Drug General Information (ID: DDICI5ZADL)
Drug Name			Fludrocortisone		Drug Info		Cholestyramine		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiinflammatory Agents				Bile Acid Sequestrants
Structure

Mechanism of Fludrocortisone-Cholestyramine Interaction (Severity Level: Moderate)
Complex formation Click to Show/Hide Mechanism Graph
Drug Name		Fludrocortisone				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 Fludrocortisone

Recommended Action
Management		Oral corticosteroids should be administered at least 1 hour before or 4 to 6 hours after a cholestyramine or colestipol dose, and at least 4 hours before a colesevelam dose.

References
1	Johansson C, Adamsson U, Stierner U, Lindsten T "Interaction by cholestyramine on the uptake of hydrocortisone in the gastrointestinal tract." Acta Med Scand 204 (1978): 509-12. [PMID: 735882]
2	Nekl KE, Aron DC "Hydrocortisone-colestipol interaction." Ann Pharmacother 27 (1993): 980-1. [PMID: 8364291]
3	Product Information. Colestid (colestipol HCI). Pharmacia and Upjohn, Kalamazoo, MI.
4	Product Information. Questran (cholestyramine). Par Pharmaceutical Inc, Chestnut Ridge, NY.
5	Product Information. Welchol (colesevelam) Daiichi Sankyo, Inc., Parsippany, NJ.