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Lodalis
Colesevelam Hydrochloride
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Lodalis (Colesevelam)

What is  Lodalis (Colesevelam)?

Lodalis is a bile acid sequestrant medication that is used alongside exercise and dietary changes to treat and reduce the level of cholesterol in a patient’s blood. This medication is for use by patients who have not responded well or who are otherwise unable to take HMG-CoA reductase inhibitor medications. Its primary purpose is to reduce LDL-C, or low-density lipoprotein cholesterol, levels.

This medication may also be used in the management of blood glucose levels for patients with type 2 diabetes.

How is Lodalis Used?

When a patient is using Lodalis by itself with no additional medications being taken to impact their cholesterol levels, they will most often be taking this medication twice per day, using a dosing size of three tablets (1875 mg of Lodalis). Patients may also take a large dose of six tablets (3750 mg of Lodalis) once per day. The maximum dosage that should be prescribed for any patient using Lodalis is seven tablets, or 4375 mg, within the span of a day. Regardless of dosage, this medication should be taken with a meal.

Patients that are using additional medications to lower their cholesterol will typically be required to take between four and six tablets of Lodalis each day, not exceeding more than six tablets total. When using other medications for the treatment of high cholesterol levels in the blood, the patient’s doctor will provide instruction regarding when to take Lodalis either with or at another time from when they will also be taking their statin medications. If you are taking multiple medications for managing cholesterol levels, please follow your prescribing physician’s instructions for mixing these medications each day.

Patients who have been prescribed the powder form of Lodalis for oral suspension should only consume one packet of the medication, properly prepared, once per day. This suspension should still be consumed with a meal, just as one would need to do when taking the tablet form of Lodalis. Preparation of the oral suspension requires the patient to combine four to eight ounces of liquid (water, diet soda, or fruit juice) with one packet of Lodalis, and stir until the powder and liquid have combined well. It should then be consumed immediately.

Lodalis will often be paired with insulin therapy, sulfonylureas, or metformin when used to balance a patient’s blood glucose levels in the treatment of type 2 diabetes.

Storage

Lodalis should be stored away from moisture and light, and it should be kept at room temperature. It may be stored within a range of 59°F (15°C) at the lowest and 86°F (30°C) at the highest only for brief periods of time as needed.

Keep this medication out of the reach of children and pets at all times.

Uses

Lodalis is prescribed for the treatment of the following conditions:

  • high levels of cholesterol in the blood
  • type 2 diabetes

How Does Lodalis Work?

As a bile acid sequestrant, Lodalis functions by attaching itself to bile acids. It does this within the patient’s intestines, and since it binds to any substances similar to cholesterol, it removes these from the patient’s body by carrying it through the rest of their digestive tract and allowing this waste to be removed with the feces when the patient using this medication has a bowel movement.

When the detected level of cholesterol-like substances available appears to be lower, the patient’s body then becomes able to pull additional cholesterol from the individual’s blood to create more bile acids like those that were expelled. As the medication allows the liver to borrow more and more cholesterol from the body’s blood supply, this then contributes to a reduction in the amount of cholesterol present within the patient’s bloodstream.

When Lodalis is used in the treatment of type 2 diabetes, this binding mechanism of this medication allows a portion of the patient’s food to be carried out as waste and not properly absorbed while in the intestines. Doing this results in lower blood sugar levels due to the impaired absorption caused by taking Lodalis, meaning the food and its respective sugars are unable to be pulled into the body to impact the patient’s blood glucose levels.

Dosage

Lodalis is available as either of the following options regarding dosage and form:

  • 75 g powder (for oral suspension)
  • 625 mg tablet

The actual dosage a patient will need to take for treatment will vary based on a variety of different factors, such as any other medications they may be taking, any additional health conditions they may have, and their total body weight. Patients should take Lodalis exactly as prescribed by their physician.

If you have any questions regarding your prescribed dosage of Lodalis, please contact your pharmacist or prescribing physician for more information. Do not take Lodalis except exactly as instructed by your doctor.

