Formulary
Gemfibrozil: Indications, Dosing, Side Effects and Interactions
Fibrates act by decreasing serum triglycerides; they have variable effect on LDL-cholesterol.
MedNext Academy | 3 min read
Gemfibrozil: Indications, Dosing, Side Effects and Interactions
Fibrates act by decreasing serum triglycerides; they have variable effect on LDL-cholesterol.
Drug action
Fibrates act by decreasing serum triglycerides; they have variable effect on LDL-cholesterol.
Indications and dose
**Adjunct to diet and other appropriate measures in mixed hyperlipidaemia if statin contra-indicated or not tolerated,Adjunct to diet and other appropriate measures in primary hypercholesterolaemia if statin contra-indicated or not tolerated,Adjunct to diet and other appropriate measures in severe hypertriglyceridaemia,Adjunct to diet and other appropriate measures in primary prevention of cardiovascular disease in men with hyperlipidaemias if statin contra-indicated or not tolerated**
- **Adult** (By Mouth): 1.2 g daily in 2 divided doses, maintenance 0.9-1.2 g daily.
Cautions
Correct hypothyroidism before initiating treatment; elderly; risk factors for myopathy
Contraindications
History of gall-bladder or biliary tract disease including gallstones; photosensitivity to fibrates
Side effects
Common or very common Constipation; diarrhoea; fatigue; flatulence; gastrointestinal discomfort; headache; nausea; skin reactions; vertigo; vomiting Uncommon Atrial fibrillation Rare or very rare Alopecia; anaemia; angioedema; appendicitis; bone marrow failure; depression; dizziness; drowsiness; eosinophilia; gallbladder disorders; hepatic disorders; joint disorders; laryngeal oedema; leucopenia; muscle weakness; myalgia; myopathy; pain in extremity; pancreatitis; paraesthesia; peripheral neuropathy; photosensitivity reaction; sexual dysfunction; thrombocytopenia; vision blurred
Interactions
**Other interactions (28):**
- The interaction profile of gemfibrozil is complex.
- In vivo studies indicate that gemfibrozil and its metabolite gemfibrozil 1-O--glucuronide are potent inhibitors of CYP2C8 (an enzyme important for the metabolism of e.g.
- In addition, dosing reduction of drugs that are mainly metabolised by CYP2C8 enzyme may be required when gemfibrozil is used concomitantly.
- In vitro studies have shown that gemfibrozil is a strong inhibitor of CYP2C9 (an enzyme involved in the metabolism of e.g.
- Gemfibrozil 1-O--glucuronide also inhibits OATP1B1.
- Repaglinide In healthy volunteers, co-administration with gemfibrozil increased the AUC and C max of repaglinide by 8.1-fold and 2.4-fold, respectively.
Pregnancy
Manufacturers advise avoid unless essential- toxicity in animal studies.
Breast feeding
Manufacturer advises avoid-no information available.
Hepatic impairment
Manufacturer advises avoid.
Renal impairment
Avoid if eGFR less than 30 mL/minute/1.73 m 2 . M Myotoxicity Special care needed in patients with renal disease, as progressive increases in serum creatinine concentration or failure to follow dosage guidelines may result in myotoxicity (rhabdomyolysis); discontinue if myotoxicity suspected or creatine kinase concentration increases significantly. M Dose adjustments Initially 900 mg daily if eGFR 30-80 mL/minute/1.73 m 2 . M See Prescribing in renal impairment .
Medicinal forms
Tablet,Capsule
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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