Welchol colesevelam hydrochloride 625 mg Tablet, Film Coated, 180-count
Other active recalls for Colesevelam Hydrochloride (different manufacturers) — 1 · tap to view
🆔 Identity & classification
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🏷️ RxNorm drug class
This medicine belongs to the Bile Acid Sequestrant class.
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🏭 Manufacturer & labeler
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🩺 Clinical
Colesevelam is used to decrease the amount of cholesterol (a fat-like substance that can build up in blood vessels leading to heart attack or strokes or other medical conditions) control blood sugar levels in adults with type 2 diabetes (condition in which the body does not use insulin normally leading to high blood sugar) Colesevelam is in a class of medications called bile acid sequestrants. It works by binding bile acids in your intestines to form a product that is removed from the body.
Read the full MedlinePlus article ↗- That depends on why your doctor prescribed it. If you have high LDL cholesterol, colesevelam helps pull that 'bad' cholesterol down by working inside your gut — it's never absorbed...
- What exactly is colesevelam supposed to do for me?
- Yes, timing really matters here. Colesevelam — whether you're taking the tablets or mixing the powder into a drink — should always be taken with a meal. The tricky part is that it...
- How do I take it, and does it matter when I take my other medications?
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🧪 Inactive Ingredients / Excipients
Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.
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UNII 3NXW29V3WO
Hypromellose is a plant-based thickener made from cellulose. It's used in medicines as a binder to hold ingredients together, a coating for tablets, and a thickener for liquids.
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UNII 70097M6I30
Magnesium stearate is a salt made from magnesium and stearic acid, a fatty substance. It's used in tablets and capsules as a lubricant and glidant to help ingredients flow smoothly during manufacturing and prevent sticking.
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UNII OP1R32D61U
Microcrystalline cellulose is a purified form of cellulose, a natural fiber from plant sources. It acts as a binder and filler in tablets and capsules, helping hold ingredients together and give the medicine its shape and size.
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UNII ETJ7Z6XBU4
Silicon dioxide is a naturally occurring mineral used as a glidant and anti-caking agent. It helps powder ingredients flow smoothly and prevents clumping during manufacturing and storage.
4 inactive ingredients listed in the exact product block matched to this NDC.
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ingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.Inactive ingredient FAQ
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💲 Pricing
A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.
| Price system | Per ea | Per package |
|---|---|---|
| Retail pharmacies payNADAC · weekly | $5.672 | $1,020.91 / 180 tablets |
| Medicaid paysCMS SDUD · 12 mo | $4.89 | $880.20 / 180 tablets |
| Medicare drug plans payPart D · quarterly | No Part D plan price is available for this NDC in our data. | |
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🔁 Therapeutic equivalents
| Product | Labeler | Pack | NADAC/unit | TE | Status | Price vs. this |
|---|---|---|---|---|---|---|
| Colesevelam Hydrochloride 625 mg 00115-1320-19 | Amneal | 180 tablets | $0.261 | AB | Availability likely | save 95% |
| Colesevelam Hydrochloride 625 mg 00713-0936-81 | Cosette | 180 tablets | $0.261 | AB | Discontinued | save 95% |
| Colesevelam hydrochloride 625 mg 27808-0190-01 | Cranbury | 180 tablets | $0.261 | AB | Availability likely | save 95% |
| Colesevelam Hydrochloride 625 mg 43598-0230-18 | Dr.Reddys | 180 tablets | $0.261 | AB | Availability likely | save 95% |
| Colesevelam Hydrochloride 625 mg 60687-0385-25 | American | 1 tablet | $0.261 | AB | Availability likely | save 95% |
| colesevelam hydrochloride 625 mg 68462-0433-18 | Glenmark | 180 tablets | $0.261 | AB | Availability likely | save 95% |
| Colesevelam Hydrochloride 625 mg 69452-0158-25 | Bionpharma | 180 tablets | $0.261 | AB | Availability likely | save 95% |
| Colesevelam Hydrochloride 625 mg 69452-0493-25 | Bionpharma | 180 tablets | $0.261 | AB | Availability likely | save 95% |
| Welchol 625 mgthis 00713-0879-81 | Cosette | 180 tablets | $5.672 | AB | Discontinued | — |
| Colesevelam Hydrochloride 625 mg 33342-0197-57 | Macleods | 180 tablets | — | — | FDA listed | — |
| Colesevelam HCL 625 mg 50090-4371-00 | A-S | 90 tablets | — | AB | FDA listed | — |
| Colesevelam Hydrochloride 625 mg 50090-6994-00 | A-S | 90 tablets | — | AB | FDA listed | — |
| Colesevelam Hydrochloride 625 mg 50090-6995-00 | A-S | 90 tablets | — | AB | FDA listed | — |
| colesevelam hydrochloride 625 mg 50090-7459-00 | A-S | 90 tablets | — | AB | FDA listed | — |
| colesevelam hydrochloride 625 mg 50090-7460-00 | A-S | 90 tablets | — | AB | FDA listed | — |
| Colesevelam hydrochloride 625 mg 50090-7604-00 | A-S | 90 tablets | — | AB | FDA listed | — |
| Colesevelam hydrochloride 625 mg 50090-7605-00 | A-S | 90 tablets | — | AB | FDA listed | — |
| Colesevelam HCL 625 mg 50090-7811-00 | A-S | 90 tablets | — | AB | FDA listed | — |
| Colesevelam Hydrochloride 625 mg 51407-0336-18 | Golden | 180 tablets | — | AB | FDA listed | — |
| Colesevelam HCL 625 mg 63629-8767-01 | Bryant | 180 tablets | — | AB | FDA listed | — |
| Colesevelam HCL 625 mg 67877-0506-05 | Ascend | 500 tablets | — | AB | FDA listed | — |
| Colesevelam 625 mg 68382-0619-10 | Zydus | 1000 tablets | — | AB | FDA listed | — |
| Colesevelam 625 mg 70771-1368-00 | Zydus | 1000 tablets | — | AB | FDA listed | — |
| Colesevelam HCL 625 mg 71335-2905-01 | Bryant | 180 tablets | — | AB | FDA listed | — |
| Colesevelam HCL 625 mg 72162-1846-02 | Bryant | 180 tablets | — | AB | FDA listed | — |
| Colesevelam HCL 625 mg 72789-0476-93 | PD-Rx | 180 tablets | — | AB | FDA listed | — |
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⏳ Availability & generic status
FDA-approved generic versions are listed, and recent pricing/market data suggests they may be available — see Therapeutic equivalents.
