Bile acid binders
In general medical parlance, medicinal substances are referred to as bile acid binders , which are used either as a cholesterol-lowering agent in hypercholesterolemia or in chronic diarrhea .
Mode of action
Bile acid binders are not absorbed by the body, so they only remain in the intestine and lead to the excretion of bile acids in the stool . Bile acid and cholesterol metabolism are closely related. If bile acids are withdrawn from the body, they have to be regenerated in the liver from cholesterol , which is withdrawn from the blood. The result: the cholesterol level drops.
Medicinal use of bile acid binders
Hypercholesterolemia
As a supplement or alternative to statins , which inhibit the biosynthesis of cholesterol in the liver, bile acid binders can be used to lower cholesterol. Colestyramine was not able to establish itself in practice because the high daily powder intake (on average 8 to 16 g), its artificial taste and the gastrointestinal side effects it caused made the long-term treatment unbearable. Around 30 to 50% of patients complained of flatulence, a feeling of tension and fullness, nausea and, above all, constipation after taking it.
The active ingredient colesevelam , which binds bile acids, causes cholesterol to be excreted in the stool in much smaller amounts of powder. Colesevelam is used in combination with other lipid-lowering drugs or as monotherapy in primary hypercholesterolemia. The active ingredient is said to have better gastrointestinal tolerance than cholestyramine; only constipation and dyspepsia are more common with colesevelam treatment than with placebo .
Chronic diarrhea
Loperamide is most commonly used for chronic diarrhea . Diarrhea caused or aggravated by unabsorbed bile acids may respond to treatment with bile acid binders.
Web links
- Therapy of chronic diarrhea (PDF; 149 kB)