Overdose

If you have accidentally or intentionally ingested too much Lodalis, please seek out emergency medical attention or contact your local Poison Control Center. A possible side effect of ingesting too much of this medication may be severe constipation. Since Lodalis is not absorbed into the body like many other medications, there is a low risk of toxicity, but digestive disturbances are likely to occur.

Side Effects

Numerous side effects have been reported by patients taking Lodalis, although many of these adverse effects appear to resolve on their own or be well-managed.

The most common side effects of taking Lodalis are as follows:

  • abdominal pain
  • abnormal bowel movements (stools)
  • constipation
  • diarrhea
  • feelings of weakness
  • gassiness
  • headaches
  • hemorrhoids that increase in severity
  • nausea
  • muscle aches and pain
  • runny nose
  • sore throat

Some of the following side effects may occur and should be discussed with your doctor if they remain persistent or increase in severity while taking Lodalis. These symptoms can develop into serious health issues if not treated and resolved promptly:

  • flu-like symptoms
    • cough
    • fever
    • fatigue
    • sore throat
  • severe constipation
  • severe diarrhea
  • severe nausea
  • severe stomach pain
  • skin rash
  • tarry, black stools
  • vomiting

Please seek out emergency medical care if you experience any of the following serious symptoms while taking Lodalis:

  • allergic reactions symptoms
    • breathing difficulties
    • hives
    • swelling of the throat or face
  • bowel obstruction symptoms
    • constipation
    • cramps
    • distension
    • fecal vomiting
    • stomach pain
    • vomiting
  • fecal impaction symptoms
    • bloating
    • chronic constipation
    • loss of appetite
    • stomach pain
  • pancreatitis symptoms
    • nausea
    • severe upper abdominal pain (will radiate towards the back)
    • vomiting
  • trouble swallowing

Warnings & Precautions

Lodalis is associated with a number of potential health risks, especially for those who already have health conditions involving high levels of triglycerides and those who have an increased risk of bowel obstructions. Unlike the tablet form of Lodalis, the powder for oral suspension form of this medication is known to contain phenylalanine. Patients with phenylketonuria should discuss possible alternatives to using the powder form of this medication with their doctor.

The following additional precautions apply to both forms of Lodalis.

Hypertriglyceridemia

The use of Lodalis has been linked to an increase in triglycerides in patients using the medication for treatment. Patients also using sulfonylureas or insulin alongside Lodalis are at a heightened risk for issues associated with high triglycerides. Individuals taking this medication should have their lipid levels regularly monitored while using Lodalis to prevent the occurrence or worsening of hypertriglyceridemia that may result in acute pancreatitis.

Bowel Obstruction and Constipation

Patients with a history of gastrointestinal surgeries, certain gastrointestinal motility disorders, or gastroparesis should either not be prescribed Lodalis or should exercise extreme caution when taking Lodalis due to its constipating effects placing these individuals at significant risk of experiencing bowel obstruction. If you are a patient with any of the conditions listed that may place you in the risk category for developing a bowel obstruction, please discuss this with your physician before beginning treatment with Lodalis or any similar medications.

Impaired Medication Absorption

Due to the way in which Lodalis functions, patients using this medication may experience impaired absorption of any other vitamins, supplements, or medications they are using during treatment with Lodalis. It is advised that patients who take other medications or other substances ingest these at least four hours before taking their dose of Lodalis to ensure they are being properly absorbed and not inhibited by the functioning of the bile acid sequestrant.

Pregnancy and Breastfeeding

Lodalis is not recommended for those who are pregnant or trying to become pregnant. However, if a patient’s doctor feels that the benefits of this medication outweigh the potential risks for a pregnant patient, it may still be used in some circumstances.

It has not been determined whether Lodalis passes into breastmilk, so those who are using this medication and desiring to breastfeed should discuss this issue with their prescribing physician to determine if the dosage of the medication they are using may impact the breastfed child.

