Dosage Forms. Tablet: 600 mg
Common FDA Label Indication, Dosing, and Titration.
1. Coronary arteriosclerosis; prophylaxis-familial combined hyperlipidemia: 600 mg po bid
2. Familial type V hyperlipoproteinemia-Fredrickson type IV hyperlipoproteinemia: 600 mg po bid
1. Coronary arteriosclerosis: 600 mg po bid
2. Cerebrovascular accident; prophylaxis: 600 mg po bid
3. Hyperlipidemia: 600 mg po bid
MOA. Fibric acid derivatives activate peroxisome proliferator-activated receptor α(PPARα), which increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase and reducing production of apoprotein C-III (an inhibitor of lipoprotein lipase activity). Activation of PPARα also induces an increase in the synthesis of apoproteins A-I and A-II and HDL-cholesterol.
Drug Characteristics: Gemfibrozil
Medication Safety Issues: Gemfibrozil
Drug Interactions: Gemfibrozil
Adverse Reactions: Gemfibrozil
Efficacy Monitoring Parameters. Reduction in total cholesterol, LDL-cholesterol, and triglyceride levels; increase in HDL-cholesterol levels. Monitor baseline and every 6 mo.
Toxicity Monitoring Parameters. Seek medical attention if signs/symptoms of rhabdomyolysis (myalgias, dark urine, arthralgias, fatigue), yellowing of eyes or skin, and severe abdominal pain. Liver function tests and complete blood counts should be performed at baseline, 12 wk after initiation of therapy or dose increases. Serum creatine kinase should be measured in patients experiencing muscle pain and in those receiving other drugs associated with myopathy.
Key Patient Counseling Points. Instruct patient to report signs/symptoms of rhabdomyolysis, jaundice (yellowing of skin or eyes), or renal failure.
Clinical Pearls. The fibric acid derivatives (gemfibrozil, clofibrate, and fenofibrate) are recommended as alternatives to niacin in the treatment of Types IIb, III, IV, and V hyperlipidemia.