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🗺️ Medicaid utilization & spend
📊 Medicare Part D spend CMS · PART D · 2026 (Q1)
🔬 Reported adverse events (FAERS)
Top reported reactions
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Serious outcomes
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📦 Packaging — all sizes for this product
| Package NDC | Description | Marketing start | Status |
|---|---|---|---|
| 00713-0879-81 You're viewing this | 180 TABLET, FILM COATED in 1 BOTTLE (0713-0879-81) | 2022-09-01 | Inactivated by FDA |
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| NDC identity (package / product / labeler codes) | ✓ Available |
| Labeler | ✓ Available |
| Product & package description | ✓ Available |
| Marketing category & status | ✓ Available |
| Active ingredient / dosage form / route | ✓ Available |
| FDA label (SPL via DailyMed) | ✓ Available |
| Package photos | ✓ Available |
| Inactive ingredients (structured) | ✓ Available |
| NADAC pharmacy acquisition price (CMS) | ✓ Available |
| Orange Book / therapeutic-equivalence data | ✓ Available |
| HCPCS J-code billing crosswalk | — Not published for this NDC Most self-administered / retail products have no J-code — that is normal. |
| Medicaid utilization (CMS SDUD) | ✓ Available |
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📄 Full prescribing information FDA SPL
🎯 Indications and Usage ▾
1 INDICATIONS AND USAGE WELCHOL is a bile acid sequestrant indicated as an adjunct to diet and exercise to: reduce elevated low-density lipoprotein cholesterol (LDL-C) in adults with primary hyperlipidemia ( 1.1 ). reduce LDL-C levels in boys and postmenarchal girls, 10 to 17 years of age, with heterozygous familial hypercholesterolemia (HeFH), unable to reach LDL-C target levels despite an adequate trial of diet and lifestyle modification ( 1.1 ). improve glycemic control in adults with type 2 diabetes mellitus ( 1.2 ).
Limitations of Use ( 1.3 ): Do not use for treatment of type 1 diabetes or for diabetic ketoacidosis. Not studied in Fredrickson Type I, III, IV, and V dyslipidemias
1.1Primary Hyperlipidemia WELCHOL is indicated as an adjunct to diet and exercise to reduce elevated low-density lipoprotein cholesterol (LDL-C) in adults with primary hyperlipidemia. WELCHOL is indicated to reduce LDL-C levels in boys and postmenarchal girls, 10 to 17 years of age, with heterozygous familial hypercholesterolemia (HeFH) who are unable to reach LDL-C target levels despite an adequate trial of dietary therapy and lifestyle modification.
1.2Type 2 Diabetes Mellitus WELCHOL is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus .
1.3Limitations of Use WELCHOL should not be used for the treatment of type 1 diabetes or for the treatment of diabetic ketoacidosis. WELCHOL has not been studied in Fredrickson Type I, III, IV, and V dyslipidemias.
⏱️ Dosage and Administration ▾
2 DOSAGE AND ADMINISTRATION Obtain lipid parameters, including serum triglyceride (TG) levels, before starting WELCHOL ( 2.1 ). The recommended dosage for adults and for boys and postmenarchal girls aged 10 to 17 years with primary hyperlipidemia is 3.75 grams daily. The recommended dosage for adults with type 2 diabetes mellitus is 3.75 grams daily.
WELCHOL should be taken as follows ( 2.2 , 2.4 ): Tablets Take 6 tablets once daily or 3 tablets twice daily with a meal and liquid. For Oral Suspension Take one packet once daily with a meal. To prepare, empty the entire contents of one packet into a glass or cup.
Add 1 cup of water, fruit juice, or diet soft drinks. Stir well and drink.
2.1Testing Prior to Initiation of WELCHOL Obtain lipid parameters, including triglyceride (TG) levels, before starting WELCHOL. WELCHOL is contraindicated in patients with TG levels >500 mg/dL [see Contraindications (4) and Warnings and Precautions (5.1) ] .
2.2Recommended Dosage in Primary Hyperlipidemia and Type 2 Diabetes Mellitus The recommended dosage of WELCHOL for adults and for boys and postmenarchal girls aged 10 to 17 years with primary hyperlipidemia is 3.75 grams daily. The recommended dosage of WELCHOL for adults with type 2 diabetes mellitus is 3.75 grams daily. WELCHOL should be taken as follows: Tablets Take 6 tablets once daily or 3 tablets twice daily.
Due to tablet size, WELCHOL for oral suspension is recommended for use in the pediatric population. For Oral Suspension Take one packet once daily.
