From the Guidelines
Gemfibrozil should be taken twice daily, typically 600 mg thirty minutes before morning and evening meals, while avoiding concomitant use with statins due to increased risk of muscle damage, as recommended by the 2013 American College of Cardiology/American Heart Association guideline 1. This medication works best when combined with a low-fat diet, regular exercise, and lifestyle modifications like quitting smoking and limiting alcohol. Gemfibrozil reduces triglycerides and increases HDL (good) cholesterol by activating peroxisome proliferator-activated receptors, which regulate fat metabolism. Common side effects include stomach upset, diarrhea, and muscle pain. Contact your doctor immediately if you experience severe muscle pain or weakness, as this could indicate a rare but serious condition called rhabdomyolysis. It is essential to inform your doctor about all medications you're taking, including over-the-counter drugs and supplements, and continue regular blood tests to monitor your lipid levels and liver function while on this medication. Additionally, the dosage may need to be adjusted in patients with kidney disease, as the rate of drug clearance is greatly reduced in those with creatinine clearance < 50 mL/min, and it is recommended to decrease the dose or consider alternative therapy in patients with serum creatinine > 2 mg/dL 1. The mechanism of action and potential interactions of gemfibrozil, including its inhibition of CYP2C8 and OATP2-mediated hepatic uptake, should be considered when prescribing this medication, as described in the 2016 American Heart Association scientific statement 1. Overall, gemfibrozil can be an effective treatment for hypertriglyceridemia and low HDL cholesterol when used appropriately and with careful monitoring.
From the FDA Drug Label
Gemfibrozil is completely absorbed after oral administration of gemfibrozil tablets, reaching peak plasma concentrations 1 to 2 hours after dosing. Gemfibrozil pharmacokinetics are affected by the timing of meals relative to time of dosing. In one study (ref.4), both the rate and extent of absorption of the drug were significantly increased when administered 0. 5 hour before meals.
The FDA drug label does not provide explicit instructions on how to take Gemfibrozil. However, it mentions that the pharmacokinetics of Gemfibrozil are affected by the timing of meals, with increased absorption when taken 0.5 hours before meals 2.
From the Research
Dosage and Administration
- Gemfibrozil is typically taken in doses of 600mg twice daily, with a total daily dose of 1200mg 3.
- However, a daily dose of 900mg has also been found to be effective in some patients 4.
- The medication can be taken with or without food, but it is recommended to take it with food to minimize gastrointestinal side effects.
Special Considerations
- Gemfibrozil should be used with caution in patients with renal or hepatic impairment, as it may increase the risk of myopathy or rhabdomyolysis 5.
- Patients taking gemfibrozil should be monitored regularly for signs of muscle toxicity, such as muscle pain or weakness.
- Gemfibrozil can be used in combination with statins, but the risk of myopathy or rhabdomyolysis may be increased, especially with certain statins 6, 5.
Patient Populations
- Gemfibrozil has been found to be effective in dyslipidemic postmenopausal women and smokers, with significant reductions in triglycerides, low-density lipoprotein cholesterol, and apolipoprotein B 4.
- The medication has also been used in patients with familial type IIb hyperlipoproteinemia or combined hyperlipidemia, with significant reductions in cholesterol levels and improvements in lipid profile 7.