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gemfibrozil

(jem fi' broe zil)


Apo-Gemfibrozil (CAN), Gen-Fibro (CAN), Lopid, Novo-Gemfibrozil (CAN)

Pregnancy Category C

Drug class
Antihyperlipidemic

Therapeutic actions
Inhibits peripheral lipolysis and decreases the hepatic excretion of free fatty acids; this
reduces hepatic triglyceride production; inhibits synthesis of VLDL carrier
apolipoprotein; decreases VLDL production; increases HDL concentration.

Indications
• Hypertriglyceridemia in adult patients with very high elevations of triglyceride
levels (type IV and V hyperlipidemia) at risk of pancreatitis unresponsive to diet
therapy
• Reduction of coronary heart disease risk in patients who have not responded to
diet, exercise, and other agents and have low HDL levels in addition to high LDL
and triglyceride levels

Contraindications and cautions


• Contraindicated with allergy to gemfibrozil, hepatic or renal dysfunction, primary
biliary cirrhosis, gallbladder disease.
• Use cautiously with pregnancy, lactation, cholethiasis, and renal impairment

Available forms
Tablets—600 mg

Dosages
ADULTS
1,200 mg/day PO in 2 divided doses, 30 min before morning and evening meals.
Caution: Use only if strongly indicated and lipid studies show a definite response;
hepatic tumorigenicity occurs in laboratory animals.
PEDIATRIC PATIENTS
Safety and efficacy not established.

Pharmacokinetics
Route Onset Peak
Oral Varies 1–2 hr

Metabolism: Hepatic; T1/2: 90 min


Distribution: Crosses placenta; enters breast milk
Excretion: Urine and feces

Adverse effects
• CNS: Headache, dizziness, blurred vision, vertigo, insomnia, paresthesia, tinnitus,
fatigue, malaise, syncope
• Dermatologic: Eczema, rash, dermatitis, pruritus, urticaria
• GI: Abdominal pain, epigastric pain, diarrhea, nausea, vomiting, flatulence, dry
mouth, constipation, anorexia, dyspepsia, cholelithiasis
• GU: Impairment of fertility
• Hematologic: Anemia, eosinophilia, leukopenia, hypokalemia, liver function
changes, hyperglycemia
• Other: Painful extremities, back pain, arthralgia, muscle cramps, myalgia,
swollen joints

Interactions
Drug-drug
• Risk of rhabdomyolysis from 3 wk to several mo after therapy when combined
with HMG-CoA inhibitors (eg lovastatin, simvastatin)
• Risk of increased bleeding when combined with anticoagulants; monitor patient
closely
• Risk of hypoglycemia if combined with sulfonylureas and repaglinide; monitor
closely

Nursing considerations
Assessment
• History: Allergy to gemfibrozil, hepatic or renal dysfunction, primary biliary
cirrhosis, gallbladder disease, pregnancy, lactation
• Physical: Skin lesions, color, temperature; gait, range of motion; orientation,
affect, reflexes; bowel sounds, normal output, liver evaluation; lipid studies, CBC,
liver and renal function tests, blood glucose

Interventions
• Administer drug with meals or milk if GI upset occurs.
• Arrange for regular follow-up visits, including blood tests for lipids, liver
function, CBC, blood glucose during long-term therapy.

Teaching points
• Take the drug with meals or with milk if GI upset occurs; changes in diet will
need to be made.
• These side effects may occur: Diarrhea, loss of appetite, flatulence (eat frequent
small meals); muscular aches and pains, bone and joint discomfort; dizziness,
faintness, blurred vision (use caution if driving or operating dangerous
equipment).
• Have regular follow-up visits to your doctor for blood tests to evaluate drug
effectiveness.
• Report severe stomach pain with nausea and vomiting, fever and chills or sore
throat, severe headache, vision changes.
Adverse effects in Italic are most common; those in Bold are life-threatening.

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