Cholestyramine (CSM) is has been used for many years and has a variety of possible applications. It is FDA-approved to lower cholesterol levels but has numerous off-label uses. Cholestyramine’s ability to bind to toxins makes it an especially useful treatment for biotoxin illness. It is used to treat many conditions including diabetes, Crohn’s, Chronic Inflammatory Response Syndrome (CIRS), and hyperthyroidism. Cholestyramine itself is not absorbed by the body, but binds to other substances which are then removed with it.

How is Cholestyramine Prescribed?

CSM is most often prescribed to be taken with water or juice 2-3 times per day. Since this drug interferes with absorption, it is recommended that other medications be taken at least 1 hour before or 4 hours after it is taken. It is also usually recommended that it be taken 1 hour before a meal, as it can bind to nutrients in food and prevent their absorption. The most common side effect of CSM is constipation, which can usually be relieved by increasing fluid intake or taking laxatives.

Cholestyramine for High Cholesterol

One of the longest uses for CSM is as a cholesterol-lowering monotherapy. This drug can effectively reduce LDL cholesterol levels when used along with a healthy diet for lowering cholesterol. The cholestyramine binds to bile acids that normally re-circulate in the body. This causes the liver to compensate by increasing its conversion of cholesterol to bile acids, which reduces cholesterol levels in the body. CSM has been shown to both reduce the rate of progression and increase the regression of coronary artherosclerosis.

Cholestyramine for Biotoxin Illness

Treating biotoxin illness from mold exposure is now one of the more frequently prescribed uses for CSM. The resin has the ability to bind toxins in the small intestine. These toxins are then able to be excreted from the body along with the cholestyramine instead of being re-absorbed. The resin itself is not absorbed into the body through this process.

Patients who take cholestyramine for biotoxin illness sometimes report having a “detox” reaction as the toxins are cleared from their body. Most patients will experience some improvement in symptoms within one week of starting treatment, but for others it can take up to a month.

Multiple treatments are usually required to effectively treat biotoxin illness. Cholestyramine is needed to remove toxins from the body, but the inflammation and colonization of fungi and bacteria require different treatments. Nasal sprays like amphotericin B and EDTA can topically treat infections in the sinuses that result from mold exposure. These nasal sprays are often prescribed to be used along with cholestyramine.

Cholestyramine for Lyme Disease

The toxins from borrelia infection can be removed with the use of CSM. Many individuals have a genetic predisposition that stops Lyme toxins from being eliminated from their bodies. When Lyme toxins leave the liver they are re-absorbed by the intestines. Cholestyramine can bind to these toxins so they can be excreted from the body. Similar to treating biotoxin illness, Lyme disease patients may feel worse initially before they feel better as the detoxification process occurs.

Cholestyramine for Bile Acid Malabsorption from Crohn’s Disease

Crohn’s disease causes swelling and inflammation that can lead to symptoms like abdominal pain and diarrhea from bile malabsorption. To prevent diarrhea for Crohn’s patients, CSM can be taken 30-60 minutes before meals.

Cholestyramine for Hyperthyroidism

CSM has been shown to be an effective additional treatment for hyperthyroidism. Thyroid hormones are metabolized in the liver, and in cases of hyperthyroidism the rate of absorption of these hormones may be increased. Cholestyramine interferes with the absorption of endogenous thyroid hormones, which prevents symptoms of hyperthyroidism. When combined together with common anti-thyroidal drugs methimazole and propranolol, cholestyramine can bring a quicker decline in thyroid hormone than when the drugs are used alone.

Cholestyramine for Diabetes

For patients with type 2 diabetes, CSM may be an effective method of glucose control. In one study, plasma glucose levels were reduced by 13% after 6 weeks of cholestyramine use. While it has not been studied as a monotherapy for diabetes, cholestyramine may be used in addition to other diabetes drugs. It may be especially effective for patients with type 2 diabetes with hyper-LDL-cholesterolemia.

Pure Cholestyramine Resin

CSM that is commercially available comes with fillers, preservatives, coloring, and other additives that make it less pure. For a patient already suffering from chemical sensitivities these may be undesirable to have included in a medication that they will take daily. At our pharmacy we offer pure cholestyramine resin free of additives. Pure cholestyramine resin is not available commercially and can only be obtained from a compounding pharmacy.