Hyperlipidemia gemfibrozil

In 80 patients with primary mixed hyperlipidemia, gemfibrozil used together with lovastatin resulted in 3% discontinuation because of myositis, but none attributable to rhabdomyolysis or myoglobinuria (72). 

While the fibric acid derivatives have antihyperlipidemic effects, their use varies depending on the drug. For example, Clofibrate (Atromid-S) and gemfibrozil (Lopid) are used to treat individuals with very high serum triglyceride levels who present a risk of abdominal pain and pancreatitis and who do not experience a response to diet modifications. Clofibrate is not used for the treatment of other types of hyperlipidemia and is not thought to be effective for prevention of coronary heart disease. Fenofibrate (Tricor) is used as adjunctive treatment for the reduction of LDL, total cholesterol, and triglycerides in patients with hyperlipidemia. 

Hyperlipidemia Diet HMG-CoA reductase inhibitors (stati ns) Gemfibrozil Ezetemibe CSA greater than TAC consider switch to TAC discontinue or hold SRL CSA/TAC may increase statin levels start at lowest dose Monitor for muscle cramps, CPK levels and LFTs Adjust dose in those with Rl Caution with concomitant statin Often used in combination with a statin... 

A 30-year-old white man with hypertension, type 1 diabetes mellitus, and hyperlipidemia developed myalgias, nausea, and vomiting, which began 4 days after he started working as a jackhammer operator (52). His medications were lisinopril, aspirin, insulin, and gemfibrozil. Creatine kinase and creatinine, which had previously been respectively mildly raised and normal, were markedly raised, consistent with rhabdomyolysis with acute renal insufficiency. 

Trade names Bolutol Decrelip Fibrocit Gemlipid Gen-Fibro Gevilon Uno Jezil Lipur Lopid (Pfizer) Nu-Gemfibrozil Indications Hyperlipidemia Category Fibrate Lipid regulator Half-life 1.5 hours... 

Lipid-regulating Reduce blood cholesterol and treat hyperlipidemia Clofibric acid, gemfibrozil 33, 40, 55, 62... 

Epidemiologic studies have indicated a very strong inverse association between HDL-cholesterol levels and the incidence of arteriosclerotic cardiovascular disease [32]. HDL is thought to promote efflux of cholesterol from peripheral cells in the vascular wall and return of that cholesterol to the liver for excretion in bile, a process known as reverse cholesterol transport [21]. HDL has also been shown to have anti-inflammatory and anti-thrombotic activities [21]. Therefore, HDL levels may influence both the hyperlipidemia and inflammatory processes proposed as factors in the development of atherosclerosis. Although clinical data in support of HDL-raising are limited, in the VA-HIT trial gemfibrozil therapy in men with coronary artery disease and low HDL-cholesterol modestly increased HDL levels and reduced coronary events by 22% [33]. Presently, other methods of effectively and safely increasing HDL-cholesterol levels have not been discovered. 

Yang CY, Gu ZW, Xie YH, et al. Effects of gemfibrozil on very-low-density lipoprotein composition and low-density lipoprotein size in patients with hypertriglyceridemia or combined hyperlipidemia. Atherosclerosis 1996 126 105—116. 

Renal failure is a relative contraindication to the use of fibric acid agents, as is hepatic dysfunction. Combined statin-fibrate therapy should be avoided in patients with compromised renal function. Gemfibrozil should be used with caution and at a reduced dosage to treat the hyperlipidemia of renal failure. Fibrates should not be used by children or pregnant women. 

Gemfibrozil is indicated in the treatment of hypertriglyceridemia in adult patients with type IV or V hyperlipidemia that presents risk of pancreatitis and does not respond to diet and reduction of coronary heart disease risk in type Ilb patients who have low HDL levels (in addition to elevated LDL and triglycerides) and have not responded to other measures. 

Fehrman-Kkhohn I, Jogestrand T, Ar elin B. Decreased cyclo xirine levels during gemfibrozil treatment of hyperlipidemia after kidney tran lantaticxi. Nephron ( 996) 72,483. 

Knoll RW, Ciafone R, Galen M. Rhabdomyolysis and renal failure secondary to combination therapy of hyperlipidemia with lovastatin and gemfibrozil. Corm Med (1993) 593-4. 

Interest in fenofibrate has re-emerged with the near demise of gemfibrozil in some countries, once it became apparent that a statin+fenofibrate combination was highly likely to be safe. It is currently by far the preferred fibrate for the management of hypertriglyceridemia or in combination with a statin for treating combined hyperlipidemia. Different studies with a variety of statins have uniformly found no greater incidence of serious adverse reactions when fenofibrate is added compared with placebo. 

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