2.3Important Dosing Information for Primary Hyperlipidemia WELCHOL can be dosed at the same time as a statin, or WELCHOL and the statin can be dosed apart . Monitor lipid levels within 4 to 6 weeks after initiation of WELCHOL.
2.4Administration Instructions Tablets Take WELCHOL tablets with a meal and liquid. For patients with difficulty swallowing tablets, use WELCHOL for oral suspension [see Warnings and Precautions (5.2) ]. For Oral Suspension To prepare, empty the entire contents of one packet into a glass or cup.
Add 1 cup (8 ounces) of water, fruit juice, or diet soft drinks. Stir well and drink. Take WELCHOL oral suspension with meals.
Do not take WELCHOL oral suspension in its dry form. Due to tablet size, WELCHOL for oral suspension is recommended for use in the pediatric population.
💊 Dosage Forms and Strengths ▾
3 DOSAGE FORMS AND STRENGTHS Tablets: 625 mg tablets are off-white, oval, film-coated and imprinted with "Sankyo" and "C01" on one side. For Oral Suspension: 3.75 gram packet containing a white to pale yellow powder with yellow granules. Tablets: 625 mg ( 3 ) For Oral Suspension: 3.75 gram packet ( 3 )
⛔ Contraindications ▾
4 CONTRAINDICATIONS WELCHOL is contraindicated in patients with: Serum TG concentrations >500 mg/dL [see Warnings and Precautions (5.1) ] History of hypertriglyceridemia-induced pancreatitis [see Warnings and Precautions (5.1) ] A history of bowel obstruction [see Warnings and Precautions (5.2) ] Patients with serum triglyceride levels >500 mg/dL ( 4 ) Patients with a history of hypertriglyceridemia-induced pancreatitis ( 4 ) Patients with a history of bowel obstruction ( 4 )
⚠️ Warnings and Cautions ▾
5 WARNINGS AND PRECAUTIONS Hypertriglyceridemia and Pancreatitis: WELCHOL can increase TG. Hypertriglyceridemia can cause acute pancreatitis. Monitor lipids, including TG.
Instruct patients to discontinue WELCHOL and seek prompt medical attention if the symptoms of acute pancreatitis occur ( 5.1 ). Gastrointestinal Obstruction: Cases of bowel obstruction have occurred. WELCHOL is not recommended in patients with gastroparesis, other gastrointestinal motility disorders, and in those who have had major gastrointestinal tract surgery and who may be at risk for bowel obstruction ( 5.2 ).
Vitamin K or Fat-Soluble Vitamin Deficiencies: WELCHOL may decrease absorption of fat-soluble vitamins. Patients with a susceptibility to deficiencies of vitamin K (e.g., patients on warfarin, patients with malabsorption syndromes) or other fat-soluble vitamins may be at increased risk. Patients on oral vitamin supplementation should take their vitamins at least 4 hours prior to WELCHOL ( 5.3 ).
Drug Interactions: Due to the potential for decreased absorption of other drugs that have not been tested for interaction, consider administering at least 4 hours prior to WELCHOL ( 5.4 , 7 , 12.3 ). Risks in Patients with Phenylketonuria (PKU): Phenylalanine can be harmful to patients with phenylketonuria. WELCHOL for oral suspension contains 27 mg phenylalanine per 3.75 gram packet ( 5.5 , 11 ).
5.1Hypertriglyceridemia and Pancreatitis WELCHOL, like other bile acid sequestrants, can increase serum TG concentrations. Hypertriglyceridemia can cause acute pancreatitis. WELCHOL had effects on serum TG (median increase 5% compared to placebo) in trials of patients with primary hyperlipidemia.
In trials in patients with type 2 diabetes, greater increases in TG levels occurred when WELCHOL was used as monotherapy (median increase 9.7% compared to placebo) and when WELCHOL was used in combination with pioglitazone (median increase 11% compared to placebo in combination with pioglitazone), sulfonylureas (median increase 18% compared to placebo in combination with sulfonylureas), and insulin (median increase 22% compared to placebo in combination with insulin) [see Adverse Reactions (6.1) ]. Obtain lipid parameters, including TG levels, before starting WELCHOL and periodically thereafter.
WELCHOL is contraindicated in patients with TG levels >500 mg/dL or patients with a history of hypertriglyceridemia-induced pancreatitis [see Contraindications (4) ] . Patients with TG levels greater than 300 mg/dL could have greater increases in serum TG levels with WELCHOL and may require additional TG monitoring. Instruct patients to discontinue WELCHOL and seek prompt medical attention if the symptoms of acute pancreatitis occur (e.g., severe abdominal pain with or without nausea and vomiting).
Discontinue WELCHOL if TG levels exceed 500 mg/dL [see Adverse Reactions (6.1) ] .
5.2Gastrointestinal Obstruction Postmarketing cases of bowel obstruction have occurred with WELCHOL [see Adverse Reactions (6.2) ] . Because of its constipating effects, WELCHOL is not recommended in patients with gastroparesis, other gastrointestinal motility disorders, and in those who have had major gastrointestinal tract surgery and who may be at risk for bowel obstruction. WELCHOL is contraindicated in patients with a history of bowel obstruction [see Contraindications (4) ] .
Instruct patients to promptly discontinue WELCHOL and seek medical attention if severe abdominal pain or severe constipation occurs. Because of the tablet size, WELCHOL tablets can cause dysphagia or esophageal obstruction. For patients with difficulty swallowing tablets, use WELCHOL for oral suspension.
