Selected HMG-CoA Reductase Inhibitors/Gemfibrozil Interactions
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Severe. These medicines may interact and cause very harmful effects and are usually not taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
The cause of the interaction is not known.
What might happen:
You may experience an increased risk of severe muscle pain, flu-like symptoms, and sudden decrease in the amount of urine.
What you should do about this interaction:
Contact your healthcare professionals (e.g. doctor or pharmacist) as soon as possible about taking these two medicines together. This interaction may be worse if you currently have any type of kidney problem. Tell your doctor right away if you experience muscle pain, tenderness, or weakness; unexplained tiredness; or discolored urine.Your healthcare professionals may already be aware of this drug interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
- 1.Thompson GR, Ford J, Jenkinson M, Trayner I. Efficacy of mevinolin as adjuvant therapy for refractory familial hypercholesterolaemia. Q J Med 1986 Aug;60(232):803-11.
- 2.East C, Alivizatos PA, Grundy SM, Jones PH, Farmer JA. Rhabdomyolysis in patients receiving lovastatin after cardiac transplantation. N Engl J Med 1988 Jan 7;318(1):47-8.
- 3.Marais GE, Larson KK. Rhabdomyolysis and acute renal failure induced by combination lovastatin and gemfibrozil therapy. Ann Intern Med 1990 Feb 1; 112(3):228-30.
- 4.Pierce LR, Wysowski DK, Gross TP. Myopathy and rhabdomyolysis associated with lovastatin-gemfibrozil combination therapy. JAMA 1990 Jul 4; 264(1):71-5.
- 5.Glueck CJ, Speirs J, Tracy T. Safety and efficacy of combined gemfibrozil-lovastatin therapy for primary dyslipoproteinemias. J Lab Clin Med 1990 May;115(5):603-9.
- 6.Glueck CJ, Oakes N, Speirs J, Tracy T, Lang J. Gemfibrozil-lovastatin therapy for primary hyperlipoproteinemias. Am J Cardiol 1992 Jul 1; 70(1):1-9.
- 7.Wirebaugh SR, Shapiro ML, McIntyre TH, Whitney EJ. A retrospective review of the use of lipid-lowering agents in combination, specifically, gemfibrozil and lovastatin. Pharmacotherapy 1992;12(6):445-50.
- 8.Wiklund O, Angelin B, Bergman M, Berglund L, Bondjers G, Carlsson A, Linden T, Miettinen T, Odman B, Olofsson SO, et al. Pravastatin and gemfibrozil alone and in combination for the treatment of hypercholesterolemia. Am J Med 1993 Jan;94(1):13-20.
- 9.Chucrallah A, De Girolami U, Freeman R, Federman M. Lovastatin/gemfibrozil myopathy: a clinical, histochemical, and ultrastructural study. Eur Neurol 1992;32(5):293-6.
- 10.Knoll RW, Ciafone R, Galen M. Rhabdomyolysis and renal failure secondary to combination therapy of hyperlipidemia with lovastatin and gemfibozil. Conn Med 1993 Sep;57(9):593-4.
- 11.Goldman JA, Fishman AB, Lee JE, Johnson RJ. The role of cholesterol-lowering agents in drug-induced rhabdomyolysis and polymyositis. Arthritis Rheum 1989 Mar;32(3):358-9.
- 12.Rosenson RS. Gemfibrozil-lovastatin-associated myalgia. Am J Cardiol 1993 Feb 15;71(5):497.
- 13.Illingworth DR, Bacon S. Influence of lovastatin plus gemfibrozil on plasma lipids and lipoproteins in patients with heterozygous familial hypercholesterolemia. Circulation 1989 Mar;79(3):590-6.
- 14.Lopid (gemfibrozil) US prescribing information. Pfizer Pharmaceuticals, Ltd. April, 2018.
- 15.Mevacor (lovastatin) US prescribing information. Merck & Co., Inc. February, 2014.
- 16.Backman JT, Kyrklund C, Neuvonen M, Neuvonen PJ. Gemfibrozil greatly increases plasma concentrations of cerivastatin. Clin Pharmacol Ther 2002 Dec;72(6):685-91.
- 17.Kyrklund C, Backman JT, Kivisto KT, Neuvonen M, Laitila J, Neuvonen PJ. Plasma concentrations of active lovastatin acid are markedly increased by gemfibrozil but not by bezafibrate. Clin Pharmacol Ther 2001 May; 69(5):340-5.
- 18.Kyrklund C, Backman JT, Neuvonen M, Neuvonen PJ. Gemfibrozil increases plasma pravastatin concentrations and reduces pravastatin renal clearance. Clin Pharmacol Ther 2003 Jun;73(6):538-44.
