II. Efficacy

  1. Lipid effects
    1. Decreases Triglycerides (20-50%)
    2. Increases LDL Cholesterol (10-15%)
    3. Decreases VLDL Cholesterol
    4. Increases HDL Cholesterol (10-15%)
  2. Outcome effects
    1. No effect on all cause mortality
    2. NNT to prevent one coronary event: 46-125

III. Adverse effects

  1. Gastrointestinal effects
    1. Gastrointestinal upset
    2. Abdominal Pain
    3. Higher rate of Gastrointestinal Disease
      1. Cholecystitis (increased risk by 2-3%)
      2. Appendicitis
  2. Miscellaneous
    1. Rash
    2. Renal dysfunction (rare)
    3. Myopathy (rare)

IV. Drug Interactions

  1. May potentiate effects of:
    1. Coumadin
    2. Oral Hypoglycemic Agents

V. Contraindications

  1. Absolute
    1. Severe Hepatic or renal disease
    2. Preexisting Gallstones
  2. Relative
    1. Concurrent Statin due to Myopathy risk
      1. Exercise caution when using these together
      2. Tricor is commonly used with Statins (Gemfibrozil is higher risk)
    2. Concurrent Coumadin use
    3. Avoid as a single agent in Coronary Artery Disease

VI. Preparations

  1. Gemfibrozil (Lopid)
    1. Dose: 600 mg bid ($75/month)
  2. Fenofibrate (Tricor)
    1. Less likely to cause Rhabdomyolysis with Statin
  3. Fenofibrate (Trilipix)
    1. Rebranded version of Tricor in time for generic Fenofibrate release in 2011
  4. Clofibrate
    1. Discontinued in 2002
    2. Increased mortality from malignant and GI disease

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Cost: Medications

gemfibrozil (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
GEMFIBROZIL 600 MG TABLET Generic $0.09 each
fenofibrate (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
FENOFIBRATE 130 MG CAPSULE Generic $3.92 each
FENOFIBRATE 134 MG CAPSULE Generic $1.29 each
FENOFIBRATE 145 MG TABLET Generic $0.75 each
FENOFIBRATE 150 MG CAPSULE Generic $4.97 each
FENOFIBRATE 160 MG TABLET Generic $0.68 each
FENOFIBRATE 200 MG CAPSULE Generic $2.03 each
FENOFIBRATE 43 MG CAPSULE Generic $1.30 each
FENOFIBRATE 48 MG TABLET Generic $0.52 each
FENOFIBRATE 50 MG CAPSULE Generic $2.31 each
FENOFIBRATE 54 MG TABLET Generic $0.45 each
FENOFIBRATE 67 MG CAPSULE Generic $0.64 each
tricor (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
TRICOR 145 MG TABLET Generic $0.75 each
TRICOR 48 MG TABLET Generic $0.52 each
trilipix (on 12/23/2015 at Medicaid.Gov Survey of pharmacy drug pricing)
TRILIPIX DR 135 MG CAPSULE Generic $1.80 each
TRILIPIX DR 45 MG CAPSULE Generic $1.00 each

Ontology: Clofibrate (C0009002)

Definition (NCI) An aryloxyisobutyric acid derivate with antihyperlipidemic activity. Although the exact mechanism of action has not been fully characterized, clofibrate may enhance the conversion of very-low-density lipoprotein (VLDL) to low-density lipoprotein (LDL), decreasing the production of hepatic VLDL, inhibiting cholesterol production, and increasing fecal excretion of neutral sterols.
Definition (MSH) A fibric acid derivative used in the treatment of HYPERLIPOPROTEINEMIA TYPE III and severe HYPERTRIGLYCERIDEMIA. (From Martindale, The Extra Pharmacopoeia, 30th ed, p986)
Definition (CSP) fibric acid derivative used in the treatment of hyperlipoproteinemia and hypertriglyceridemia.
Definition (PDQ) An aryloxyisobutyric acid derivate with antihyperlipidemic activity. Although the exact mechanism of action has not been fully characterized, clofibrate may enhance the conversion of very-low-density lipoprotein (VLDL) to low-density lipoprotein (LDL), decreasing the production of hepatic VLDL, inhibiting cholesterol production, and increasing fecal excretion of neutral sterols. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42108&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42108&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C378" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D002994
SnomedCT 387439004, 77035009
LNC LP16082-7, MTHU016298
English clofibrate, Chlorophenoxyisobutyrate, Ethyl, Ethyl Chlorophenoxyisobutyrate, Propanoic acid, 2-(4-chlorophenoxy)-2-methyl-, ethyl ester, 2-(4-Chlorophenoxy)-2-methylpropanoic acid ethyl ester, Ethyl 2-(4-Chlorophenoxy)-2-methylpropanoate, Ethyl p-Chlorophenoxyisobyturate, Clofibrate, CFB, clofibrate (medication), Clofibrate [Chemical/Ingredient], clofibrates, Clofibric Acid, Ethyl Ester, Clofibrate (product), Clofibrate (substance), CLOFIBRATE
Swedish Klofibrat
Czech klofibrát
Finnish Klofibraatti
Russian KLOFIBRAT, КЛОФИБРАТ
Italian Etil clorofenossi isobutirrato, Clofibrato
Croatian KLOFIBRAT
Polish Klofibrat
Japanese クロフィブレート, クロフィブラート
Spanish clofibrato (producto), clofibrato (sustancia), clofibrato, Clofibrato
French Clofibrate
German Clofibrat
Portuguese Clofibrato

Ontology: Gemfibrozil (C0017245)

Definition (NCI) A fibric acid derivative with hypolipidemic effects. Gemfibrozil interacts with peroxisome proliferator-activated receptors (PPARalpha) resulting in PPARalpha-mediated stimulation of fatty acid oxidation and an increase in lipoprotein lipase (LPL) synthesis. This enhances triglyceride-rich lipoprotein clearance and reduces the expression of apolipoprotein C-III (apoC-III). The reduction in hepatic production of apoC-III results in subsequent reduction of serum levels of very-low-density-lipoprotein cholesterol (VLDL-C). In addition, gemfibrozil-mediated PPARalpha stimulation of apoA-I and apoA-II expression results in an increase in high-density lipoprotein cholesterol (HDL-C).
Definition (MSH) A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol.
Definition (CSP) lipid regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol.
Concepts Pharmacologic Substance (T121) , Lipid (T119)
MSH D015248
SnomedCT 35282000, 387189002
LNC LP15168-5, MTHU002557
English Gemfibrozil, Gemfibrosil, Pentanoic acid, 5-(2,5-dimethylphenoxy)-2,2-dimethyl-, gemfibrozil, gemfibrozil (medication), gemfibrozil (Lopid), GEMFIBROZIL, Gemfibrozil [Chemical/Ingredient], gemfibrosil, Gemfibrozil product, Gemfibrozil (product), Gemfibrozil (substance)
Swedish Gemfibrozil
Czech gemfibrozil
Finnish Gemfibrotsiili
Russian GEMFIBROZIL, ГЕМФИБРОЗИЛ
Japanese ジェムフィブロジィル, ゲムフィブロジル, ゲンフィブロジル
Spanish genfibrocil (producto), gemfibrozilo (producto), genfibrocil, Gemfibrozil, gemfibrozilo (sustancia), gemfibrozilo, gemfibrozil, genfibrocil (sustancia), Gemfibrozilo
Italian Gemfibrosil, Gemfibrozil
French Gemfibrosil, Gemfibrozil
Polish Gemfibrozil
Croatian Gemfibrozil
Portuguese Genfibrozil, Genfibrozila
German Gemfibrozil