5.3Vitamin K or Fat-Soluble Vitamin Deficiencies WELCHOL may decrease the absorption of fat-soluble vitamins A, D, E, and K. Patients with a susceptibility to deficiencies of vitamin K (e.g., patients on warfarin, patients with malabsorption syndromes) or other fat-soluble vitamins may be at increased risk when taking WELCH…
🤒 Adverse Reactions ▾
6 ADVERSE REACTIONS The following important adverse reactions are described below and elsewhere in the labeling: Hypertriglyceridemia and Pancreatitis [see Warnings and Precautions (5.1) ] Gastrointestinal Obstruction [see Warnings and Precautions (5.2) ] Vitamin K or Fat-Soluble Vitamin Deficiencies [see Warnings and Precautions (5.3) ] In clinical trials, the most common (incidence ≥2% and greater than placebo) adverse reactions with WELCHOL included constipation, dyspepsia, and nausea ( 6.1 ). To report SUSPECTED ADVERSE REACTIONS, contact Cosette Pharmaceuticals, Inc. at 1-800-922-1038 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
6.1Clinical Studies Experience Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in clinical studies of another drug and may not reflect the rates observed in practice. Primary Hyperlipidemia In 7 double-blind, placebo-controlled clinical trials, 807 patients with primary hyperlipidemia (age range 18-86 years, 50% women, 90% Caucasians, 7% Blacks, 2% Hispanics, 1% Asians) and elevated LDL-C were treated with WELCHOL 1.5 g/day to 4.5 g/day from 4 to 24 weeks (total exposure 199 patient-years).
Table 1 Clinical Studies of WELCHOL for Primary Hyperlipidemia: Adverse Reactions Reported in ≥ 2% of Patients and More Commonly than in Placebo WELCHOL N=807 Placebo N=258 Constipation 11.0% 7.0% Dyspepsia 8.3% 3.5% Nausea 4.2% 3.9% Accidental injury 3.7% 2.7% Asthenia 3.6% 1.9% Pharyngitis 3.2% 1.9% Flu syndrome 3.2% 3.1% Rhinitis 3.2% 3.1% Myalgia 2.1% 0.4% Pediatric Patients 10 to 17 Years of Age In an 8-week double-blind, placebo-controlled study, boys and post-menarchal girls, 10 to 17 years of age, with HeFH (n=194), were treated with WELCHOL tablets (1.9-3.8 g, daily) or placebo tablets.
Table 2 Clinical Study of WELCHOL for Primary Hyperlipidemia in HeFH Pediatric Patients: Adverse Reactions Reported in ≥2% of Patients and More Commonly than in Placebo WELCHOL N=129 Placebo N=65 Nasopharyngitis 6.2% 4.6% Headache 3.9% 3.1% Fatigue 3.9% 1.5% Creatine Phosphokinase Increase 2.3% 0.0% Rhinitis 2.3% 0.0% Vomiting 2.3% 1.5% The reported adverse reactions during the additional 18-week open-label treatment period with WELCHOL 3.8 g per day were similar to those during the double-blind period and included headache (7.6%), nasopharyngitis (5.4%), upper respiratory tract infection (4.9%), influenza (3.8%), and nausea (3.8%).
Type 2 Diabetes Mellitus In 5 add-on combination and 1 monotherapy double-blind, 12- to 26-week, placebo-controlled clinical trials in patients with type 2 diabetes mellitus, 1022 patients were treated with WELCHOL. The mean exposure duration was 20 weeks (total exposure 393 patient-years). Patients were to receive 3.8 grams of WELCHOL per day.
The mean age of patients was 55.7 years, 52.8 percent of the population was male and 61.9% were Caucasian, 4.8% were Asian, and 15.9% were Black or African American. At baseline the population had a mean hemoglobin A1c (HbA1c) of 8.2%, and 26% had past medical history suggestive of microvascular complications of diabetes. Table 3 shows adverse reactions associated with the use of WELCHOL in patients with type 2 diabetes.
These adverse reactions were not present at baseline, occurred more commonly on WELCHOL than on placebo, and occurred in at least 2% of patients treated with WELCHOL. Table 3 Clinical Studies of WELCHOL for Type 2 Diabetes: Adverse Reactions Reported in ≥2% of Patients and More Commonly than in Placebo WELCHOL N=1022 Placebo N=1010 Constipation 6.5% 2.2% Hypoglycemia 3.4% 3.1% Dyspepsia 2.8% 1.0% Nausea 2.6% 1.6% Hypertension 2.6% 1.9% Back Pain 2.3% 1.3% A total of 5.3% of WELCHOL-treated patients and 3.6% of placebo-treated patients were discontinued from the diabetes trials due to adverse reactions.
This difference was driven mostly by gastrointestinal adverse reactions such as abdominal pain and cons…
🔄 Drug Interactions ▾
7 DRUG INTERACTIONS Concomitant use with WELCHOL may decrease the exposure of the following drugs: Drugs with a narrow therapeutic index (e.g., cyclosporine), phenytoin, thyroid hormone replacement therapy, warfarin, oral contraceptives containing ethinyl estradiol and norethindrone, olmesartan medoxomil, and sulfonylureas (glimepiride, glipizide, glyburide). Administer these drugs 4 hours prior to WELCHOL. For patients on warfarin, monitor International Normalized Ratio (INR) frequently during initiation then periodically ( 7.1 ).
Concomitant use with WELCHOL may increase the exposure of the following drugs: Metformin extended release. Monitor patients' glycemic control ( 7.2 ).
