Top 300 Pharmacy Drug Cards

GEMFIBROZIL: Lopid, Various

Class: Antihyperlipidemic

Dosage Forms. Tablet: 600 mg

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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

Off-Label Uses.

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

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Medication Safety Issues: Gemfibrozil

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Drug Interactions: Gemfibrozil

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Adverse Reactions: Gemfibrozil

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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.