Lopid (gemfibrozil) is a lipid-regulating medication belonging to the fibrate class, specifically designed to address specific dyslipidemias that contribute to atherosclerotic cardiovascular disease. It functions primarily by activating peroxisome proliferator-activated receptor-alpha (PPAR-α), leading to a significant reduction in serum triglycerides and very-low-density lipoprotein (VLDL) synthesis, while concurrently increasing high-density lipoprotein cholesterol (HDL-C) levels. This targeted mechanism of action makes it a cornerstone therapy for patients whose lipid profiles are not adequately managed by statins alone or for those with specific hypertriglyceridemic phenotypes. Its use is a critical component of a comprehensive cardiovascular risk mitigation strategy, particularly in high-risk patient populations.

Features

• Active Pharmaceutical Ingredient: Gemfibrozil 600 mg
• Pharmacologic Class: Fibric acid derivative (Fibrate)
• Primary Mechanism: PPAR-α agonist
• Formulation: Film-coated, oblong, white tablets
• Standard Dosing: Twice daily administration
• Prescription Status: Rx-only medication

Benefits

• Significantly reduces elevated serum triglyceride levels, a key independent risk factor for pancreatitis and cardiovascular events.
• Increases high-density lipoprotein cholesterol (HDL-C), often referred to as “good” cholesterol, which is associated with improved vascular health.
• Provides an alternative or adjunctive lipid-management pathway for patients intolerant to or requiring additional therapy beyond HMG-CoA reductase inhibitors (statins).
• Helps modify the overall atherogenic lipid profile, potentially slowing the progression of atherosclerosis.
• Supported by clinical trial data demonstrating a reduction in the incidence of coronary heart disease in specific patient cohorts with dyslipidemia.

Common use

Lopid is indicated as an adjunct to diet and exercise for several specific dyslipidemic conditions. Its primary use is for the treatment of adult patients with very high serum triglyceride levels (type IV and type V hyperlipidemia) who are at risk of abdominal pain and pancreatitis. Furthermore, it is indicated to reduce the risk of developing coronary heart disease in a specific subset of patients: those with type IIb hyperlipidemia who have low HDL-C levels in combination with elevated LDL-C and triglycerides, and who have not responded adequately to weight loss, dietary therapy, exercise, and other pharmacologic agents like statins. It is not intended for use in the general population for mild cholesterol elevations.

Dosage and direction

The recommended adult dosage is 600 mg administered orally twice daily, taken 30 minutes before the morning and evening meals. This timing is crucial for optimal absorption and efficacy. Dosage adjustments are not typically required for elderly patients or those with mild renal impairment, provided there is no concomitant use of drugs that significantly interact with gemfibrozil. Treatment should always be initiated only after a period of diligent dietary management, exercise, and other non-pharmacological interventions have proven insufficient. Liver function tests and lipid levels should be monitored periodically to assess therapeutic response and safety. Therapy should be discontinued if a significant biochemical response is not achieved within three months.

Precautions

• Liver Function: Lopid may cause abnormal liver function tests and, in rare instances, hepatitis. Baseline liver function tests (LFTs) should be obtained, and periodic monitoring is advised during therapy.
• Cholelithiasis: Fibrates like gemfibrozil may increase cholesterol excretion into the bile, potentially leading to cholelithiasis. Lopid should be used with caution in patients with a history of gallbladder disease.
• Musculoskeletal Effects: Myositis and rhabdomyolysis have been reported. Patients should be instructed to report any unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever, immediately.
• Hematologic Effects: Mild hemoglobin, hematocrit, and white blood cell decreases have been observed. Periodic blood counts are recommended during the first year of treatment.
• Renal Impairment: Use with caution in patients with significant renal impairment as the drug is primarily renally excreted; dosage adjustment may be necessary, and the risk of myopathy and rhabdomyolysis is increased.
• Surgical Procedures: Gemfibrozil may potentiate the effects of anticoagulants. It should be discontinued several days to one week prior to elective surgical procedures to minimize bleeding risk.

Contraindications

Lopid is contraindicated in patients with:

• Hypersensitivity to gemfibrozil or any component of the formulation.
• Pre-existing hepatic or severe renal dysfunction, including primary biliary cirrhosis.
• Pre-existing gallbladder disease.
• Concurrent use of repaglinide or simvastatin due to a significantly increased risk of severe drug interactions, including rhabdomyolysis.

