Welchol Shortage: A Provider's Update for 2026

The ongoing intermittent supply disruptions affecting Welchol (Colesevelam hydrochloride) and its generic equivalents continue to impact patients across the United States. This article provides clinicians with an overview of the current shortage, clinical considerations for patient management, and practical tools to help patients locate available supply.

Current Shortage Overview

Welchol, manufactured by Daiichi Sankyo, and generic Colesevelam products have experienced intermittent availability issues due to manufacturing complexities, limited generic competition, and raw material supply constraints. The shortage has affected all dosage forms — tablets, oral suspension packets, and chewable bars — though availability varies significantly by region.

Colesevelam is a complex polymer requiring specialized manufacturing processes. Unlike simpler small-molecule generics with numerous manufacturers, the Colesevelam market has limited producers, making it particularly vulnerable to supply disruptions.

Clinical Impact

Colesevelam serves dual clinical roles as both a lipid-lowering agent and an adjunctive therapy for glycemic control in type 2 diabetes. The shortage affects two distinct patient populations:

Hyperlipidemia Patients

• Patients on Colesevelam monotherapy (often statin-intolerant) may experience LDL-C rebound
• Patients using Colesevelam as add-on therapy to statins have more therapeutic flexibility
• Pediatric patients (ages 10-17) with familial heterozygous hypercholesterolemia may have fewer alternative options

Type 2 Diabetes Patients

• Colesevelam provides modest A1C reduction (approximately 0.5%) as adjunctive therapy
• Discontinuation may require adjustment of other glycemic agents
• Other bile acid sequestrants (Cholestyramine, Colestipol) are not FDA-approved for glycemic control

Therapeutic Alternatives

When Colesevelam is unavailable, consider the following substitutions based on indication:

For Hyperlipidemia

Same-class alternatives (bile acid sequestrants):

• Cholestyramine (Questran): Powder for suspension, 4-24 g/day in divided doses. Higher incidence of GI adverse effects. More extensive drug interaction profile — administer other medications 1 hour before or 4-6 hours after. Generally well-stocked and affordable.
• Colestipol (Colestid): Available as tablets (2-16 g/day) or granules. Similar efficacy and adverse effect profile to Cholestyramine. Tablet formulation may improve compliance.

Different-class alternatives:

• Ezetimibe (Zetia): 10 mg once daily. Cholesterol absorption inhibitor. Well-tolerated with fewer GI effects. Affordable generic available. Can be combined with statins. Not a bile acid sequestrant.
• Bempedoic acid (Nexletol): ATP citrate lyase inhibitor for statin-intolerant patients. 180 mg once daily.
• PCSK9 inhibitors (Repatha, Praluent): For high-risk patients requiring aggressive LDL lowering. Injectable, higher cost, usually requires prior authorization.

For Type 2 Diabetes (Adjunctive Glycemic Control)

Since other bile acid sequestrants lack FDA approval for diabetes, consider:

• Dose optimization of existing oral antidiabetic agents
• Addition or adjustment of SGLT2 inhibitors, GLP-1 receptor agonists, or DPP-4 inhibitors
• Closer monitoring of A1C and fasting glucose during the transition period

Drug Interaction Considerations When Switching

Colesevelam has a more favorable drug interaction profile than older bile acid sequestrants. When switching patients to Cholestyramine or Colestipol, review the following high-risk interactions:

• Levothyroxine: Administer 4+ hours apart (applies to all bile acid sequestrants)
• Warfarin: Monitor INR closely during transition; Cholestyramine has greater interaction potential
• Oral contraceptives: Administer 4+ hours apart
• Cyclosporine: Administer 4+ hours apart
• Phenytoin, Glipizide, Glyburide, Olmesartan: Timing separation required

For a comprehensive list, see our reference: Welchol Drug Interactions: What to Avoid.

Helping Patients Locate Available Supply

Before switching therapies, help patients find available Colesevelam:

• MedFinder for Providers: medfinder.com/providers — Real-time pharmacy inventory search. Direct patients here or use it during appointments to identify stocked pharmacies.
• Formulation flexibility: If tablets are unavailable, oral suspension packets or chewable bars may be in stock. Consider prescribing an alternative formulation.
• Generic substitution: Ensure prescriptions allow generic Colesevelam substitution to maximize pharmacy options.
• Mail-order pharmacies: May have larger inventories than retail pharmacies.

For a detailed provider workflow, see How to Help Your Patients Find Welchol in Stock.

Insurance and Prior Authorization During Shortages

Many payers have shortage-specific policies that may:

• Waive prior authorization for alternative therapies
• Allow early refills
• Override step-therapy requirements
• Authorize brand-name Welchol when generic is unavailable, or vice versa

Document the shortage in the patient's chart and on prior authorization forms. Reference the FDA Drug Shortage Database or ASHP shortage listings as supporting documentation.

Patient Communication

Patients concerned about the shortage may benefit from:

• Reassurance that missing a few doses of Colesevelam does not cause withdrawal effects
• Clear instructions on what to do if they can't fill their prescription
• Information about MedFinder as a self-service tool for locating medication
• A follow-up plan including lab monitoring if therapy is interrupted

Direct patients to our patient-focused shortage article: Welchol Shortage Update: What Patients Need to Know in 2026.

Monitoring Official Shortage Status

Stay current on the Colesevelam supply situation through:

• FDA Drug Shortage Database: accessdata.fda.gov/scripts/drugshortages
• ASHP Drug Shortage Resource Center: ashp.org/drug-shortages
• MedFinder Provider Dashboard: medfinder.com/providers

For cost-saving resources to share with patients, see How to Help Patients Save Money on Welchol.