Comprehensive medication guide to Prevalite including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$5–$25 copay for generic cholestyramine on most commercial insurance plans and Medicare Part D; it is typically covered on Tier 1 or Tier 2 with no prior authorization required. Medicaid plans generally cover it as well.
Estimated Cash Pricing
$30–$180 per 30-day supply for generic cholestyramine depending on the dose and pharmacy; bulk canisters are typically cheaper than individual packets. With GoodRx or SingleCare discount cards, prices drop to as low as $45–$50 per 30-day supply at many participating pharmacies.
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Prevalite is the brand name for cholestyramine, a bile acid sequestrant medication used primarily to lower elevated LDL ("bad") cholesterol levels and to relieve itching caused by partial biliary obstruction. The Prevalite brand has been discontinued by its manufacturer; all cholestyramine currently on the market is available as a generic drug.
Cholestyramine comes as a powder that is mixed with water, juice, or another liquid before drinking. Each dose contains 4 grams of anhydrous cholestyramine resin. The medication is not absorbed into the bloodstream — it works entirely in the digestive tract, which gives it a unique safety profile compared to many other cholesterol-lowering drugs.
In addition to its FDA-approved uses, cholestyramine is commonly prescribed off-label for bile acid diarrhea (bile acid malabsorption), a condition causing chronic diarrhea that is frequently seen in patients with Crohn's disease, after ileal resection, or with idiopathic causes.
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Cholestyramine is an anion exchange resin — a positively charged molecule that acts like a sponge for negatively charged bile acids in your intestine. Your liver normally produces bile acids from cholesterol; these are secreted into the intestine to help digest dietary fat and then reabsorbed and recycled back to the liver through a process called enterohepatic circulation.
When you take cholestyramine, it binds bile acids in the intestine and prevents their reabsorption. Instead, the bile acid-resin complex is excreted in your stool. With less bile acid returning to the liver, the liver compensates by synthesizing new bile acids — drawing cholesterol from LDL particles in the blood to do so. This process lowers circulating LDL cholesterol levels by 15–30% at therapeutic doses.
For bile acid diarrhea, cholestyramine traps excess bile acids that have reached the colon, preventing them from irritating the colon lining and triggering secretory diarrhea. For pruritus from biliary obstruction, binding bile acids reduces their accumulation in skin tissue, relieving itching over 1–3 weeks of therapy.
4 g — powder for oral suspension (regular)
Each packet or scoop contains 4g anhydrous cholestyramine resin (5.5g Prevalite powder). Starting dose: 1 packet/scoop once or twice daily. Maintenance: 2-4 packets/scoops daily divided into 2 doses.
4 g — powder for oral suspension (light/sugar-free)
Same active ingredient as regular formulation; uses aspartame instead of sugar as sweetener. Suitable for diabetic patients. Avoid in phenylketonuria (PKU).
As of 2026, Prevalite (generic cholestyramine) is experiencing intermittent supply disruptions across the United States. The brand-name Prevalite has been discontinued; all supply is generic. Availability varies significantly by region and pharmacy. Urban areas with multiple pharmacy options generally have better access, while rural areas served by a single distributor may experience more significant shortages.
The shortage is driven by generic market consolidation (fewer manufacturers), raw material supply chain disruptions, rising off-label demand for bile acid diarrhea treatment, and wholesale distribution allocation policies that create regional pockets of scarcity. Both the regular and light (sugar-free) formulations are affected, though one may be available when the other is not.
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Cholestyramine (Prevalite) is not a controlled substance, so it can be prescribed by any licensed prescriber without special DEA registration. Any physician, nurse practitioner, or physician assistant with prescribing authority in their state can write a prescription for cholestyramine. The most common prescribers include:
Cholestyramine can be prescribed via telehealth in all 50 states, as it is not a controlled substance. Telehealth platforms such as Teladoc, MDLive, and Doctor on Demand, as well as many insurance-provided virtual care portals, can prescribe or renew cholestyramine prescriptions for established patients with a prior lipid panel on file.
