Colesevelam (Welchol) Treatment for Type 2 Diabetes

Are you sick and tired of taking pills?

Are you sick and tired of taking pills?

David Mendosa’s May 20, 2009, blog post at brought to my attention a little-used diabetes drug, colesevelam HCl.  The brand name is Welchol, and it has been around in the U.S. since 2000 for treatment of high cholesterol.
Colesevelam is in a class called bile acid sequestrants.  Taken in pill form, it is minimally absorbed from the gastrointestinal tract, which generally minimizes the chance for serious side effects.  It can, however, interfere with absorption of many other drugs, thereby impairing the effectiveness of those drugs. 

The U.S. Food and Drug Administration has approved the drug for 1) treating high cholestrol, and 2) treatment of type 2 diabetes in combination with insulin or oral antidiabetes medications.  So, it’s not a diabetic medication to be used by itself.  The most common side effects are constipation and dyspepsia. 

WebMD has a patient-friendly article on colesevelam.

I see very few patients using Welchol for treatment of diabetes, and I’m not entirely sure why.  It may be related to the interference with absorption of other drugs.  Many people with diabetes are on multiple oral medications.  Another reason is that, since it cannot be used alone, it adds a layer of complexity to treatment.  Some physicians would be tempted to use it in a diabetic with high cholesterol: the old “kill two birds with one stone” trick.  However, it’s unknown whether such use acturally reduces cardiovasular disease and mortality.  Statin drugs – the market leaders in lowering cholesterol – do reduce cardiovascular disease rates and mortality. 

By my count, we how have 10 classes of drugs to help us fight diabetes, compared with three or so when I started my medical career.

Steve Parker, M.D.

Additional information:  FDA Prescribing Information.

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