Gemfibrozil Fluvastatin

Fenofibrate (Anatra, Lipofen, Lofibra, TriCor, Triglide) Fluvastatin (Lescol) Gemfibrozil (Lopid) Lovastatin (Mevacor, Altocor)... 

Clinically important, potentially hazardous interactions with amiloride, aminoglycosides, amphotericin B, ampicillin, anisindione, anticoagulants, armodafinil, atorvastatin, azathioprine, azithromycin, bacampicillin, basiliximab, bezafibrate, bosentan, bupropion, carbenicillin, caspofungin, cholestyramine, clarithromycin, cloxacillin, co-trimoxazole, corticosteroids, cyclophosphamide, daclizumab, danazol, dicloxacillin, dicumarol, digoxin, diltiazem, disulfiram, echinacea, erythromycin, ethotoin, etoposide, ezetimibe, flunisolide, fluoxymesterone, fluvastatin, foscarnet, fosphenytoin, gemfibrozil, hemophilus B vaccine, HMG-CoA reductase inhibitors, imatinib, imipenem/cilastatin, influenza vaccines, ketoconazole, lanreotide, lopinavir, lovastatin, mephenytoin, methicillin, methoxsalen, methylphenidate, methylprednisolone, methyltestosterone, mezlocillin, mizolastine, mycophenolate, nafcillin, nisoldipine, NSAIDs, orlistat, oxacillin, penicillins, phellodendron, phenytoin, pravastatin, prednisolone, prednisone, pristinamycin, ranolazine, red rice yeast, rifabutin, rifampin, rifapentine, ritonavir, rosuvastatin, simvastatin, sirolimus, spironolactone, St John s wort, sulfacetamide, sulfadiazine, sulfamethoxazole, sulfisoxazole, sulfonamides, tacrolimus, telithromycin, tenoxicam, testosterone, ticarcillin, tolvaptan, trabectedin, triamterene, troleandomycin, ursodeoxycholic acid, vaccines, vecuronium, warfarin, zofenopril... 

Figure 17.4 Compounds which are mentioned throughtout the chapter and numbered in the main text as follows (1) DMZ, (2) diclofenac, (3) flurbiprofen, (4) warfarin, (5) fluconazole, (6) coumarin, (7) dapsone, (8) retinoic acid, (9) arachidonic acid, (10) troglitazone, (11) fluvastatin, (12) cerivastatin, (13) taxol, (14) gemfibrozil, (15) verapamil, (16) amodiaquine, (17) amiodarone, (18) metyrapone, (19) progesterone, (20) testosterone, (21) erythromycin, (22) ketoconazole, (23) nicotine, (24) IV -Nitrosonor-nicotine, (25) 4-(Methylnitrosamino)-l-(3-pyridyl)-l-butanone...

Noe, J., Portmann, R., Brun, M., and Funk, C. (2007) Substrate dependent drug-drug interactions between gemfibrozil, fluvastatin and other OATP substrates on OATPIBI, OATP2B1 and OATP1B3. Drug Metabolism and Disposition, 35, 1308-1314. 

CYP2C8 <5 1-2 Disopyramide Amiodarone Clozapine Diclofenac Fluvastatin Nicardipine Paclitaxel Retinoic acid Rosiglitazone Torsemide Repaglinide Amiodarone Celecoxib Felodipine Nicardipine Fluoxetine Ketoconazole Ritonavir Indinavir Troglitazone Zafirlukast Retinoic acid Clotrimazole Phenobarbital Dexamethasone Gemfibrozil Rifampin Phenytoin Ritonavir... 

The plasma levels of lovastatin, simvastatin, atorvastatin and pravastatin are increased by gemfibrozil, the levels of fluvastatin are increased by bezaflbrate, and the levels of pravastatin are increased by fenoflbrate. No pharmacokinetic interactions occur with the combinations of fluvastatin with gemfibrozil, lovastatin with bezaflbrate, and pravastatin, rosuvastatin or simvastatin with fenoflbrate. Both statins and fibrates are known to cause rhabdomyolysis, and their concurrent use increases the risk of this reaction. 

In a randomised, crossover study 15 patients were given fluvastatin 20 mg and gemfibrozil 600 mg twice daily. The pharmacokinetics of both gemfibrozil and fluvastatin were unchanged by concurrent use and no significant adverse effects were noted."... 

All other statins, which entered the market, are produced by total synthesis (Fig. 5.153). Fluvastatin is marketed as the racemate. After the Lipobay scandal, cerivastatin was withdrawn from the market worldwide in 2001, due to reports of fatal rhabdomyolysis associated with renal failure. The reasons behind these toxicities were a too narrow therapeutic window (effective dose compared to toxic dose) and the drug interaction with fibrates, especially with gemfibrozil. 

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