- 19.Backman JT, Kyrklund C, Kivisto KT, Wang JS, Neuvonen PJ. Plasma concentrations of active simvastatin acid are increased by gemfibrozil. Clin Pharmacol Ther 2000 Aug;68(2):122-9.
- 20.Tal A, Rajeshawari M, Isley W. Rhabdomyolysis associated with simvastatin-gemfibrozil therapy. South Med J 1997 May;90(5):546-7.
- 21.McDonald KB, Garber BG, Perreault MM. Pancreatitis associated with simvastatin plus fenofibrate. Ann Pharmacother 2002 Feb;36(2):275-9.
- 22.Kind AH, Zakowski LJ, McBride PE. Rhabdomyolysis from the combination of a statin and gemfibrozil: an uncommon but serious adverse reaction. WMJ 2002;101(7):53-6.
- 23.Crestor (rosuvastatin calcium) US prescribing information. AstraZeneca Pharmaceuticals LP May, 2016.
- 24.Pravachol (pravastatin sodium) US prescribing information. Bristol-Myers Squibb Company July, 2016.
- 25.Zocor (simvastatin) US prescribing information. Merck & Co., Inc. February, 2018.
- 26.Vytorin (ezetimibe/simvastatin) US prescribing information. Merck/Schering-Plough Pharmaceuticals February, 2018.
- 27.Tricor (fenofibrate) US prescribing information. Abbott Laboratories February, 2013.
- 28.VHA Pharmacy Benefits Management-Strategic Healthcare Group and The Medical Advisory Panel. STATIN-FIBRATE REPORT: Focus on Safety. available at: http://www.pbm.va.gov/PBM/clinicalguidance/clinicalrecommendations/statin fibratesafetyreportFinal.doc September, 2004.
- 29.Jones PH, Davidson MH. Reporting rate of rhabdomyolysis with fenofibrate + statin versus gemfibrozil + any statin. Am J Cardiol 2005 Jan 1; 95(1):120-2.
- 30.Prueksaritanont T, Zhao JJ, Ma B, Roadcap BA, Tang C, Qiu Y, Liu L, Lin JH, Pearson PG, Baillie TA. Mechanistic studies on metabolic interactions between gemfibrozil and statins. J Pharmacol Exp Ther 2002 Jun; 301(3):1042-51.
- 31.Backman JT, Luurila H, Neuvonen M, Neuvonen PJ. Rifampin markedly decreases and gemfibrozil increases the plasma concentrations of atorvastatin and its metabolites. Clin Pharmacol Ther 2005 Aug; 78(2):154-67.
- 32.Fujino H, Yamada I, Shimada S, Hirano M, Tsunenari Y, Kojima J. Interaction between fibrates and statins--metabolic interactions with gemfibrozil. Drug Metabol Drug Interact 2003;19(3):161-76.
- 33.Duell PB, Connor WE, Illingworth DR. Rhabdomyolysis after taking atorvastatin with gemfibrozil. Am J Cardiol 1998 Feb 1;81(3):368-9.
- 34.Shanahan RL, Kerzee JA, Sandhoff BG, Carroll NM, Merenich JA. Low myopathy rates associated with statins as monotherapy or combination therapy with interacting drugs in a group model health maintenance organization. Pharmacotherapy 2005 Mar;25(3):345-51.
- 35.Graham DJ, Staffa JA, Shatin D, Andrade SE, Schech SD, La Grenade L, Gurwitz JH, Chan KA, Goodman MJ, Platt R. Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs. JAMA 2004 Dec 1;292(21):2585-90.
- 36.Alsheikh-Ali AA, Kuvin JT, Karas RH. Risk of adverse events with fibrates. Am J Cardiol 2004 Oct 1;94(7):935-8.
- 37.Oldemeyer JB, Lund RJ, Koch M, Meares AJ, Dunlay R. Rhabdomyolysis and acute renal failure after changing statin-fibrate combinations. Cardiology 2000;94(2):127-8.
- 38.Livalo (pitavastatin) US prescribing information. Kowa Pharmaceuticals America, Inc. October, 2013.
- 39.USFood and Drug Administration. FDA Drug Safety Communication: New restrictions, contraindications, and dose limitations for Zocor (simvastatin) to reduce the risk of muscle injury. available at: http://www.fda.gov/Drugs/DrugSafety/DrugSafetyPodcasts/ucm258399.htm June 8, 2011.
- 40.Stone NJ, Robinson JG, Lichtenstein AH, Goff DC Jr, Lloyd-Jones DM, Smith SC Jr, Blum C, Schwartz JS. Treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: synopsis of the 2013 American College of Cardiology/American Heart Association cholesterol guideline. Ann Intern Med 2014 Mar 4;160(5):339-43.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.