Welchol (Colesevelam) - Oral

What Is Welchol?

Welchol (colesevelam) is an oral prescription medication used to lower cholesterol and improve blood sugar levels in adults with type 2 diabetes.

Welchol contains the active ingredient colesevelam, a bile acid sequestrant drug. It works by binding to bile acids produced by the liver to help digest food. When Welchol binds to bile acids, it eliminates them from the body as waste. When bile acid levels are reduced, your liver converts cholesterol to make more bile acid, lowering your cholesterol levels.

Welchol is available in two forms: a tablet and an oral solution. The oral solution comes as a powder that you dissolve into an 8-ounce drink.

Drug Facts

Generic Name: Colesevelam

Brand Name(s): Welchol

Administration Route(s): Oral

Drug Availability: Prescription

Therapeutic Classification: Antihyperlipidemic

Available Generically: Yes

Controlled Substance: N/A

Active Ingredient: Colesevelam

Dosage Form(s): Tablet, powder for suspension

What Is Welchol Used For?

Welchol is used to treat high cholesterol or type 2 diabetes. Specifically, the Food and Drug Administration (FDA) approved it for the following uses, along with a healthy diet and exercise:

Welchol (Colesevelam) Drug Information - Illustration by Zoe Hansen

Verywell / Zoe Hansen

How to Take Welchol

Take Welchol by mouth as directed by your healthcare provider. How you take it will depend on whether you take the tablet or solution. The usual dosing schedule for Welchol is either once or twice daily.

Tablets

Swallow Welchol tablets whole, with a meal and a drink. Do your best to take the medication on a consistent schedule each day. If you also take a statin (a commonly prescribed class of cholesterol-lowering drugs), you may take it at the same time or separately from Welchol.

If you have trouble swallowing Welchol tablets, ask your healthcare provider about trying the oral suspension.

Oral Suspension

Empty the powder from one packet into a glass. Add 8 ounces (equal to 1 cup) of water, stir until dissolved, and drink along with a meal. Other beverage options that you can use with Welchol powder are fruit juice or diet soda.

Storage

Store Welchol at room temperature, away from moisture.

Off-Label Uses

Colesevelam is most often prescribed to treat high cholesterol or type 2 diabetes. However, healthcare providers may also prescribe Welchol off-label for uses that the FDA hasn’t approved.

Welchol can be used off-label to treat:

How Long Does Welchol Take to Work?

It usually takes at least two weeks for Welchol to work if you are treating high cholesterol. 

If you have type 2 diabetes, you may notice improvement within four to six weeks as you monitor your blood sugar levels. Your provider will likely send you for a blood test called an A1C at least three months after starting Welchol. An A1C test is used to check your average blood sugar level.

What Are the Side Effects of Welchol?

This is not a complete list of side effects and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

The most common side effects of Welchol are:

  • Constipation
  • Indigestion
  • Nausea

Severe Side Effects

Rarely, serious side effects can occur in some people taking Welchol. If you notice the symptoms described below, do not wait to see if they go away. Call your healthcare provider right away, or call 911 for emergency medical care if your symptoms feel life-threatening.

Serious side effects and their symptoms can include the following:

  • Pancreatitis (inflammation of the pancreas): Symptoms to watch for include nausea and vomiting, feeling weak, and severe pain in the upper abdomen, or dull pain that gets worse after you eat.
  • Bowel obstruction (blockage in your intestines): Symptoms to watch include abdominal pain, bloating, abdominal distension, nausea, vomiting, bad breath.
  • Very high triglycerides levels in your blood: This side effect itself doesn’t cause symptoms, but high levels of triglycerides (greater than 500 milligrams per deciliter, or mg/dL) can lead to pancreatitis.

Long-Term Side Effects

It’s rare but possible that the severe side effects of Welchol may continue to affect you even after treatment. For example, some people need surgery to treat pancreatitis or bowel obstruction. In some cases, it may take a while to recover.

