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?
- 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.
- 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.
- 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.
- 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.
- 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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