Treatments

Bile Acid Sequestrants (BAS) are usually prescribed to help manage the symptoms of bile acid diarrhoea. The medications work by binding to the bile acids in the small bowel and preventing them from irritating the large intestine. It may take several days before an improvement in diarrhoea is seen and up to several weeks or months to find the right level of medication and dietary adaptation that help control the symptoms.

The main medications include:

  • Colestyramine and Colestipol - these medications only come in powder form. Unfortunately, some people find they can be unpalatable and are not tolerated due to taste or texture. If the dose is too high it can cause constipation, so it is important to adjust the dose according to symptoms
  • Colesevelam - this is a newer medication and comes in a tablet form. Some patients find it more palatable than Colestyramine. Again if the dose is too high it can cause constipation. These medications can affect the absorption of other drugs so must be taken 4 hours before or after other medications

It is important to keep taking the medicines for ten days before deciding they do not work. It is very unlikely that having had a diagnosis of bile acid diarrhoea that it will improve without treatment, this treatment will likely continue for life. If the treatment is effective and it’s stopped, symptoms will almost certainly return either immediately or within a few days.

If you are pregnant or thinking about conceiving then please discuss your treatment with your GP and or antenatal team

Once a diagnosis of bile acid diarrhoea is made it is advisable to see a dietician. A key piece of dietary advice will be to keep to a strictly low fat diet (40g of fat per day). There are other specialised diets that can be recommended and the dietician will go through these in detail.

Further information on taking medications and diet is provided in our Living with BAD section.

Primary Medications used in the treatment of Bile Acid Diarrhoea

The three main medications used to treat the symptoms of BAD are Colesevelam (Cholestagel), Colestyramine (Questran & Questran Light) and Loperamide (Imodium).

  Colesevelam  is a tablet-form bile acid aequestrant that may be prescribed in place of Question.

Colesevelam is a tablet-form bile acid aequestrant that may be prescribed in place of Question.

  Colestyramine  is a powder bile acid sequestrate that is often used as the first treatment for BAD

Colestyramine is a powder bile acid sequestrate that is often used as the first treatment for BAD

  Loperamide  (Immodium) is used to slow down the bowels and is often used in conjunction with bile acid sequestrate.

Loperamide (Immodium) is used to slow down the bowels and is often used in conjunction with bile acid sequestrate.