7.1WELCHOL Drug Interactions that Decrease the Exposure of the Concomitant Medication Table 4 includes a list of drugs that decrease exposure of the concomitant medication when administered concomitantly with WELCHOL and instructions for preventing or managing them. Table 4 WELCHOL Drug Interactions that Decrease the Exposure of the Concomitant Medication Drugs with a Narrow Therapeutic Index Clinical Impact: Concomitant use with WELCHOL may decrease the exposure of the narrow therapeutic index drug. In vivo drug interactions studies showed a decrease in exposure of cyclosporine when coadministered with WELCHOL [see Clinical Pharmacology (12.3) ].
Intervention: Administer the narrow therapeutic index drug at least 4 hours prior to WELCHOL. Monitor drug levels when appropriate. Examples: Cyclosporine Phenytoin Clinical Impact: There have been postmarketing reports of increased seizure activity or decreased phenytoin levels in patients receiving phenytoin [see Adverse Reactions (6.2) ].
Intervention: Administer phenytoin 4 hours prior to WELCHOL. Thyroid Hormone Replacement Therapy Clinical Impact: In vivo drug interactions studies showed a decrease in exposure of levothyroxine when coadministered with WELCHOL [see Clinical Pharmacology (12.3) ]. There have been postmarketing reports of elevated thyroid-stimulating hormone (TSH) in patients receiving thyroid hormone replacement therapy [see Adverse Reactions (6.2) ].
Intervention: Administer thyroid hormone replacement therapy 4 hours prior to WELCHOL. Warfarin Clinical Impact: There have been postmarketing reports of reduced INR in patients receiving warfarin therapy [see Adverse Reactions (6.2) ]. Intervention: Monitor INR frequently during WELCHOL initiation then periodically thereafter.
Oral Contraceptives Containing Ethinyl Estradiol and Norethindrone Clinical Impact: In vivo drug interactions studies showed a decrease in exposure of ethinyl estradiol and norethindrone when coadministered with WELCHOL [see Clinical Pharmacology (12.3) ]. Intervention: Administer oral contraceptives containing ethinyl estradiol and norethindrone 4 hours prior to WELCHOL. Olmesartan Medoxomil Clinical Impact: In vivo drug interactions studies showed a decrease in olmesartan medoxomil when coadministered with WELCHOL [see Clinical Pharmacology (12.3) ].
Intervention: Administer olmesartan medoxomil 4 hours prior to WELCHOL. Sulfonylureas Clinical Impact: In vivo drug interactions studies showed a decrease in sulfonylureas when coadministered with WELCHOL [see Clinical Pharmacology (12.3) ]. Intervention: Administer sulfonylureas 4 hours prior to WELCHOL.
Examples: Glimepiride, glipizide, and glyburide Oral Vitamin Supplements Clinical Impact: WELCHOL may decrease the absorption of fat-soluble vitamins A, D, E, and K [see Warnings and Precautions (5.3) ]. Intervention: Patients on oral vitamin supplementation should take their vitamins at least 4 hours prior to WELCHOL.
7.2WELCHOL Drug Interactions that Increase the Exposure of the Concomitant Medication Table 5 WELCHOL Drug Interactions that Increase the Exposure of the Concomitant Medication Metformin Extended Release (ER) Clinical Impact: In vivo drug interactions studies showed an increase in metformin extended release (ER) when coadministered with WELCHOL [see C…
👥 Use in Specific Populations ▾
8 USE IN SPECIFIC POPULATIONS
8.1Pregnancy Risk Summary WELCHOL is not absorbed systemically following oral administration, and maternal use is not expected to result in fetal exposure to the drug. Limited available data on the use of WELCHOL are insufficient to determine a drug-associated risk of major congenital malformations or miscarriage. In animal reproduction studies, no evidence of either maternal or fetal toxicity was found in rats or rabbits exposed to colesevelam hydrochloride during the period of fetal organogenesis at 8 and 5 times, respectively, the maximum recommended human dose (MRHD) of 3.75 g/day, based on body surface area (mg/m 2 ).
No adverse effects on offspring survival and development were observed in rats administered 5 times the MRHD (see Data ). WELCHOL may decrease the absorption of fat-soluble vitamins [see Warnings and Precautions (5.3) ]. There are no data available on the effect of colesevelam hydrochloride on the absorption of fat-soluble vitamins in pregnant women.
If the patient becomes pregnant while taking WELCHOL, the patient should be advised of the lack of known clinical benefit with continued use during pregnancy. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. In the US general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.
Data Human Data There are no adequate and well-controlled studies of colesevelam hydrochloride use in pregnant women. In the postmarketing setting there have been infrequent reports of pregnancy with use of WELCHOL and a causal association with congenital anomalies has not been established. Animal Data In pregnant rats given dietary doses of 0.3, 1.0, 3.0 g/kg/day colesevelam hydrochloride from gestation days 7 through 17, no teratogenic effects were observed.
Exposures at 3.0 g/kg/day were 8 times the human exposure at 3.75 g/day MRHD, based on body surface area (mg/m 2 ). In pregnant rabbits given oral gavage doses of 0.1, 0.5, 1.0 g/kg/day colesevelam hydrochloride from gestation days 6 through 18, no teratogenic effects were observed. Exposures at 1.0 g/kg/day were 5 times the human exposure at 3.75 g/day MRHD, based on body surface area (mg/m 2 ).
