The most common side effects are GI. Constipation (11%) and dyspepsia (8%) are more common with colesevelam than placebo. Because of the constipating effects of colesevelam, it is not recommended in patients with gastroparesis, bowel obstruction, or a history of major GI surgery. It also should not be used in patients with significant swallowing or esophageal issues, as it may worsen the underlying condition or cause obstruction. Colesevelam should be taken with a large amount of water to lower the risk of the above issues. Hypoglycemia rates were low, although caution with insulin or sulfonylureas is prudent.