Bile acid sequestrants, also referred to as bile acid resins or BARs, are medications classified under antihyperlipidemic agents. They are primarily utilized to decrease lipid levels in the bloodstream, specifically targeting low-density lipoprotein (LDL) cholesterol and triglycerides. Despite their efficacy, these agents are generally not recommended as initial therapy for cholesterol reduction due to potential gastrointestinal side effects.
Bile acid sequestrants are positively charged molecules that attract the negatively charged bile acid molecules in the intestine, preventing them from getting absorbed. Moreover, the liver compensates by increasing the production of bile salts, eventually using up a lot of cholesterol. The liver also increases the uptake of low-density lipoproteins, hence lowering its levels in the blood.
Bile acid sequestrants are used as an additive in cholesterol-lowering therapy or when patient safety is a concern, such as in children and women.
Examples of bile acid sequestrants include:
Colesevelam and colestipol are available as tablets and resin powder, while cholestyramine is available as resin powder only.
Of note, bile acid sequestrants are not used as the first line of treatment for high cholesterol. However, they are used as an adjuvant medication in certain patient conditions.
Too much LDL can lead to various life-threatening conditions, such as myocardial infarction, atherosclerosis, and deep vein thrombosis, by narrowing the arteries. Healthcare providers prescribe these agents to lower LDL levels.
Bile acid sequestrants are a drug of choice in conditions such as:
Bile acid sequestrants are not absorbed through the gastrointestinal tract. However, they remain in the intestines for about five hours, where they combine with bile salts and are excreted through feces by forming an insoluble compound; hence, the levels of bile decrease. That forces the liver to synthesize bile from its precursor- cholesterol. Due to this, blood cholesterol levels decrease.
Since the small intestine needs bile acids to emulsify lipids and form chylomicrons, absorption of all lipids and lipid-soluble drugs decreases until the bile acids are replaced.
Generally, bile acid sequestrants are well tolerated. However, in long-term use, they can cause adverse symptoms such as:
Rarely, it can lead to:
Bile acid sequestrants are positively charged molecules. Therefore, they can hinder the absorption of other drugs. Here, we discuss the drug interactions that can occur with bile acid sequestrant therapy. They can:
Interfere with the absorption of digoxin, hydrocortisone, and oral phosphate supplements.
Decrease the absorption of drugs, such as propranolol, tetracycline, furosemide, penicillin G, hydrochlorothiazide, and gemfibrozil.
Interfere with the absorption of fat-soluble vitamins such as A, D, E, and K, as they need lipids to get absorbed. Vitamin K deficiency can affect the prothrombin time and increase the risk of bleeding. Therefore, monitor the prothrombin time with bile acid sequestrants.
As a nurse, evaluate if the patient should receive bile acid sequestrant therapy and for how long or which other drugs can be given. Here are the nursing processes appropriate for patients undergoing treatment with bile-sequestering agents.
Bile acid sequestrants help lower LDL levels. With it, ask the patient to maintain a healthy lifestyle and make dietary changes with the medication. Patients should be instructed to maintain a healthy weight, cease smoking, and maintain a daily exercise routine.
As a nurse, you should counsel the patient about the adverse effects of bile acid sequestrants.
About the Author:
Mariya Rizwan is an experienced pharmacist who has been working as a medical writer for four years. Her passion lies in crafting articles on topics ranging from Pharmacology, General Medicine, Pathology to Pharmacognosy.
Mariya is an independent contributor to CEUfast’s Nursing Blog Program.
Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
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