gemfibrozil: clinical use

Prescribing considerations

• Use with diet and other appropriate non-pharmacological measures; address contributory conditions such as hypothyroidism and diabetes before initiation.
• Assess renal function and review medicines for CYP2C8, CYP2C9 and OATP1B1 interactions.
• Consider gallstone risk and investigate compatible biliary symptoms.

Contraindications and cautions

• Hepatic impairment or severe renal impairment.
• Existing or previous gallbladder or biliary-tract disease, including gallstones.
• Previous fibrate-associated photoallergy or phototoxicity.
• Hypersensitivity to gemfibrozil or an excipient.
• Concomitant repaglinide, dasabuvir, selexipag, simvastatin or contraindicated rosuvastatin use.

Monitoring

• Serum lipids and clinical response.
• Periodic liver-function tests and blood counts during the first year.
• Glucose with insulin or oral glucose-lowering medicines.
• INR with coumarin vitamin K antagonists.
• Creatine kinase and clinical assessment when muscle toxicity is suspected.
• Renal function where impairment or potential muscle injury is present.

Clinical pharmacology

Gemfibrozil enhances lipoprotein-lipase-associated clearance of triglyceride-rich lipoproteins and inhibits hepatic VLDL synthesis. It inhibits several metabolic enzymes and OATP1B1, contributing to its interaction profile.

Formulation and product differences

• The selected product is a white, biconvex, oval film-coated tablet.
• The selected formulation is essentially sodium-free.
• Excipients and tablet appearance may differ between manufacturers.

Tablet

Route: Oral

Strengths: 600 mg