Report Side Effects

Welchol may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Welchol Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (powder for suspension):
    • For high cholesterol:
      • Adults, boys, and girls who have had their first menstrual period 10 to 17 years of age—One 3.75 gram-packet once a day.
      • Children younger than 10 years of age or girls who have not had their first menstrual period—Use and dose must be determined by your doctor.
    • For type 2 diabetes:
      • Adults—One 3.75 gram-packet once a day.
      • Children—Use and dose must be determined by your doctor.
  • For oral dosage form (tablets):
    • For high cholesterol:
      • Adults—6 tablets each day. This may be taken as a single dose or 3 tablets 2 times a day. Each tablet contains 625 milligrams (mg) of colesevelam.
      • Children—The oral suspension is recommended in this age group.
    • For type 2 diabetes:
      • Adults—6 tablets each day. This may be taken as one dose or 3 tablets 2 times a day. Each tablet contains 625 milligrams (mg) of colesevelam.
      • Children—Use and dose must be determined by your doctor.

Modifications

Your healthcare provider may recommend dose adjustments based on several factors, such as:

  • Your ability to swallow large-size tablets
  • Other medications you may be taking
  • Other health conditions you may have

Tell your healthcare provider if you have trouble swallowing Welchol tablets due to their size. Your provider may switch you to the oral suspension. You should not cut or crush Welchol tablets. Be sure to talk to your provider before making any changes to your dose.

Missed Dose

If you miss a dose of Welchol, try to take it as soon as possible. But, if you miss a day, just wait and take your next dose at the regular time. You should not double your daily dose to make up for a missed dose.

It is best to take Welchol every day to get the medication’s full benefits.

Overdose: What Happens If I Take Too Much Welchol?

Taking too much Welchol should not be dangerous. This is because medication stays in your digestive tract and does not get absorbed into your bloodstream.

However, taking more than the recommended dose of Welchol may worsen side effects, such as constipation. Taking more than your healthcare provider prescribes can also increase your risk for severe side effects, such as pancreatitis or bowel obstruction.

What Happens If I Overdose on Welchol?

If you think you or someone else may have overdosed on Welchol and are experiencing side effects, call a healthcare provider.

If someone collapses or isn't breathing after taking Welchol, call 911 immediately.

Precautions

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It is very important that the doctor check your or your child's progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.

This medicine may increase triglyceride levels in the blood which may cause serious heart problems. Your doctor may check your triglycerides or fatty acids in the blood before using this medicine.

Your doctor may want to measure the cholesterol levels in your blood on a regular basis to make sure this medicine is working properly. Be sure to keep all of your appointments. You will also need to check your blood sugar regularly at home.

Do not stop using this medicine without first checking with your doctor. When you stop using this medicine, your blood cholesterol and sugar levels may increase again.

This medicine can cause low blood sugar (hypoglycemia). The symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out). People may feel different symptoms with a low blood sugar. It is important that you learn which symptoms you get when your blood sugar is low. The symptoms of low blood sugar include: anxiety, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool, pale skin, difficulty with thinking, drowsiness, excessive hunger, a fast heartbeat, continuing headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, and unusual tiredness or weakness.

If you have any symptoms of low blood sugar, check your blood sugar level right away. If needed, you can eat glucose tablets or gel, corn syrup, honey, or sugar cubes, or you can drink fruit juice, a non-diet soft drink, or sugar dissolved in water.

Check with your doctor right away if you have sudden and severe stomach pain, chills, constipation, nausea, vomiting, fever, or lightheadedness. These may be symptoms of acute pancreatitis.

This medicine can cause constipation, and for some people this can be very uncomfortable. If you have problems with severe constipation while using this medicine, talk to your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Welchol?

You should not take Welchol if:

  • You have very high triglyceride blood levels (greater than 500 mg/dL).
  • You had pancreatitis due to very high triglycerides (also called hypertriglyceridemia-induced pancreatitis) in the past.
  • You had a bowel obstruction in the past.
  • You had an allergic reaction to Welchol or one of its ingredients in the past.


If you have phenylketonuria (PKU), you should not take Welchol oral suspension. This form of the drug comes in a powder that contains phenylalanine, an ingredient that can be harmful to people with PKU.

What Other Medications May Interact With Welchol?

Welchol can interact with many other medications. You can manage most of these interactions by separating the administration of other medications from Welchol.

