Can you take Bile acid sequestrants with Vitamin K2 (Menaquinone)?
This is general information, not medical advice. Supplements can interact with medicines and health conditions. Always check with your doctor or pharmacist before starting or changing supplements.
What the evidence says
Bile acid sequestrants like cholestyramine bind bile acids in the gut, and bile acids are what your intestine needs to absorb fat-soluble vitamins, including vitamin K2. A clinical reference on this drug class specifically names vitamin K among the fat-soluble vitamins it depletes, recommending vitamins be taken a full 4 hours before the sequestrant dose; a separate clinical reference on cholestyramine specifically gives the more general rule of spacing other oral substances 1 hour before or 4 hours after it. Rather than track two slightly different windows, the safest and simplest instruction is to keep a full 4-hour gap between your vitamin K2 dose and your sequestrant dose, on either side. A published case report describes vitamin K deficiency and bleeding after 25 years of cholestyramine use, though that patient also had a separate liver condition (intrahepatic cholestasis) that can itself impair clotting-factor production, so the case doesn't isolate cholestyramine's effect alone -- it's illustrative rather than conclusive.
Keep at least 4 hours between them.
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We check against a limited set of medications. Absence of a warning here is not evidence of safety. Always confirm with your pharmacist.