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Therapy for Hypercholesterolemia; Standardization of Cholesterol Measurements-Reply

Conrad B. Blum, MD; Robert I. Levy, MD
JAMA. 1990;263(3):376. doi:10.1001/jama.1990.03440030058022.
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In Reply. —  The issue raised by Dr Hamburger is an important one, and it was considered in our review. We stated that "bile acid sequestrants can interfere with the absorption of concurrently administered drugs." Limits on the length of our article precluded greater detail.Since the bile acid sequestrants are anion exchange resins, they have the potential to interfere with the absorption of anionic drugs. Such an interaction has been demonstrated for thyroxine, phenylbutazone, warfarin, chlorothiazide, propranolol, digoxin, tetracycline, and penicillin G. This interaction certainly exists with many other anionic drugs that have not yet been tested. It is, therefore, prudent to administer other medication at least 1 hour before or 4 hours after dosing with a bile acid sequestrant. If this precaution is not observed, marked changes in blood levels of concurrently administered medications may occur when treatment with a bile acid sequestrant is initiated or discontinued. Patients


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