In pregnant rats given oral gavage doses of 0.1, 0.3, 1.0 g/kg/day colesevelam hydrochloride from gestation day 6 through lactation day 21 (weaning), no adverse effects on survival and development were observed. Exposures at 1.0 g/kg/day were 5 times the human exposure at 3.75 g/day MRHD, based on body surface area (mg/m 2 ).
8.2Lactation Risk Summary WELCHOL is not absorbed systemically by the mother following oral administration, and breastfeeding is not expected to result in exposure of the child to WELCHOL.
8.3Females and Males of Reproductive Potential Contraception Use of WELCHOL may reduce the efficacy of oral contraceptives. Advise patients to take oral contraceptives at least 4 hours prior to taking WELCHOL [see Drug Interactions (7) ].
8.4Pediatric Use Primary Hyperlipidemia The safety and effectiveness of WELCHOL to reduce LDL-C levels in boys and postmenarchal girls 10 to 17 years of age with HeFH who are unable to reach LDL-C target levels despite an adequate trial of dietary therapy and lifestyle modification have been established. Use of WELCHOL for this indication is supported by a study in 129 WELCHOL-treated pediatric patients aged 10 to 17 years with HeFH [see Clinical Studies (14.1) ] . Adverse reactions commonly observed in pediatric patients compared to placebo, but not in adults, included headache (3.9%), creatine phosphokinase increase (2.3%), and vomiting (2.3%) [see Adverse Reactions (6.1) ] .
There were no significant effects on fat-soluble vitamin levels or clotting factors in the adolescent boys or girls relative to placebo. Due to WELCHOL tablet size, WELCHOL for oral suspension is recommended for use in the pedi…
🤰 Pregnancy ▾
8.1Pregnancy Risk Summary WELCHOL is not absorbed systemically following oral administration, and maternal use is not expected to result in fetal exposure to the drug. Limited available data on the use of WELCHOL are insufficient to determine a drug-associated risk of major congenital malformations or miscarriage. In animal reproduction studies, no evidence of either maternal or fetal toxicity was found in rats or rabbits exposed to colesevelam hydrochloride during the period of fetal organogenesis at 8 and 5 times, respectively, the maximum recommended human dose (MRHD) of 3.75 g/day, based on body surface area (mg/m 2 ).
No adverse effects on offspring survival and development were observed in rats administered 5 times the MRHD (see Data ). WELCHOL may decrease the absorption of fat-soluble vitamins [see Warnings and Precautions (5.3) ]. There are no data available on the effect of colesevelam hydrochloride on the absorption of fat-soluble vitamins in pregnant women.
If the patient becomes pregnant while taking WELCHOL, the patient should be advised of the lack of known clinical benefit with continued use during pregnancy. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. In the US general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.
Data Human Data There are no adequate and well-controlled studies of colesevelam hydrochloride use in pregnant women. In the postmarketing setting there have been infrequent reports of pregnancy with use of WELCHOL and a causal association with congenital anomalies has not been established. Animal Data In pregnant rats given dietary doses of 0.3, 1.0, 3.0 g/kg/day colesevelam hydrochloride from gestation days 7 through 17, no teratogenic effects were observed.
Exposures at 3.0 g/kg/day were 8 times the human exposure at 3.75 g/day MRHD, based on body surface area (mg/m 2 ). In pregnant rabbits given oral gavage doses of 0.1, 0.5, 1.0 g/kg/day colesevelam hydrochloride from gestation days 6 through 18, no teratogenic effects were observed. Exposures at 1.0 g/kg/day were 5 times the human exposure at 3.75 g/day MRHD, based on body surface area (mg/m 2 ).
In pregnant rats given oral gavage doses of 0.1, 0.3, 1.0 g/kg/day colesevelam hydrochloride from gestation day 6 through lactation day 21 (weaning), no adverse effects on survival and development were observed. Exposures at 1.0 g/kg/day were 5 times the human exposure at 3.75 g/day MRHD, based on body surface area (mg/m 2 ).
🧒 Pediatric Use ▾
8.4Pediatric Use Primary Hyperlipidemia The safety and effectiveness of WELCHOL to reduce LDL-C levels in boys and postmenarchal girls 10 to 17 years of age with HeFH who are unable to reach LDL-C target levels despite an adequate trial of dietary therapy and lifestyle modification have been established. Use of WELCHOL for this indication is supported by a study in 129 WELCHOL-treated pediatric patients aged 10 to 17 years with HeFH [see Clinical Studies (14.1) ] . Adverse reactions commonly observed in pediatric patients compared to placebo, but not in adults, included headache (3.9%), creatine phosphokinase increase (2.3%), and vomiting (2.3%) [see Adverse Reactions (6.1) ] .
There were no significant effects on fat-soluble vitamin levels or clotting factors in the adolescent boys or girls relative to placebo. Due to WELCHOL tablet size, WELCHOL for oral suspension is recommended for use in the pediatric population [see Dosage and Administration (2.2 , 2.4) ] . The safety and effectiveness of WELCHOL in pediatric patients with HeFH less than 10 years of age or in premenarchal females have not been established.
Type 2 Diabetes Mellitus The safety and effectiveness of WELCHOL to improve glycemic control in pediatric patients with type 2 diabetes mellitus have not been established. Effectiveness was not demonstrated in a 6-month, adequate and well-controlled study conducted in 141 WELCHOL-treated pediatric patients aged 10 to 17 years with type 2 diabetes mellitus.
🧓 Geriatric Use ▾
8.5Geriatric Use Primary Hyperlipidemia Of the 1350 patients enrolled in the hyperlipidemia clinical studies, 349 (26%) were ≥65 years old, and 58 (4%) were ≥75 years old. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. Type 2 Diabetes Mellitus Of the 2048 patients enrolled in the six diabetes studies, 397 (19%) were ≥65 years old, and 36 (2%) were ≥75 years old.