You should take other medications at least four hours before taking Welchol. This is particularly important for the following:

  • Birth control pills (oral contraceptives) that contain the ingredients ethinyl estradiol and norethindrone
  • Thyroid replacement medications such as Synthroid and Levothroid (levothyroxine)
  • Sulfonylureas, a type of diabetes medication, such as Amaryl (glimepiride), Glucotrol (glipizide), and glyburide (brand names Diabeta, Glycron, Glynase Pres-Tab, and Micronase)
  • Dilantin, Phenytek (phenytoin) a seizure medication
  • Benicar (olmesartan), a blood pressure drug
  • Supplements that contain fat-soluble vitamins (e.g., vitamins A, D, E, and K)

Welchol may also affect the levels of certain medications in your body. Your provider may monitor you more carefully if you take one of the following prescription drugs:

  • Coumadin, Jantoven (warfarin) 
  • Extended-release metformin (brand names Fortamet and Glumetza, among others)

Before starting Welchol, tell your provider about all of your current prescription and over-the-counter medications.

What Medications Are Similar?

Bile acid sequestrants similar to Welchol include:

  • Questran, Prevalite (cholestyramine)
  • Colestid (colestipol)

Your healthcare provider will likely prescribe other medications besides Welchol to treat your condition. These other medications depend on whether you have high cholesterol, type 2 diabetes, or both. If you have questions about other treatment options, talk to your provider.

This is a list of drugs in the same class as Welchol. This is not a list of drugs recommended to take with Welchol. You should not take these drugs together because they work the same way.

Frequently Asked Questions

  • How does Welchol work?

    Welchol is a bile acid sequestrant. It contains the active ingredient colesevelam, which binds to bile acids in your digestive tract. The liver produces bile acids to help digest food. When the drug binds to bile acids, a complex is formed that your body cannot absorb. It gets eliminated from the body with your waste. Then your liver makes more bile acids by converting cholesterol into bile acids. This results in lower LDL (“bad”) cholesterol in your body.

    Welchol also works to improve control of blood sugar levels in people with type 2 diabetes. But experts don’t know precisely how the drug lowers blood sugar levels. Keeping your cholesterol and blood sugar levels in a healthy range can help to reduce your risk of complications of these conditions.

  • How will I know if Welchol is working?

    Welchol takes at least two weeks to start working. Since you cannot feel when your cholesterol or blood sugar levels are high, you will need to have your blood checked to find out if Welchol is working.

    If you have high cholesterol, your healthcare provider will likely order a blood cholesterol test for you at least four to six weeks after you start treatment.

    If you have type 2 diabetes, you may notice improvement as you monitor your blood sugar at home. Your provider will likely send you for an A1C blood test at least three months after starting Welchol.

  • Is there a generic or lower-cost alternative to Welchol?

    Yes, Welchol is available as a generic version. Generic drugs are as safe and effective as the brand-name equivalent, and usually less expensive. The generic name for Welchol is colesevelam.

  • Can I take Welchol along with a statin?

    Yes, some people require more than one medication to control their cholesterol levels. Welchol can be taken alone or along with a statin drug to help control cholesterol. If you also take a statin, you can take your dose at the same time as Welchol, but separating it is also okay.

How Can I Stay Healthy While Taking Welchol?

Taking Welchol can help manage the levels of LDL cholesterol and sugar in your body. This is important because high cholesterol and blood sugar levels can increase the risk of serious cardiovascular problems, like a heart attack or stroke. But, just taking Welchol is not enough. The medication is meant to be used with a healthy diet and a regular exercise program.

Having a healthy diet and lifestyle will help your medication work more effectively. Consider diet changes such as limiting red meat, fried foods, and saturated fats. Instead of processed foods, turn to fresh vegetables and other whole foods. If you’re new to exercising, start with a short daily walk. You can ask your healthcare provider about other exercises that are good options for you.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your doctor before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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2 Sources
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  1. Lent-Schochet D, Jialal I. StatPearls. Antilipemic agent bile acid sequestrants.

  2. Food and Drug Administration. Welchol (colesevelam hydrochloride) tablets, for oral use. Welchol (colesevelam hydrochloride) oral suspension.