Drug General Information (ID: DDI8TIK4JW)
Drug Name			Bumetanide		Drug Info		Cholestyramine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Diuretics				Bile Acid Sequestrants
Structure

Mechanism of Bumetanide-Cholestyramine Interaction (Severity Level: Moderate)
Complex formation Click to Show/Hide Mechanism Graph
Drug Name		Bumetanide				Cholestyramine
Mechanism		Binds to anion exchange resin/polymer				Anion exchange resin/polymer
Key Mechanism Factor 1
		Factor Name		Chelation
		Factor Description		Chelation is a direct drug interaction that usually involves the formation of dimers or trimers, resulting in larger complexes and poorer absorption.
Mechanism Description		Decreased absorption of Cholestyramine due to formation of complexes caused by Bumetanide

Recommended Action
Management		Diuretics should be administered at least 2 to 3 hours before cholestyramine or colestipol. If alternating dosage schedules is ineffective, it may be necessary to increase diuretic dosage during coadministration. Patients should be monitored for altered diuretic efficacy.

References
1	Neuvonen PJ, Kivisto K, Hirvisalo EL "Effects of resins and activated charcoal on the absorption of digoxin, carbamazepine and frusemide." Br J Clin Pharmacol 25 (1988): 229-33. [PMID: 3358884]
2	Product Information. Colestid (colestipol HCI). Pharmacia and Upjohn, Kalamazoo, MI.