In these trials, WELCHOL 3.8 g/day or placebo was added onto background anti-diabetic therapy. No overall differences in safety or effectiveness were observed between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out.
🆘 Overdosage ▾
10 OVERDOSAGE WELCHOL is not absorbed and the risk of systemic toxicity is low. Excessive doses of WELCHOL may cause more severe local gastrointestinal effects (e.g., constipation).
🧬 Clinical Pharmacology ▾
12 CLINICAL PHARMACOLOGY
12.1Mechanism of Action Primary Hyperlipidemia : Colesevelam hydrochloride, the active pharmaceutical ingredient in WELCHOL, is a non-absorbed, lipid-lowering polymer that binds bile acids in the intestine, impeding their reabsorption. As the bile acid pool becomes depleted, the hepatic enzyme, cholesterol 7-α-hydroxylase, is upregulated, which increases the conversion of cholesterol to bile acids. This causes an increased demand for cholesterol in the liver cells, resulting in the dual effect of increasing transcription and activity of the cholesterol biosynthetic enzyme, HMG-CoA reductase, and increasing the number of hepatic LDL receptors.
These compensatory effects result in increased clearance of LDL-C from the blood, resulting in decreased serum LDL-C levels. Serum TG levels may increase or remain unchanged. Type 2 Diabetes Mellitus : The mechanism by which WELCHOL improves glycemic control is unknown.
12.2Pharmacodynamics A maximum therapeutic response to the lipid-lowering effects of WELCHOL was achieved within 2 weeks and was maintained during long-term therapy. In the diabetes clinical studies, a therapeutic response to WELCHOL, as reflected by a reduction in HbA1c, was initially noted following 4-6 weeks of treatment and reached maximal or near-maximal effect after 12-18 weeks of treatment.
12.3Pharmacokinetics Absorption Colesevelam hydrochloride is a hydrophilic, water-insoluble polymer that is not hydrolyzed by digestive enzymes and is not absorbed. Distribution Colesevelam hydrochloride is not absorbed, and therefore, its distribution is limited to the gastrointestinal tract. Elimination Metabolism Colesevelam hydrochloride is not metabolized systemically and does not interfere with systemic drug-metabolizing enzymes such as cytochrome P450.
Excretion In 16 healthy volunteers, an average of 0.05% of administered radioactivity from a single 14 C-labeled colesevelam hydrochloride dose was excreted in the urine. Drug Interaction Studies Drug interactions between colesevelam and concomitantly administered drugs were screened through in vitro studies and confirmed in in vivo studies. In vitro studies demonstrated that cephalexin, metformin, and ciprofloxacin had negligible binding to colesevelam hydrochloride.
Therefore, an in vivo pharmacokinetic interaction of WELCHOL with these drugs is unlikely. WELCHOL was found to have no significant effect on the bioavailability of aspirin, atenolol, digoxin, enalapril, fenofibrate, lovastatin, metoprolol, phenytoin, pioglitazone, quinidine, rosiglitazone, sitagliptin, valproic acid, and warfarin. The results of additional in vivo drug interactions of WELCHOL are presented in Table 6.
Table 6 Mean Change in Drug Exposure (AUC 0-∞ and C max ) when Administered with WELCHOL (3.75 g) With verapamil, the dose of WELCHOL was 4.5 g. Drug Dose Co-administered 1 hr prior to WELCHOL 4 hrs prior to WELCHOL AUC 0-∞ C max AUC 0-∞ C max AUC 0-∞ C max N/A − not available Cyclosporine 200 mg -34% -44% N/A N/A N/A N/A Ethinyl Estradiol Oral contraceptive containing norethindrone and ethinyl estradiol 0.035 mg -24% -24% -18% -1% -12% 0% Glimepiride 4 mg -18% -8% N/A N/A -6% 3% Glipizide 20 mg -12% -13% N/A N/A -4% 0% Glyburide 3 mg -32% -47% -20% -15% -7% 4% Levothyroxine 600 µg -22% -33% 6% -2% 1% 8% Metformin ER 1500 mg 44% 8% N/A N/A N/A N/A Norethindrone 1 mg -1% -20% 5% -3% 6% 7% Olmesartan Medoxomil 40 mg -39% -28% N/A N/A -15% -4% Repaglinide 2 mg -7% -19% -6% -1% N/A N/A Verapamil Sustained Release 240 mg -11% -31% N/A N/A N/A N/A
🧬 Mechanism of Action ▾
12.1Mechanism of Action Primary Hyperlipidemia : Colesevelam hydrochloride, the active pharmaceutical ingredient in WELCHOL, is a non-absorbed, lipid-lowering polymer that binds bile acids in the intestine, impeding their reabsorption. As the bile acid pool becomes depleted, the hepatic enzyme, cholesterol 7-α-hydroxylase, is upregulated, which increases the conversion of cholesterol to bile acids. This causes an increased demand for cholesterol in the liver cells, resulting in the dual effect of increasing transcription and activity of the cholesterol biosynthetic enzyme, HMG-CoA reductase, and increasing the number of hepatic LDL receptors.
These compensatory effects result in increased clearance of LDL-C from the blood, resulting in decreased serum LDL-C levels. Serum TG levels may increase or remain unchanged. Type 2 Diabetes Mellitus : The mechanism by which WELCHOL improves glycemic control is unknown.