Possible side effect

A range of adverse reactions may occur. Common side effects (affecting >1% of users) include gastrointestinal disturbances such as dyspepsia, abdominal pain, epigastric pain, nausea, vomiting, diarrhea, and constipation. Other frequently reported effects are headache, fatigue, dizziness, and rash. More serious but less common side effects require immediate medical attention and include:

• Signs of myopathy/rhabdomyolysis: Unexplained muscle pain, tenderness, or weakness, especially with fever or malaise.
• Signs of hepatitis: Jaundice (yellowing of the skin or eyes), upper right abdominal pain, dark urine, severe nausea.
• Signs of a severe allergic reaction: Rash, hives, itching, difficulty breathing, swelling of the face, lips, tongue, or throat.
• Signs of pancreatitis: Severe abdominal pain that radiates to the back, nausea, vomiting.
• Unusual bleeding or bruising.

Drug interaction

Lopid has a significant potential for pharmacokinetic and pharmacodynamic drug interactions. Concomitant use requires extreme caution, dosage adjustment, or is outright contraindicated.

• HMG-CoA Reductase Inhibitors (Statins): Contraindicated with simvastatin. Concomitant use with any statin (e.g., atorvastatin, rosuvastatin) dramatically increases the risk of severe myopathy and rhabdomyolysis. This combination should generally be avoided.
• Repaglinide: Contraindicated. Concomitant use increases repaglinide plasma levels and significantly elevates the risk of severe hypoglycemia.
• Oral Anticoagulants (Warfarin): Lopid potentiates the effect of coumarin anticoagulants, significantly increasing prothrombin time and the risk of bleeding. The dosage of the anticoagulant should be reduced and prothrombin time monitored frequently.
• CYP2C8/9 Substrates: Gemfibrozil is a strong inhibitor of CYP2C8/9. It can increase plasma concentrations of drugs metabolized by this pathway (e.g., pioglitazone, rosiglitazone, certain NSAIDs, phenytoin).
• Bile Acid Sequestrants (e.g., cholestyramine): These agents may bind to Lopid in the GI tract, reducing its absorption. Doses should be spaced at least 2 hours apart.

Missed dose

If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed one, as this increases the risk of adverse effects.

Overdose

In the event of an overdose, symptomatic and supportive care is the mainstay of treatment. Since Lopid is highly protein-bound, dialysis is not likely to be effective in removing it from the bloodstream. Specific symptoms of overdose may include severe abdominal cramping, nausea, vomiting, diarrhea, and joint and muscle pain. Given the drug’s effects on coagulation, monitoring for signs of abnormal bleeding is also prudent. Healthcare providers should contact a poison control center for the most current management guidelines.

Storage

Store Lopid tablets at room temperature, between 20°C to 25°C (68°F to 77°F), in a tightly closed container. The medication must be kept in its original packaging to protect it from light and moisture. It should always be stored out of reach of children and pets. Do not flush medication down the toilet or pour it into a drain. Dispose of unused or expired medication through a medicine take-back program or according to FDA guidelines.

Disclaimer

This information is for educational and informational purposes only and does not constitute medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting, stopping, or changing any prescribed part of your care plan. Never disregard professional medical advice or delay in seeking it because of something you have read here. The content has been compiled from various sources but may not be comprehensive or reflect the most recent medical evidence.

Reviews

“After struggling with persistently high triglycerides despite maximal statin therapy, my cardiologist added Lopid. Within two months, my triglyceride levels were cut by more than half and my HDL improved noticeably. The twice-daily dosing is manageable.” — M.B., verified patient.

“As a clinical lipidologist, Lopid remains a vital tool in my arsenal for managing severe hypertriglyceridemia. Its efficacy in this specific patient population is well-documented. However, its use requires vigilant monitoring for drug interactions, particularly with statins, and for musculoskeletal side effects.” — Dr. A. Sharma, MD.

“I experienced significant gastrointestinal discomfort when first starting Lopid, but taking it exactly 30 minutes before a meal as directed made a world of difference. The side effects subsided after the first week. The improvement in my lipid panel was worth the initial adjustment period.” — R.K., verified patient.

“From a pharmacy perspective, dispensing Lopid always requires a thorough medication reconciliation. Its interaction profile, especially with anticoagulants and certain diabetes medications, mandates clear patient counseling and often necessitates communication with the prescriber to ensure safety.” — J. Miller, PharmD.