Names and pronunciation
(jem-fi′broe-zil) Lopid
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Drug reference
(jem-fi′broe-zil) Lopid
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Func. class.: Antilipemic
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Chem. class.: Fibric acid derivative
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Do not confuse: gemfibrozil/gabapentin
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ACTION: Inhibits biosynthesis of VLDL, decreases triglycerides, production in the liver increases HDL
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USES: For use as an adjunct to diet for the treatment of hyperlipoproteinemia and for hypertriglyceridemia including Type IV (elevated triglycerides, VLDL) and Type V (elevated triglycerides, chylomicrons, VLDL) in patients who have significant risk of coronary artery disease or pancreatitis and who have not responded to diet G
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CONTRAINDICATIONS: Severe renal/hepatic disease, preexisting gall bladder disease, primary biliary cirrho- sis, hypersensitivity, use with dasabuvir, repaglinide, or simvastatin Precautions: Pregnancy, breastfeeding, renal disease, cholelithiasis, children
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SIDE EFFECTS CNS: Fatigue, vertigo, headache, pares- thesia, dizziness GI: Dyspepsia, diarrhea, abdominal pain, nausea, vomiting HEMA: Leukopenia, anemia, eosino- philia, thrombocytopenia INTEG: Rash, urticaria, pruritus MS: Myopathy, rhabdomyolysis
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INTERACTIONS • Do not use with dasabuvir, repaglinide, simvastatin Increase: hypoglycemic effect—sulfonyl- ureas, repaglinide, metformin, glyburide, pioglitazone, other antidiabetic agents Increase: myopathy–colchicine Increase: anticoagulant effect—warfa- rin; monitor coagulation tests Increase: nephrotoxicity—cyclosporine; monitor renal function Increase: levels of CYP2C8, CYP2C9, CYP2C19; monitor for toxicities Increase: risk of myositis, myalgia, rhab- domyolysis—HMG-CoA reductase inhibi- tors; avoid concurrent use Decrease: effect of gemfibrozil—bile acid sequestrants, colestipol, separate by >2 hr Decrease: level of cyclosporine Drug/Lab Test Increase: LFTs, CK, bilirubin, alkaline phosphatase Decrease: HB, Hct, WBC, potassium, eosinophils, platelets
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DOSAGE AND ROUTES • Adult: PO 600 mg bid 30 min before AM, PM meal Hepatic/renal dose • Avoid use
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Available forms: Tabs 600 mg; caps 300 mg
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Administer: PO route • 30 min before AM, PM meals • Discontinue product if response does not occur within 3 mo
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Assess: • Hyperlipidemia: diet history; fats, tri- glycerides, cholesterol; if lipids increase, product should be discontinued; LDL, VLDL baseline and periodically • Myopathy, rhabdomyolysis: for mus- cle pain, tenderness; obtain baseline CPK; if elevated or if these occur, product should be discontinued; at greater risk if com- bined with HMG-CoA reductase inhibitors • Renal, hepatic studies, CBC, blood glucose if patient is receiving long-term therapy; if LFTs increase, therapy should be discontinued; monitor hematologic and hepatic functions • Bowel pattern daily; watch for increas- ing diarrhea (common) • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; do not breastfeed, excretion unknown
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Evaluate: • Therapeutic response: decreased cho- lesterol, triglyceride levels; HDL, choles- terol ratios improved
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That compliance is needed for positive results; not to double or skip dose, to take missed dose as soon as remem- bered unless almost time for next dose • To minimize risk factors: high-fat diet, smoking, alcohol consumption, absence of exercise • To notify prescriber of diarrhea, nau- sea, vomiting, chills, fever, sore throat, muscle cramps, abdominal cramps, se- vere flatulence, tendon pain • To avoid driving, hazardous activities if dizziness, blurred vision occur
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PHARMACOKINETICS Peak 1-2 hr; plasma protein binding >95%; half-life 1½ hr; 70% excreted in urine mostly unchanged; metabolized in liver (minimal)
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• Adult: PO 600 mg bid 30 min before AM, PM meal Hepatic/renal dose
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• Avoid use
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