📦 How Supplied / Storage and Handling ▾
16 HOW SUPPLIED/STORAGE AND HANDLING WELCHOL 625 mg tablets are supplied as off-white, solid tablets imprinted with the word "Sankyo" and "C01" on one side and are available as follows: Bottles of 180 – NDC 0713-0879-81 WELCHOL 3.75 gram packets for oral suspension contain a white to pale yellow powder containing yellow granules and are available as follows: Cartons of 30 packets – NDC 0713-0880-30 Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature]. Protect from moisture.
Brief exposure to 40°C (104°F) does not adversely affect WELCHOL tablets.
📦 Storage and Handling ▾
Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature]. Protect from moisture. Brief exposure to 40°C (104°F) does not adversely affect WELCHOL tablets.
📋 Description ▾
11 DESCRIPTION WELCHOL (colesevelam hydrochloride) is a non-absorbed, polymeric, lipid-lowering and glucose-lowering agent for oral administration. Colesevelam hydrochloride is a high-capacity bile acid-binding molecule. Colesevelam hydrochloride is poly(allylamine hydrochloride) cross-linked with epichlorohydrin and alkylated with 1-bromodecane and (6-bromohexyl)-trimethylammonium bromide.
The chemical name (IUPAC) of colesevelam hydrochloride is allylamine polymer with 1-chloro-2,3-epoxypropane, [6-(allylamino)-hexyl]trimethylammonium chloride and N-allyldecylamine, hydrochloride. The chemical structure of colesevelam hydrochloride is represented by the following formula: wherein (a) represents allyl amine monomer units that have not been alkylated by either of the 1-bromodecane or (6-bromohexyl)-trimethylammonium bromide alkylating agents or cross-linked by epichlorohydrin; (b) represents allyl amine units that have undergone cross-linking with epichlorohydrin; (c) represents allyl amine units that have been alkylated with a decyl group; (d) represents allyl amine units that have been alkylated with a (6-trimethylammonium) hexyl group, and m represents a number ≥100 to indicate an extended polymer network.
A small amount of the amines are dialkylated and are not depicted in the formula above. No regular order of the groups is implied by the structure; cross-linking and alkylation are expected to occur randomly along the polymer chains. A large amount of the amines are protonated.
The polymer is depicted in the hydrochloride form; a small amount of the halides are bromide. Colesevelam hydrochloride is hydrophilic and insoluble in water. WELCHOL tablets are off-white, oval, film-coated, solid tablets each containing 625 mg colesevelam hydrochloride.
In addition, each tablet contains the following inactive ingredients: magnesium stearate, microcrystalline cellulose, silicon dioxide, HPMC (hydroxypropyl methylcellulose), and acetylated monoglyceride. The tablets are imprinted using a water-soluble black ink (<5 calories per 6 tablets). WELCHOL for oral suspension is a citrus-flavored, white to pale yellow powder containing yellow granules packaged in a packet containing 3.75 gram colesevelam hydrochloride.
In addition, each packet contains the following inactive ingredients: lemon flavor, orange flavor, propylene glycol alginate, simethicone, aspartame, citric acid, medium chain triglycerides, and magnesium trisilicate (<5 calories per 3.75 gram single-dose packet). PHENYLKETONURICS: WELCHOL for oral suspension contains 27 mg phenylalanine per 3.75 gram dose. Chemical Structure
💬 Information for Patients ▾
17 PATIENT COUNSELING INFORMATION Hypertriglyceridemia and Pancreatitis Inform patients that WELCHOL may increase their serum triglycerides which can lead to hypertriglyceridemia and pancreatitis. Instruct patients to discontinue WELCHOL and seek prompt medical attention if the symptoms of acute pancreatitis occur (e.g., severe abdominal pain with or without nausea and vomiting) [see Warnings and Precautions (5.1) ]. Gastrointestinal Inform patients that WELCHOL may cause bowel obstruction.
Instruct patients to promptly discontinue WELCHOL and seek medical attention if severe abdominal pain or severe constipation occurs [see Warnings and Precautions (5.2) ]. Drug and Vitamin Interactions Advise patients that WELCHOL has drug interactions, and WELCHOL may decrease the absorption of fat-soluble vitamins A, D, E, and K. Instruct patients to take oral vitamins at least 4 hours prior to WELCHOL.
Instruct patients to inform their physician about all the drugs and vitamins that they are prescribed or take over the counter [see Warnings and Precautions (5.3) and Drug Interactions (7) ]. Hypertriglyceridemia and Cardiovascular Disease Inform patients that WELCHOL may increase serum triglycerides and that the long-term effect of hypertriglyceridemia on the risk of coronary artery disease is uncertain [see Warnings and Precautions (5.1) ]. Administration [see Dosage and Administration (2.2 , 2.4) ]: Tablets Advise patients to take WELCHOL tablets with a meal and liquid.
Inform patients that WELCHOL tablets can be taken as 6 tablets once daily or 3 tablets twice daily. For Oral Suspension Instruct patients to empty the entire contents of one packet into a glass or cup and add 1 cup (8 ounces) of water, fruit juice, or diet soft drinks. Stir well and drink.
Advise patients to take WELCHOL oral suspension with meals. Advise patient to not take WELCHOL oral suspension in its dry form. Females of Reproductive Potential Advise females of reproductive potential that WELCHOL may reduce the effectiveness of oral contraceptives, and to take oral contraceptives at least 4 hours before taking WELCHOL [see Drug Interactions (7.1) and Use in Specific Populations (8.3) ].