Additional Medical Conditions

If you have any of the following medical conditions, exercise caution when taking Lodalis and discuss your medical history with your doctor before beginning this medication:

  • A history of bowel motility conditions or bowel surgeries
  • A history of bowel obstructions
  • Certain vitamin deficiencies (A, D, E, K)
  • Diabetic ketoacidosis
  • Dysphagia (difficulty swallowing)
  • High levels of triglycerides (before beginning Lodalis)
  • Malabsorption syndrome
  • Pancreatitis (due to hypertriglyceridemia)
  • Phenylketonuria (PKU)
  • Type 1 diabetes

Drug Interactions

Speak to your doctor about any medications or herbal supplements you are currently taking before beginning treatment with Lodalis. Discuss any concerns you may have with your doctor or a trusted pharmacist.

The following medications are known to interact with Lodalis and may increase your chances of experiencing adverse Lodalis side effects. However, some may still be prescribed and used with Lodalis under the supervision of the patient’s prescribing physician:

  • Amiodarone
  • Anti-coagulant medications
  • Anti-seizure medications
  • Bezafibrate
  • Birth control pills
  • Calcitriol
  • Carbamazepine
  • Cholecalciferol
  • Corticosteroids
  • Cyclosporine
  • Deferasirox
  • Desogestrel
  • Dexamethasone
  • Diabetes medications
  • Diclofenac
  • Dienogest
  • Diuretics
  • Doxycycline
  • Drospirenone
  • Estradiol
  • Ethinyl estradiol
  • Ethynodiol
  • Ezetimibe
  • Furosemide
  • Gestodone
  • Glimepiride
  • Glipizide
  • Glyburide
  • Hydrochlorothiazide
  • Hydrocortisone
  • Ibuprofen
  • Indapamide
  • Leflunomide
  • Levothyroxine
  • Levonorgestrel
  • Lomitapide
  • Mestranol
  • Metformin
  • Methotrexate
  • Minocycline
  • Multivitamins
  • Mycophenolate
  • Mycophenolate mofetil
  • Mycophenolic acid
  • Naproxen
  • Niacin
  • Nomegestrol
  • Norethindrone
  • Norgestimate
  • Norgestrel
  • NSAIDs
  • Obeticholic acid
  • Olmesartan
  • Phenytoin
  • Pravastatin
  • Prednisone
  • Propranolol
  • Raloxifene
  • Repaglinide
  • Teriflunomide
  • Tetracycline
  • Thyroid replacement medications
  • Thyroxine
  • Ursodiol
  • Vancomycin (oral)
  • Valproic acid
  • Verapamil
  • Vitamin D analogs
  • Warfarin

Alternative Medications

For patients who are unable to take Lodalis or experiencing significant adverse side effects, alternative medications may be used to treat some of the associated conditions for which this medication is commonly prescribed.

Some of the alternative medication options for the treatment of high cholesterol include the following:

  • Crestor (rosuvastatin)
  • Colestid (colestipol)
  • Lipitor (atorvastatin)
  • Praluent (alirocumab)
  • Prevalite (cholestyramine)
  • Repatha (evolocumab)
  • Zetia (ezetimibe)

Some of the alternative medication options for the treatment of type 2 diabetes include the following:

  • Actos (pioglitazone)
  • Farxiga (dapagliflozin)
  • Fortamet (metformin)
  • Glucotrol (glipizide)
  • Humalog (insulin lispro)
  • Lantus (insulin glargine)
  • Tradjenta (linagliptin)
  • Trulicity (dulaglutide)

Frequently Asked Questions

Due to the way in which Lodalis functions, it is capable of decreasing the absorption of certain medications and supplements. Among those that may have their absorption impacted are birth control pills, particularly those containing norethindrone and ethinyl estradiol. If you have questions or concerns about taking this medication alongside your usual birth control pills, please consult your pharmacist or prescribing physician for more information.

Lodalis may take multiple weeks to show significant signs of improvement in a patient’s cholesterol levels, but some improvement may be noticeable within just two weeks of treatment.

It is recommended that patients using Lodalis that also take other medications ingest these at least four hours before taking Lodalis to ensure the best possible absorption. If you are taking Lodalis and are concerned about the absorption of your other medications, please speak with your prescribing physician.