Repaglinide
Contraindicated
Database
CYP2C8 inhibition → massive repaglinide rise, severe hypoglycaemia
Absolute contraindication — do not co-administer
Source: Kimi deep-research + Cla
Drug reference
Gemfibrozil
Fibric acid derivative (PPAR-alpha agonist) · Lipid-modifying agent
Also known as Lopid
START
600 mg PO BID, 30 min before morning and evening meals
TYPICAL MAX
1200 mg/day
STOP IF
Myopathy/rhabdomyolysis, gallbladder disease, significant hepatotoxicity
WATCH
CK if muscle symptoms, LFTs, gallbladder symptoms; AVOID with repaglinide/simvastatin
CDSCO approvedATC C10AB04
KDIGO 2024 + manufacturer label
- ONSET
- 1.5h · absorption
- PEAK
- 1.5h · Cmax
- t½
- 1.5h · plasma t½
- DURATION
- 12h · BID interval
EXCRETION
Hepatic conjugation; ~70% renal conjugates
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Avoid — limited data; lipid therapy generally deferred in pregnancy
FDA category + note
Top interactionssee all 12 →
- RepaglinideContraindicatedDatabaseKimi deep-research + Cla
- RosuvastatinContraindicatedDatabaseKimi deep-research + Cla · p949
- SimvastatinContraindicatedDatabaseKimi deep-research + Cla · p949
- AtorvastatinSevereTextbook-citedKDT 7e · p949
Available in India
20 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Activates PPAR-alpha increasing lipoprotein lipase activity and reducing hepatic VLDL synthesis → marked triglyceride lowering, modest HDL rise, variable LDL effect.
Indications
Severe hypertriglyceridaemia (especially TG >500 mg/dL — pancreatitis prevention)Mixed dyslipidaemia where fibrate indicated and statin insufficient/contraindicated
Dosing
- Adult
- 600 mg PO twice daily, 30 minutes before morning and evening meals.
- Pediatric
- Not established.
- Renal adjustment
- Avoid in severe renal impairment; caution and monitor in moderate (myopathy risk).
- Hepatic adjustment
- Contraindicated in significant hepatic dysfunction.
- Geriatric
- No specific adjustment; monitor.
- Max dose
- 1200 mg/day (600 mg BID)
Pharmacokinetics
Onset
Lipid effect over 2–4 weeks
Peak effect
Cmax 1–2 h
Duration
BID dosing
Half-life
~1.5 h
Bioavailability
~98%
Protein binding
~97%
Metabolism
Hepatic (oxidation, glucuronidation); potent inhibitor of CYP2C8 and OATP1B1
Excretion
Renal (~70%, mostly conjugates) and faecal
Contraindications
- Severe renal impairment
- Significant hepatic dysfunction / primary biliary cholangitis
- Pre-existing gallbladder disease
- Concomitant repaglinide, simvastatin, dasabuvir, or selexipag
- Hypersensitivity to gemfibrozil
Side effects
Common
Dyspepsia, abdominal painNausea/diarrhoeaHeadache, dizzinessRash
Serious
- Myopathy/rhabdomyolysis (markedly increased with statins)
- Cholelithiasis/cholecystitis
- Hepatotoxicity
- Severe hypersensitivity (rare); blood dyscrasias (rare)
Pregnancy & lactation
Pregnancy
Avoid — limited data; lipid therapy generally deferred in pregnancy
Lactation
Avoid (excreted in animal milk; theoretical risk)
Drug interactions
Rosuvastatin
Contraindicated
Database
Increased risk of myopathy/rhabdomyolysis when combined with statins
Avoid combination; use fenofibrate if fibrate needed
Source: Kimi deep-research + Cla · p949
Simvastatin
Contraindicated
Database
OATP1B1/CYP inhibition → severe myopathy/rhabdomyolysis
Contraindicated; avoid all statin–gemfibrozil combinations where possible (prefer fenofibrate)
Source: Kimi deep-research + Cla · p949
Atorvastatin
Severe
Textbook-cited
Increased risk of myopathy and rhabdomyolysis.
Use with caution; monitor for muscle symptoms and CK levels
Source: KDT 7e · p949
Lovastatin
Severe
Textbook-cited
Increased risk of myopathy and rhabdomyolysis.
Use with caution; monitor for muscle symptoms and CK levels
Source: KDT 7e · p949
Pravastatin
Severe
Textbook-cited
Increased risk of myopathy and rhabdomyolysis.
Use with caution; monitor for muscle symptoms and CK levels
Source: KDT 7e · p949
Alirocumab
Severe
Textbook
Increased plasma concentration of statin hydroxy acids, leading to an increased risk of myopathy (including rhabdomyolysis).
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing fibrates in 2016.
Source: G&G 14e · p736
Atorvastatin + Aspirin
Severe
Textbook
Increased plasma concentration of statin hydroxy acids, leading to an increased risk of myopathy (including rhabdomyolysis).
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing fibrates in 2016.
Source: G&G 14e · p736
Evolocumab
Severe
Textbook
Increased plasma concentration of statin hydroxy acids, leading to an increased risk of myopathy (including rhabdomyolysis).
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing fibrates in 2016.
Source: G&G 14e · p736
Lomitapide
Severe
Textbook
Increased plasma concentration of statin hydroxy acids, leading to an increased risk of myopathy (including rhabdomyolysis).
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing fibrates in 2016.
Source: G&G 14e · p736
Mevastatin
Severe
Textbook
Increased plasma concentration of statin hydroxy acids, leading to an increased risk of myopathy (including rhabdomyolysis).
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing fibrates in 2016.
Source: G&G 14e · p736
Nicotinic Acid
Severe
Textbook
Increased plasma concentration of statin hydroxy acids, leading to an increased risk of myopathy (including rhabdomyolysis).
Avoid coadministration. The FDA withdrew approval for statin drug combinations containing fibrates in 2016.
Source: G&G 14e · p736
Related guidelines
Ask House about Gemfibrozil
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19