Hydrocortisone and Colestipol: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Colestipol
Hydrocortisone
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.
What happens
Decreased hydrocortisone effectiveness
Interaction Deep Dive
One case has been reported of a possible interaction between colestipol and hydrocortisone. A patient on chronic hydrocortisone therapy developed signs of glucocorticoid withdrawal after colestipol was added to his regimen2. Colestipol may bind to other concomitantly administered medications, thereby reducing or delaying their absorption. Concomitant medications should be administered at least 1 hour before or 4 hours after administration of colestipol 3.
Why it happens (mechanism)
Decreased absorption of hydrocortisone due to binding by colestipol
Literature reports
2 reports — tap to read
a) One study reports the case of a 67-year-old man with hypopituitarism and hypercholesterolemia. He was being treated with hydrocortisone 20 mg PO in the morning and 10 mg PO in the evening when colestipol 15 g PO TID taken 30 minutes before meals was added to his drug therapy. Within 4 days he developed symptoms of glucocorticoid withdrawal (lethargy, headaches, and unsteady gait); when hydrocortisone 100 mg IV was administered, his mental status returned to normal within a few hours. Colestipol was discontinued 2.
b) Supporting the assumption of an interaction between bile acid sequestering resins and hydrocortisone is a study of the concurrent use of hydrocortisone and cholestyramine which resulted in decreased peak cortisol levels and delayed time to peak levels. Cholestyramine appears to reduce and delay hydrocortisone absorption 1.
Common questions
Can I take Hydrocortisone and Colestipol together?
Decreased hydrocortisone effectiveness Always confirm with your pharmacist or prescriber before making any change.
How serious is the Hydrocortisone and Colestipol interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
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 "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Hydrocortisone or Colestipol 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 (3)
- 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
- Nekl KE & Aron DC: Hydrocortisone-colestipol interaction (letter). Ann Pharmacother 1993; 27:980-981. DOI
- Product Information: colestipol hcl oral suspension, colestipol hcl oral suspension. Global Pharmaceuticals, Philadelphia, PA, 2005.
Keep reading about Colestipol
Keep reading about Hydrocortisone
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:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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