GENERIC NAME: gemfibrozil

BRAND NAME: Lopid

DRUG CLASS AND MECHANISM: Gemfibrozil is a lipid- and cholesterol-modifying medicine. It reduces triglycerides and increases cholesterol carried in high density lipoprotein (HDL) in the blood. HDL cholesterol is sometimes called "good" cholesterol because higher concentrations of HDL cholesterol in the blood are associated with a reduced risk of heart disease. The decrease in triglycerides is thought to be due in part to reduced release of triglycerides from fat tissue in the body. In one large study, gemfibrozil decreased the risk of heart attacks but did not affect the overall survival of persons with high cholesterols.

PRESCRIPTION: yes

GENERIC AVAILABLE: yes

PREPARATIONS: Tablets: 600mg

STORAGE: Tablets should be stored below 30°C (86°F).

PRESCRIBED FOR: Gemfibrozil is used for selected persons with either low HDL cholesterol and/or high triglyceride concentrations to reduce the risk of heart attacks. It also is used in persons with very high triglyceride concentrations that may cause pancreatitis (inflammation of the pancreas).

DOSING: Gemfibrozil is prescribed twice daily, and it is recommended that it be taken 30 minutes before meals.

DRUG INTERACTIONS: Gemfibrozil, when used together with some of the "statin" family of cholesterol-reducing medications [lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), or atorvastatin (Lipitor)] increases the risk of a condition called rhabdomyolysis in which muscles break down, causing muscle aches and possibly kidney damage from the chemical products of the breakdown of muscle. This interaction is best described with lovastatin, but the other statins also may interact in a similar way. The reaction may be seen as early as 3 weeks after starting the combined therapy or as late as several months.

Gemfibrozil can increase the effect of warfarin (Coumadin) and thus may lead to bleeding. Therefore, patients on warfarin may need to have their doses of warfarin reduced when starting gemfibrozil.

Gemfibrozil may increase the likelihood of developing a low blood sugar in patients receiving glyburide (Glyburide; Diabeta) or other medications that reduce sugar levels in diabetic patients.

Colestipol (Colestid) and cholestyramine (Questran) reduce the absorption of gemfibrozil and reduce its effectiveness if taken at the same time. Patients who are taking gemfibrozil and colestipol or cholestyramine should take the medicines at least two hours apart.

PREGNANCY: Gemfibrozil has not been shown to produce developmental toxicity or teratogenicity among offspring in rats or rabbits but did produce a reduction in litter size (reduced number of offspring). Its effects in pregnant women has not been well- studied. Gemfibrozil should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

NURSING MOTHERS: It is not known whether gemfibrozil is excreted in human milk. Since most drugs are excreted in human milk and because gemfibrozil has been shown to produce tumors in animal studies, the physician needs to decide whether to instruct the pregnant woman to discontinue nursing or to discontinue the drug.

SIDE EFFECTS: The most common side effects of gemfibrozil are upset stomach (1 in 5 patients), diarrhea (1 in 14 patients), tiredness (1 in 30 patients) and nausea or vomiting (1 in 40 patients). Others may experience dizziness, tiredness, tingling in the extremities, headache, decreased sexual drive, impotence, depression, or blurred vision. Less common are muscle aches, pains, weakness or tenderness. Rarely, these muscle-related symptoms are associated with damage to the muscles which releases chemicals into the blood that then damage the kidney. Muscle damage is of concern primarily when gemfibrozil is being taken along with one of the "statin" medications. (See Drug Interactions above)