Protecting the Gut from Bile Acids During Budesonide Withdrawal

Bile acid sequestrants bind to bile acids, preventing their reabsorption in the gut. They are used to lower cholesterol levels. One such drug is COLESEVELAM HYDROCHLORIDE. Colesevelam is used for the treatment of bile acid malabsorption although not licensed for this indication. Colesevelam which has the brand name Cholestagel in the UK comes in 625 mg tablets. The recommended dose is 1.25 to 3.75 mg (2 – 6 tablets) daily.

I tried gradually reducing my Budesonide dose many times but was unable to do so. I needed three tablets daily.

I started colesevelam four tablets daily in divided doses for a couple of weeks and was able to reduce my budesonide to two tablets daily. The budesonide dose was then gradually titrated down as seen in the graph below. The full dose of colesevelam (4 tablets) was continued for a week after stopping budesonide and then continued at half-dose (2 tablets) for one more week.

The above strategy was 100% successful, I have been symptom free since November 2016. The tapering strategy may have been excessive, but it is a one-off activity. A summary follows.