gemfibrozil

gemfibrozil

(jem fi' broe zil)

Apo-Gemfibrozil (CAN), Gen-Gemfibrozil (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 carrierapolipoprotein; 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

WARNING: 1,200 mg/day PO in two 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; T_1/2: 90 min

Distribution: Crosses placenta; enters breast milk

Excretion: Feces, urine

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, elevated ALT and AST

·        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, T; gait, range of motion; orientation, affect, reflexes; bowel sounds, normal output, liver evaluation; lipid studies, CBC, LFTs, 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 be needed.

·        Have regular follow-up visits to your doctor for blood tests to evaluate drug effectiveness.

·        You may experience these side effects: 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).

·        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.