Gemfibrozil

Action

Inhibits peripheral lipolysis, resulting in decreased triglyceride levels. Also inhibits synthesis and increases clearance of very-low-density lipoproteins.

Availability

Tablets: 600 mg

Indications and dosages

➣ Type IIb hyperlipidemia in patients without coronary artery disease who don't respond to other treatments; adjunctive therapy for types IV and V hyperlipidemia

Adults: 1,200 mg P.O. daily in two divided doses

Contraindications

• Hypersensitivity to drug

• Gallbladder disease

• Severe renal dysfunction

• Hepatic dysfunction

Precautions

Use cautiously in:

• renal impairment, cholelithiasis, diabetes, hypothyroidism

• pregnant or breastfeeding patients

• children (safety not established).

Administration

• Give 30 minutes before a meal.

• Know that before starting drug and throughout therapy, patient should use dietary measures and exercise, as appropriate, to control hyperlipidemia.

Adverse reactions

CNS: fatigue, hypoesthesia, paresthesia, drowsiness, syncope, vertigo, dizziness, headache, seizures

CV: vasculitis

EENT: cataracts, blurred vision, retinal edema, hoarseness

GI: nausea, vomiting, diarrhea, abdominal or epigastric pain, heartburn, flatulence, gallstones, dry mouth

GU: dysuria, erectile dysfunction, decreased male fertility

Hematologic: eosinophilia, anemia, bone marrow hypoplasia, leukopenia, thrombocytopenia

Hepatic: hepatotoxicity

Metabolic: hypoglycemia

Musculoskeletal: joint, back, or muscle pain; myasthenia; myopathy; synovitis; myositis; rhabdomyolysis

Respiratory: cough

Skin: alopecia, rash, urticaria, eczema, pruritus, angioedema

Other: abnormal taste, chills, weight loss, increased risk of bacterial and viral infection, lupuslike syndrome, anaphylaxis

Interactions

Drug-drug. Chenodiol, ursodiol: decreased gemfibrozil efficacy

Cyclosporine: decreased cyclosporine effects

HMG-CoA reductase inhibitors: increased risk of rhabdomyolysis

Sulfonylureas: increased hypoglycemic effects

Warfarin: increased bleeding risk

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, creatine kinase (CK), glucose, lactate dehydrogenase: increased values

Hematocrit, hemoglobin, potassium, white blood cells: decreased values

Patient monitoring

• Monitor kidney and liver function test results and serum lipid levels.

☞ Watch for signs and symptoms of adverse reactions, especially bleeding tendency and hypersensitivity reaction.

• Monitor periodic blood counts during first year of therapy.

• Check CK level if myopathy occurs.

Patient teaching

• Tell patient to take drug 30 minutes before breakfast and dinner.

☞ Advise patient to immediately report signs or symptoms of anaphylaxis (such as difficulty breathing or rash) or other allergic reactions.

☞ Instruct patient to immediately report unusual bleeding or bruising or muscle pain.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• Stress importance of diet and exercise in lowering lipid levels.

• Inform patient that he'll undergo regular blood testing during therapy.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.