No. Cholestyramine (Prevalite) is not a controlled substance and is not scheduled by the DEA. It is a prescription medication, but any licensed prescriber — including primary care physicians, nurse practitioners, and physician assistants — can prescribe it without special DEA registration or prescribing restrictions.
Because it is not a controlled substance, there are no federal or state limits on the quantity that can be prescribed at one time, no restrictions on early refills, and it can be prescribed via telehealth visits in all 50 states without any additional requirements. Prescriptions can also be transferred between pharmacies freely.
Most side effects of cholestyramine are gastrointestinal:
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Colesevelam (Welchol)
Second-generation bile acid sequestrant; same mechanism as cholestyramine but in tablet form. Has significantly fewer drug interactions and better GI tolerability. Also FDA-approved for type 2 diabetes glycemic control. More expensive than generic cholestyramine but generic colesevelam is available.
Colestipol (Colestid)
First-generation bile acid sequestrant similar to cholestyramine. Available as granules and tablets. Similar efficacy and pricing to generic cholestyramine. Same drug interaction profile — take other medications 1 hour before or 4-6 hours after.
Ezetimibe (Zetia)
Cholesterol absorption inhibitor that blocks cholesterol uptake in the small intestine. Different mechanism from bile acid sequestrants; useful for high cholesterol but not appropriate for bile acid diarrhea or pruritus.
Statins (atorvastatin, rosuvastatin)
HMG-CoA reductase inhibitors; first-line for LDL cholesterol lowering with strong cardiovascular outcome evidence. Not appropriate if cholestyramine is being used for bile acid diarrhea or pruritus. Additive LDL-lowering effect when used together with cholestyramine.
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Warfarin (Coumadin)
majorCholestyramine significantly reduces warfarin absorption. Monitor INR closely when starting or stopping cholestyramine. Take warfarin at least 1 hour before cholestyramine dose.
Levothyroxine (Synthroid)
majorCholestyramine can reduce levothyroxine absorption by up to 90%. Take levothyroxine at least 4 hours before cholestyramine. Recheck TSH 6-8 weeks after any change in cholestyramine therapy.
Digoxin (Lanoxin)
majorReduced digoxin absorption can lower therapeutic levels. Monitor digoxin levels when starting cholestyramine. Take digoxin well before cholestyramine.
Mycophenolate (CellCept)
majorCholestyramine markedly reduces mycophenolate exposure. Avoid concurrent use in transplant patients if possible; if unavoidable, monitor immunosuppression levels closely.
Raloxifene (Evista)
majorCholestyramine reduces raloxifene absorption by up to 90%. Concurrent use is generally not recommended.
Oral contraceptives (estrogens/progestins)
moderateReduced absorption of hormonal birth control. Take at least 1 hour before cholestyramine. Consider backup contraception.
Fat-soluble vitamins (A, D, E, K)
moderateCholestyramine reduces absorption of fat-soluble vitamins. Take vitamin supplements at least 4-6 hours separate from cholestyramine. Long-term use may require vitamin supplementation.
Statins (pravastatin, lovastatin, fluvastatin)
minorAdditive LDL-lowering effect — a beneficial combination. However, separate doses by at least 1 hour before or 4-6 hours after cholestyramine to prevent reduced statin absorption.
Prevalite (cholestyramine) is a time-tested bile acid sequestrant with over 50 years of clinical use for high LDL cholesterol and bile acid conditions. While the brand name has been discontinued, generic cholestyramine remains an important medication for patients who cannot tolerate statins, those who need combination lipid-lowering therapy, and those with bile acid diarrhea or pruritus from biliary obstruction.
The current intermittent supply shortage makes finding it more challenging, but not impossible. Key strategies include checking both regular and light formulations, trying different pharmacy chains or independent pharmacies, requesting 90-day supplies, and using GoodRx or SingleCare to reduce costs. Alternatives like colesevelam (Welchol) and colestipol (Colestid) are available if cholestyramine is completely unavailable in your area.
If you're having difficulty locating cholestyramine at your pharmacy,
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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