Issues for surgery
For hyperlipidaemia – increase in cholesterol if omitted for prolonged period.
Potential for reduced bioavailability of other oral medicines if continued – see Interactions with other common medicines used in the perioperative period.
Potential risk of increased bleeding tendency, secondary to reduced vitamin K absorption – see Further information.
Advice in the perioperative period
Elective and emergency surgery
Omit dose(s) on morning of operation.
Consider checking clotting screen pre-operatively in patients who have been taking bile acid sequestrants long-term and who are undergoing major surgery – see Further information.
Post-operative advice
Restart post-operatively once enteral intake resumed.
Ensure administration of bile acid sequestrant is separated from other oral medications to minimise effect on absorption (see Interactions with other common medicines used in the perioperative period).
Patients undergoing biliary surgery
Review ongoing need for bile acid sequestrants post-operatively.
Patients undergoing major gastrointestinal surgery
The safety and efficacy of colestipol has not been evaluated in patients having major gastrointestinal surgery; therefore, the manufacturer advises caution.
Interactions with common anaesthetic agents
None.
Interactions with other common medicines used in the perioperative period
Colestipol may affect the bioavailability of other medicines; to limit this, other medicines should be administered 1 hour before or 4 hours after colestipol.
Further information
Increased bleeding tendency
Chronic use of bile acid sequestrants may result in reduced absorption of fat-soluble vitamins, including vitamin K. A study noted prolonged prothrombin time in one patient taking colestipol. Consider checking clotting screen in patients taking long-term bile acid sequestrants who are undergoing major surgery. If hypoprothrombinaemia is detected this usually responds to parenteral vitamin K administration – discuss with haematologist if necessary.
References
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 7th March 2021]
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 7th March 2021]
Summary of Product Characteristics – COLESTID (colestipol) granules for oral suspension. Pfizer Limited. Accessed via www.medicines.org.uk 07/03/2021 [date of revision of the text July 2020]