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A surgeon has prescribed cholestyramine for me recently in an attempt to firm up my stool enough to prevent leaking into a pouch-vaginal fistula and  I have some questions about it.

Is it best to divide the dose into twice a day? I mix other powders into yogurt in the morning. Does it make sense to include cholestyramine powder in the mix or might it have a negative effect on the teeth if taken that way?

A quick search on this site isn't leaving me terribly hopeful that it will help a great deal but I'll certainly try. My stool is often fairly firm and it's only at times that it is a real problem. I'm wondering if I take this regularly if I'll develop consitipation. I could never really find the 'sweet spot' with Immodium but hopefully will with this.

Any experience/suggestions you can share is appreciated.

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Thanks Scott. I take lots of psyllium and, as I say, I'm often ok. Until I'm not. I wish I could see a reason.

I mix a probiotic powder and d manose powder (a cranberry derivative to help prevent UTIs) in yogurt . Are you saying that  not only should I not add the cholestyramine to the yogurt but actually take them a few hours apart?

My doc used to prescribe that powder as well (but now they have it in pill form as an FYI). He told me it’s fine to put it in things like apple sauce and stuff. I usually defer to what he suggests. He did say that you have to be careful taking it close to when you take other medications, however, as it doesn’t absorb as well if you do that.

i take it in pill form, in addition to loperamide and it helps a lot. Best of luck!

Thought I'd provide an update. I used the cholestryamine for two weeks without any success at all. The surgeon's second suggestion was Lomatil which I've been using with great success for the past month or so. Success in that the stool consistency is such that I am not having much leakage through the r/v fistula. I'm not sure it's sustainable though,  as it's $87 per month and although my doctor was able to get an exception and provinical pharmacare will cover it, it doesn't kick in until I've reached my over $3000 deductable.

I'm considering trying increased does of loperamide instead which, I think, is somewhat cheaper athough definitely not covered by provinicial or private drug coverage. Any thoughts on Lomatil vs Immodium? Thanks.

Funny you should ask!

I recently up my dose to 4 loperamide per day.

breakfast, before dinner, after dinner, bedtime.

adding the dose after dinner has now given me almost perfect pouch function.

be careful, I have found that taking two doses at the same time, amplifiers the effect and constipates me. By taking the doses separately allows for the proper slowing down without undesirable side effects.

I have not taken lomatil recently, so I can’t speak to its efficacy regarding pouch function.

good luck!

I take Lomotil at bedtime daily. Here in the US it seems to be an inexpensive medication, at least as well as I can determine with insurance. I was surprised to see it’s expensive anywhere, since medications are usually most expensive in the US. Perhaps the generic form (diphenoxylate/atropine) might be less pricey?

It is the generic form that I've been prescribed. I thought perhaps I could order from an American online pharmacy. I only looked at one but saw the cost for 90 tablets (close to a  month's worth) is $60 US which equates to $80 Canadian. I should likely try to see if increased loperamide (about $50 Cnd) works similarly. It's tough, though, because I've not had a major 'fistula day' since I started the Lomitil.

I won't come anywhere near my family deductible but I guess I'm grateful that my husband and I don't require much medication. I'll try Imodium but if it doesn't provide at similar effectiveness I'll have to figure out how to stay on the Lomotil. The fistula was reaching the point where I was needing to think about an ostomy.

Thanks for your input on this.

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