Choltran Sachet
✅ Lowers cholesterol levels
✅ Reduces heart disease risk
✅ Binds with bile acids
✅ Improves digestion
✅ Manages cholesterol levels
Choltran Sachet contains Cholestyramine.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
⚡ Quick Answer — What is Choltran Sachet?
Choltran Sachet contains cholestyramine (colestyramine) (4 g cholestyramine (approximate — verify label) per sachet), a non-absorbed bile acid sequestrant resin. It works entirely in the gut lumen — binding bile acids so they are excreted in stool rather than reabsorbed. This forces the liver to pull cholesterol from the bloodstream to make new bile acids, lowering LDL by ~15–30%. Uses: (1) hypercholesterolaemia in statin-intolerant patients or as statin add-on; (2) itch (pruritus) due to cholestasis — the main modern indication, often more useful than the lipid effect; (3) bile acid diarrhoea (BAD) — chronic diarrhoea after gallbladder surgery, ileal resection, or idiopathic; (4) some C. difficile-related and ileal-resection diarrhoea. Dose: 1 sachet (4 g) 1–4 times daily, mixed with water or juice. Binds many oral drugs — take other medicines 1 hour before or 4 hours after.
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What Is Choltran Sachet?
Choltran Sachet is a bile acid sequestrant supplied as 4 g cholestyramine (approximate — verify label)-sachets containing cholestyramine resin, to be mixed with water or juice before swallowing. Manufactured by WHO-GMP certified manufacturer. Supplied as 30, 60, 90 or 180 sachets. Cholestyramine is a non-absorbed, high-molecular-weight anion-exchange resin — it stays entirely in the gut lumen and has no systemic absorption.
Originator brands: Questran (Bristol-Myers Squibb, 1970s) and Olestyr. Cholestyramine is on the WHO Essential Medicines List.
What Is Choltran Sachet Used For?
- Cholestatic pruritus — itching caused by bile acid accumulation in primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), pregnancy cholestasis, and obstructive jaundice. Often the most useful modern indication.
- Bile acid diarrhoea (BAD / bile acid malabsorption) — chronic diarrhoea due to bile acid spillover into the colon, commonly seen after cholecystectomy, ileal resection (Crohn’s, right-hemicolectomy), vagotomy, or as idiopathic type-1 BAD. Rapid, often dramatic benefit.
- Primary hypercholesterolaemia — mainly in statin-intolerant patients or as add-on to statin when LDL is still above goal
- Homozygous familial hypercholesterolaemia (adjunctive)
- Clostridioides difficile recurrent colitis — off-label; binds C. difficile toxin
- Digoxin toxicity (adjunct) and leflunomide / teriflunomide washout (accelerated elimination)
In lipid management, cholestyramine has been displaced by statins and ezetimibe for most patients, but it remains important for cholestatic itch and bile acid diarrhoea, where no other drug matches it.
How Does Choltran Sachet Work?
Cholestyramine is a large positively-charged polymer (strong anion-exchange resin). In the intestinal lumen it binds anionic bile acids via electrostatic interaction, forming an insoluble complex that is excreted in the stool.
The downstream effects:
- Interrupts enterohepatic circulation — normally 95% of bile acids are reabsorbed in the terminal ileum and recycled; cholestyramine traps them for excretion
- Forces the liver to synthesise more bile acids — using cholesterol as the substrate
- Depletes hepatic cholesterol stores — the liver upregulates LDL receptors and pulls more LDL out of the bloodstream
- Lowers plasma LDL-C by 15–30%; may cause small rise in triglycerides (not recommended in severe hypertriglyceridaemia)
- Removes accumulated bile acids from the enterohepatic pool — reducing skin bile acid load and relieving cholestatic itch
- Prevents bile acid spillover into the colon — stopping bile acid diarrhoea
Dosage and Administration
Hypercholesterolaemia: 1 sachet (4 g) 1–2 times daily initially; titrate up to 1 sachet 3–4 times daily (maximum 24 g/day) over 2–4 weeks.
Cholestatic pruritus: 1 sachet 2–4 times daily; the first dose often given at breakfast when bile acid delivery to the gut is highest. Effect on itch usually within 2–4 days.
Bile acid diarrhoea: 1 sachet 1–3 times daily, titrated to effect. Many patients respond to a single sachet once daily.
Mixing: empty the sachet contents into a glass, add at least 120 mL of water, juice, or another non-carbonated liquid; stir until uniform; drink and rinse with more liquid. Never swallow the dry powder — it can cause oesophageal irritation or obstruction.
CRITICAL — drug interaction timing: cholestyramine binds many oral drugs (thyroid hormone, warfarin, digoxin, thiazides, statins, ezetimibe, fat-soluble vitamins, NSAIDs, many more). Take all other oral medicines at least 1 hour BEFORE or 4 hours AFTER cholestyramine, otherwise absorption may be impaired.
Vitamin considerations: long-term use can reduce absorption of fat-soluble vitamins (A, D, E, K). Supplementation may be needed, particularly for vitamin K (monitor INR in warfarin patients) and D.
