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| __NOTOC__
| | #REDIRECT [[Gemfibrozil#Adult Indications and Dosage]] |
| {{Gemfibrozil}}
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| {{CMG}}; {{AE}} {{SS}}
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| ==Indications and Usage==
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| LOPID (gemfibrozil tablets, USP) is indicated as adjunctive therapy to diet for:
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| Treatment of adult patients with very high elevations of serum [[triglyceride]] levels (Types IV and V [[hyperlipidemia]]) who present a risk of [[pancreatitis]] and who do not respond adequately to a determined dietary effort to control them. Patients who present such risk typically have serum [[[[triglycerides]]]] over 2000 mg/dL and have elevations of VLDL-[[cholesterol]] as well as fasting chylomicrons (Type V [[hyperlipidemia]]). Subjects who consistently have total serum or plasma [[triglycerides]] below 1000 mg/dL are unlikely to present a risk of [[pancreatitis]]. LOPID therapy may be considered for those subjects with triglyceride elevations between 1000 and 2000 mg/dL who have a history of [[pancreatitis]] or of recurrent abdominal pain typical of [[pancreatitis]]. It is recognized that some Type IV patients with [[triglyceride]]s under 1000 mg/dL may, through dietary or alcoholic indiscretion, convert to a Type V pattern with massive [[triglyceride]] elevations accompanying fasting chylomicronemia, but the influence of LOPID therapy on the risk of [[pancreatitis]] in such situations has not been adequately studied. Drug therapy is not indicated for patients with Type I [[hyperlipoproteinemia]], who have elevations of chylomicrons and plasma [[triglyceride]]s, but who have normal levels of [[very low density lipoprotein]] ([[VLDL]]). Inspection of plasma refrigerated for 14 hours is helpful in distinguishing Types I, IV, and V [[hyperlipoproteinemia]].
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| Reducing the risk of developing coronary heart disease only in Type IIb patients without history of or symptoms of existing coronary heart disease who have had an inadequate response to weight loss, dietary therapy, exercise, and other pharmacologic agents (such as [[bile acid]] sequestrants and [[nicotinic acid]], known to reduce LDL- and raise HDL-[[cholesterol]]) and who have the following triad of lipid abnormalities: low HDL-[[cholesterol]] levels in addition to elevated LDL-[[cholesterol]] and elevated [[triglyceride]] (see WARNINGS, PRECAUTIONS, and CLINICAL PHARMACOLOGY). The National [[cholesterol]] Education Program has defined a serum HDL-[[cholesterol]] value that is consistently below 35 mg/dL as constituting an independent risk factor for coronary heart disease. Patients with significantly elevated [[triglyceride]] should be closely observed when treated with gemfibrozil. In some patients with high [[triglyceride]] levels, treatment with gemfibrozil is associated with a significant increase in LDL-[[cholesterol]]. BECAUSE OF POTENTIAL TOXICITY SUCH AS MALIGNANCY, GALLBLADDER DISEASE, ABDOMINAL PAIN LEADING TO APPENDECTOMY AND OTHER ABDOMINAL SURGERIES, AN INCREASED INCIDENCE IN NON-CORONARY MORTALITY, AND THE 44% RELATIVE INCREASE DURING THE TRIAL PERIOD IN AGE-ADJUSTED ALL-CAUSE MORTALITY SEEN WITH THE CHEMICALLY AND PHARMACOLOGICALLY RELATED DRUG, CLOFIBRATE, THE POTENTIAL BENEFIT OF GEMFIBROZIL IN TREATING TYPE IIA PATIENTS WITH ELEVATIONS OF LDL-[[cholesterol]] ONLY IS NOT LIKELY TO OUTWEIGH THE RISKS. LOPID IS ALSO NOT INDICATED FOR THE TREATMENT OF PATIENTS WITH LOW HDL-[[cholesterol]] AS THEIR ONLY LIPID ABNORMALITY.
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| In a subgroup analysis of patients in the Helsinki Heart Study with above-median HDL-[[cholesterol]] values at baseline (greater than 46.4 mg/dL), the incidence of serious coronary events was similar for gemfibrozil and placebo subgroups (see Table I).
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| The initial treatment for [[dyslipidemia]] is dietary therapy specific for the type of lipoprotein abnormality. Excess body weight and excess alcohol intake may be important factors in [[triglyceride]] and should be managed prior to any drug therapy. Physical exercise can be an important ancillary measure, and has been associated with rises in HDL-[[cholesterol]]. Diseases contributory to [[hyperlipidemia]] such as [[hypothyroidism]] or diabetes mellitus should be looked for and adequately treated. [[Estrogen]] therapy is sometimes associated with massive rises in plasma [[triglyceride]], especially in subjects with familial [[triglyceride]]. In such cases, discontinuation of estrogen therapy may obviate the need for specific drug therapy of [[triglyceride]]. The use of drugs should be considered only when reasonable attempts have been made to obtain satisfactory results with nondrug methods. If the decision is made to use drugs, the patient should be instructed that this does not reduce the importance of adhering to diet.<ref>{{Cite web | last = | first = | title = DailyMed: Search | url = http://dailymed.nlm.nih.gov/dailymed/search.cfm?startswith=+Lopid&x=11&y=10 | publisher = | date = | accessdate = 13 February 2014 }}</ref>
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| ==References==
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| {{Reflist|2}}
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| | [[Category: Cardiovascular Drugs]] |
| | [[Category: Drug]] |
| [[Category:Fibrates]] | | [[Category:Fibrates]] |
| [[Category:Phenol ethers]]
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| [[Cardiovasular Drug]]
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| [[Drug]]
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