Drug Interaction Report

Cholestyramine and Hydrocortisone: Interaction Details

A pharmacist-reviewed analysis of the Cholestyramine and Hydrocortisone interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Cholestyramine

Prevalite Questran
+

Hydrocortisone

Ala-Cort Alkindi Alkindi Sprinkle® Alocane Anti-Itch Anucort-HC Anusol HC Aquanil HC Aquaphor Itch Relief
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Minor
Usually limited clinical impact.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 40 documented Cholestyramine interactions, 12 are rated minor — including this one.
Onset
delayed
Evidence
theoretical
Severity
Minor

What happens

Decreased hydrocortisone effectiveness

Interaction Deep Dive

In a controlled study, the concurrent use of cholestyramine 4 g and a single oral dose of hydrocortisone 50 mg resulted in lower peak cortisol levels and delayed time to peak levels, indicating both reduction and delay in hydrocortisone absorption. This action of cholestyramine appears to be dose-dependent1. A case report of an interaction between colestipol and hydrocortisone supports the assumption of an interaction between bile acid sequestering resins and hydrocortisone 2.

Why it happens (mechanism)

Decreased hydrocortisone absorption

Common questions

Can I take Cholestyramine and Hydrocortisone together?

Decreased hydrocortisone effectiveness Always confirm with your pharmacist or prescriber before making any change.

How serious is the Cholestyramine and Hydrocortisone interaction?

It is rated minor. Usually limited clinical impact.

How quickly could this interaction happen?

The documented onset is "delayed". Effects tend to build up gradually over days to weeks.

How strong is the evidence for this interaction?

The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.

From our Q&A

Real reader questions about these medications, each personally answered by our pharmacist:

Questions for your pharmacist

  • Does my dose of Cholestyramine or Hydrocortisone need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there anything you'd monitor while I'm on both?

References (2)

  1. Johansson C, Adamsson U, Stierner U, et al: Interaction by cholestyramine on the uptake of hydrocortisone in the gastrointestinal tract. Acta Med Scand 1978; 204:509-512. PubMed
  2. Nekl KE & Aron DC: Hydrocortisone-colestipol interaction (letter). Ann Pharmacother 1993; 27:980-981. DOI
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Cholestyramine

Keep reading about Cholestyramine

All Cholestyramine interactions (40)
Also serious with: Deferasirox Dexamethasone Injection Dexamethasone Ophthalmic Digoxin
Hydrocortisone

Keep reading about Hydrocortisone

All Hydrocortisone interactions (439) Hydrocortisone drug information
Also serious with: Mifepristone Desmopressin Ensitrelvir Desmopressin Nasal
Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Cholestyramine + Activated Charcoal Coffee Charcoal European Mandrake Glucomannan Guar Gum Gum Arabic Niacin Slippery Elm + 11 more
Hydrocortisone + Activated Charcoal Grapefruit Lily-of-the-valley St. John's Wort Acacia Rigidula Active Hexose Correlated Compound (ahcc) Adrafinil African Wild Potato + 197 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.