Side Effects
Cholestyramine does not enter the bloodstream, so systemic side effects are minimal. The main issues are gastrointestinal tolerability.
Common:
- Constipation — the most common complaint; often improves with time, fibre, and adequate fluid intake
- Bloating, abdominal discomfort, flatulence
- Nausea
- Heartburn
- Dental caries (if the powder is chewed or left in the mouth) — always mix with liquid
Uncommon:
- Steatorrhoea and fat-soluble vitamin deficiencies with high-dose, long-term use
- Hyperchloraemic acidosis — rare, usually only with very high doses in children or renal impairment
- Rise in triglycerides — not suitable for severe hypertriglyceridaemia
- Oesophageal obstruction if swallowed dry
Drug Interactions
Cholestyramine has many clinically important drug interactions by binding. Always dose other oral drugs 1 hour before or 4 hours after cholestyramine. Particularly important:
- Thyroid hormone (levothyroxine) — substantial reduction in absorption; separate doses by 4 hours.
- Warfarin — reduced absorption; also reduces vitamin K. INR changes likely in either direction; monitor closely.
- Digoxin — reduced absorption.
- Thiazide and loop diuretics — reduced absorption.
- Statins, ezetimibe, fenofibrate — reduced absorption; separate doses.
- Oral contraceptives — potentially reduced absorption; use back-up during initial dosing.
- Mycophenolate, leflunomide, teriflunomide — binds active metabolites; used deliberately for teriflunomide washout.
- NSAIDs, tetracyclines, phenobarbital, thiazolidinediones — reduced absorption.
- Fat-soluble vitamins (A, D, E, K) — reduced absorption on long-term use.
The short answer: if you are on multiple oral medicines, time cholestyramine carefully and tell your pharmacist.
Who Should Not Take Choltran Sachet?
- Complete biliary obstruction (no bile acids to bind)
- Known hypersensitivity to cholestyramine
- Hypertriglyceridaemia-induced pancreatitis (triglycerides > 400 mg/dL; cholestyramine may raise TG)
- Phenylketonuria (if the formulation contains aspartame)
- Children < 6 years without specialist supervision
- Pregnancy and breastfeeding — systemic absorption is negligible, so the drug itself is low-risk, but long-term use may cause fat-soluble vitamin deficiency in the mother
Storage
Store Choltran Sachet below 25°C in a dry place. Keep sachets sealed until use. Do not use after the expiry date. Keep out of reach of children.
Frequently Asked Questions
Is Choltran Sachet the same as Questran?
Yes — both are cholestyramine sachets. Choltran Sachet is a bioequivalent formulation to the originator Questran (BMS).
Can I use Choltran Sachet to lower cholesterol instead of a statin?
Not usually. Statins lower LDL by 30–60% and have far stronger cardiovascular outcome evidence. Cholestyramine lowers LDL by 15–30%, is less well tolerated (constipation, GI upset), and has many drug interactions. It is a reasonable option for patients who are truly statin-intolerant or when statin alternatives have failed, but it is not first-line.
How does Choltran Sachet help with itching?
In cholestatic liver disease (PBC, PSC, pregnancy cholestasis), bile acids accumulate and deposit in the skin, triggering intense itch. Cholestyramine removes these bile acids via stool excretion. Effect on itching is usually seen within 2–4 days. It is the first-line drug treatment for cholestatic pruritus in most guidelines.
I have chronic diarrhoea after my gallbladder surgery — can Choltran Sachet help?
Very likely. Post-cholecystectomy diarrhoea is often due to bile acid malabsorption (bile acids spill into the colon where they act as laxatives). Cholestyramine binds these bile acids and commonly produces rapid, near-complete relief — often at a single sachet per day. Discuss with your GP or gastroenterologist.
Will Choltran Sachet affect my thyroid tablets or other medicines?
Yes — cholestyramine binds levothyroxine and many other oral drugs. Always take your other medicines at least 1 hour BEFORE or 4 hours AFTER your cholestyramine dose. If you are on warfarin, thyroid hormone, or digoxin, tell your prescriber/pharmacist before starting.
How should I mix Choltran Sachet?
Empty the sachet into a glass with at least 120 mL of water, juice, or another non-carbonated liquid. Stir until uniform (it does not fully dissolve — more like a suspension). Drink immediately; rinse the glass and drink that too, to get the full dose. Never swallow the dry powder — it can stick in the throat or oesophagus.
Where can I buy Choltran Sachet online?
You can order Choltran Sachet (4 g cholestyramine (approximate — verify label) sachets) from MedsBase as 30, 60, 90 or 180 sachets. We ship worldwide with discreet packaging and genuine WHO-GMP certified manufacturer stock.
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Why order from MedsBase
Choltran Sachet is supplied through a WHO-GMP certified manufacturer with full COA documentation. We ship worldwide in plain, discreet packaging, and every order is covered by our Reshipment Assurance Policy. Your statement descriptor when paying by card shows the regulated payment processor (a regulated card-payment processor), never “MedsBase” or any medication name.
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| Strength | 5 g |
|---|---|
| Quantity | 5 Sachet/s, 10 Sachet/s, 15 Sachet/s, 30 Sachet/s |
Choltran Sachet
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