GEMFIBROZIL

GEMFIBROZIL (gem-fi'broe-zil) Lopid Classifications: antilipemic; fibrate; Therapeutic: cholesterol-lowering agent; fibrate Prototype: Fenofibrate Pregnancy Category: C

Availability

600 mg tablets

Action

Fibric acid derivative with lipid regulating properties. Blocks lipolysis of stored triglycerides in adipose tissue and inhibits hepatic uptake of fatty acids.

Therapeutic Effect

Decreases VLDL and therefore triglyceride synthesis. Produces a moderate increase in HDL cholesterol levels and reduces levels of total and LDL cholesterol and triglycerides.

Uses

Patients with very high serum triglyceride levels (above 750 mg/dL) (type IV and V hyperlipidemia) who have not responded to intensive diet restriction and are at risk of pancreatitis and abdominal pain. Also severe familial hypercholesterolemia (type IIa or IIb) that developed in childhood and has failed to respond to dietary control or to other cholesterol-lowering drugs.

Contraindications

Gallbladder disease, biliary cirrhosis, hepatic or severe renal dysfunction; pregnancy (category C), lactation. Safety and efficacy in children <18 y are not established.

Cautious Use

Diabetes mellitus, hypothyroidism; renal impairment, cholelithiasis.

Route & Dosage

Hypertriglyceridemia Adult: PO 600 mg b.i.d. 30 min before morning and evening meal, may increase up to 1500 mg/d

Administration

Oral

• Give 30 min before breakfast and evening meal.
• Store at 15°–30° C (59°–86° F) unless otherwise directed.

Adverse Effects (≥1%)

CNS: Headache, dizziness, blurred vision. GI: Abdominal or epigastric pain, diarrhea, nausea, vomiting, flatulence. Hematologic: Eosinophilia, mild decreases in Hct, Hgb. Musculoskeletal: Painful extremities, back pain, muscle cramps, myalgia, arthralgia, swollen joints. Skin: Rash, dermatitis, pruritus, urticaria. Endocrine: Hypokalemia, moderate hyperglycemia.

Interactions

Drug: May potentiate hypoprothrombinemic effects of oral anticoagulants; lovastatin increases risk of myopathy and rhabdomyolysis; may increase hypoglycemic effects of antidiabetic medications.

Pharmacokinetics

Absorption: Readily from GI tract. Peak: 1–2 h. Metabolism: Undergoes enterohepatic circulation. Elimination: In urine; 6% in feces. Half-Life: 1.3–1.5 h.

Nursing Implications

Assessment & Drug Effects

• Lab tests: Monitor baseline and at regular intervals during first year of therapy for serum LDL and VLDL, triglycerides, total cholesterol, CBC, blood glucose, liver function tests.
• Note: Mild decreases in WBC, Hgb, Hct may occur during early stage of treatment but generally stabilize with continued therapy.
• Notify physician if the lipid response is not adequate after 3 mo of therapy.
• Notify physician if patient presents S&S suggestive of cholelithiasis or cholecystitis; gallbladder studies may be indicated. Symptoms often occur during the night or early morning; jaundice may or may not be present.

Patient & Family Education

• Notify physician promptly if unexplained bleeding occurs (e.g., easy bruising, epistaxis, hematuria).
• Do not drive or engage in other potentially hazardous activities until response to drug is known.
• Note: Patients with high serum triglyceride levels are generally advised to lose excess weight and to restrict carbohydrate and alcohol intake (alcohol increases serum triglyceride levels).

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug