitor PT/INR if on long-term therapy or taking anticoagulants.
Target id:
/biomarker/comprehensive-nutrient-mineral-panel
Target name:
Nutrient & Mineral Panel
Severity:
moderate
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
null
Description:
Long-term use can lead to deficiencies in fat-soluble vitamins (A, D, E, K) and folate due to impaired absorption. Monitoring levels may be necessary.
Actionable advice:
Consider periodic testing for levels of fat-soluble vitamins and folate with long-term use.
Target id:
/class/nsaids
Target name:
NSAIDs
Severity:
minor
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
2
Hours after target:
1
Description:
The absorption of some NSAIDs can be delayed or reduced when taken with bile acid sequestrants, potentially delaying pain or inflammation relief.
Actionable advice:
Separate NSAID and sequestrant doses by at least 2 hours if a rapid effect is needed.