Bile Acid Sequestrant: What It Is, How It Works, and What You Need to Know

When your body makes too much LDL cholesterol, a bile acid sequestrant, a type of medication that binds to bile acids in the intestines to prevent their reabsorption. Also known as bile acid resins, it forces your liver to pull more cholesterol from your blood to make new bile acids. That’s how it lowers your bad cholesterol—without touching your liver directly. These drugs aren’t new, but they’re still used today, especially for people who can’t take statins or need a gentle, non-systemic option.

They work locally in your gut, so side effects are mostly digestive—bloating, constipation, gas. That’s why they’re often paired with fiber or taken with plenty of water. Common names you’ll see in prescriptions include cholestyramine, the first bile acid sequestrant approved, often used for high cholesterol and itching from liver disease, and colestipol, a similar resin that’s less likely to cause chalky texture in the mouth. There’s also colesevelam, a newer version with fewer GI issues and a once-daily dose. These aren’t magic pills—they don’t replace diet or exercise—but they’re a solid, predictable tool for managing cholesterol over time.

People who use them often have familial hypercholesterolemia, diabetes, or are trying to avoid statin side effects. Some doctors even prescribe them for bile acid malabsorption or to help control blood sugar in type 2 diabetes, since they slow down how fast carbs get absorbed. They’re not for everyone—especially if you’re already constipated or on other meds that need to be taken hours apart (they can interfere with absorption of thyroid meds, birth control, or warfarin). But for the right person, they’re a quiet, effective part of a long-term plan.

What you’ll find below is a collection of real comparisons between medications used for heart health, cholesterol, and related conditions. You’ll see how bile acid sequestrants stack up against other cholesterol-lowering drugs, how they interact with common prescriptions, and what alternatives patients actually switch to when side effects get tough. No fluff. Just clear, practical info from people who’ve been there.