Clinical Conundrum – Gemfibrozil and Statins, What to do?

Drug interactions is one thing that pharmacists need to be experts at managing.  Gemfibrozil and statins present an interesting drug interaction that needs to be addressed.  How should we address the interaction?

  1. Do other alternatives exist?  Other alternatives to the statin are probably unlikely as many patients have cardiovascular disease or other clinical concerns that necessitate its use.  With gemfibrozil however, we do potentially have other options like fenofibrate or niacin which may interact to a lesser extent.
  2. Clinically, we also need to assess the severity of the situation and the concern with which we are using gemfibrozil for.  Gemfibrozil will almost exclusive be used for elevated triglycerides.  Elevated triglycerides can raise the risk for acute pancreatitis.  Are the tryglycerides 400, or are they 1600 makes a substantial difference as to the seriousness with which they should be treated.
  3. If all else fails, and if a provider is adamant about continuing with gemfibrozil and a statin, monitoring and education is an absolute must.  The biggest risk with this interaction is rhabdomyolysis, so assessment of CPK might be an appropriate way to help monitor for the potential interaction between gemfibrozil and statins.
  4. Depending upon labs, cardiovascular risk, and pancreatitis risk, another alternative to consider may be to reduce the dose of one and/or the other agent.
  5. As a pharmacist, you must also look at agents that can cause what we are trying to treat.  Antipsychotics are an example that comes to mind when I think about the possibility of drug induce hypertriglyceridemia.

What else do you think about with the gemfibrozil and statins interaction?

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  1. Grant C

    Gemfibrozil is the worst offender with statins and specifically contraindicated with simvastatin. I suggest switch to another fibrate like fenofibrate if one is needed. Or, switch the statin to pravastatin for a different metabolic pathway. Fish oil works too, but niacin is less preferred the FDA actually pulled their approval for those products. Mild triglyceride elevation may not even need super aggressive interventions

  2. Felipe

    Nicely done Eric. Off topic, I’m using your BCPS Bullets book (on Amazon) to review for the NAPLEX (just graduated from UGA). Two things: Would this book help – by reinforcing the foundation of each dx state? And secondly, on page 94 (VTE), it says Eliquis 10mg bid for 5 days as opposed to 7 days. Just looking out for you. Thanks and keep it up.

    • Eric Christianson

      Thanks Felipe for that insight! Will definitely update that for future editions! – Eric

  3. Jason

    Also, per package insert, rosuvastatin can be given up to 10mg daily with gemfibrozil. In Canada, rosuvastatin is considered safe up to 20mg daily with gemfibrozil, per Facts and Comparisons. I’ve suggested switching to rosuvastatin in a situation like this with good results.

  4. Amanuel

    Per Lexicomp. Fluvastatin is considered the safest amongst the statins and possess minimal interaction with Gemfibrozil and other forms of fibrates. Thus, it could be another alternative approach to managing cholesterol .

  5. Rushank

    Nice article, along with rhabdomylosis we need to check symptoms of myopathies as well wheb using both the drugs to gather.


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Written By Eric Christianson

May 14, 2017

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