Lopid (gemfibrozil) is a lipid-regulating medication belonging to the fibrate class, specifically designed to address specific dyslipidemias. It works by reducing elevated serum triglycerides and very low-density lipoprotein (VLDL) cholesterol while often increasing high-density lipoprotein (HDL) cholesterol. This targeted action makes it a cornerstone in the pharmacological management of certain lipid disorders, particularly for patients at risk of pancreatitis or with mixed dyslipidemias unresponsive to lifestyle modifications alone. Its mechanism involves activating peroxisome proliferator-activated receptor-alpha (PPARα), leading to increased lipolysis and elimination of triglyceride-rich particles from plasma.

Features

• Active pharmaceutical ingredient: Gemfibrozil 600 mg
• Pharmaceutical class: Fibric acid derivative (fibrate)
• Available formulation: Film-coated tablets for oral administration
• Standard strength: 600 mg tablets
• Prescription status: Rx-only medication
• Manufacturer: Various FDA-approved pharmaceutical companies
• Recommended administration: Twice daily, 30 minutes before morning and evening meals
• Bioavailability: Well-absorbed from gastrointestinal tract
• Protein binding: Extensive (>95%)
• Metabolism: Hepatic oxidation via CYP3A4
• Elimination half-life: Approximately 1.5 hours
• Excretion: Primarily renal (70%), with some fecal elimination

Benefits

• Significantly reduces elevated triglyceride levels, decreasing pancreatitis risk
• Moderately increases HDL cholesterol (the “good” cholesterol) levels
• May reduce VLDL cholesterol production and enhance clearance
• Provides targeted lipid management for specific patient phenotypes
• Offers established clinical efficacy with decades of real-world use
• Complements lifestyle modifications in comprehensive lipid management

Common use

Lopid is primarily indicated as adjunctive therapy to diet for: reducing the risk of coronary heart disease in patients with Type IIb hyperlipidemia who have low HDL cholesterol and elevated LDL cholesterol and triglycerides; treatment of very high serum triglyceride levels (Type IV and Type V hyperlipidemia) in patients at risk of pancreatitis who do not respond adequately to dietary intervention. It is particularly valuable for patients with familial combined hyperlipidemia or those with metabolic syndrome components. Clinical use typically follows failure of dietary management and often precedes or accompanies statin therapy in appropriate patients.

Dosage and direction

The recommended adult dosage is 600 mg orally twice daily, taken 30 minutes before the morning and evening meals. Dosage adjustment may be necessary in patients with renal impairment or those taking concomitant medications that affect gemfibrozil metabolism. Treatment should be initiated only after a thorough lipid evaluation and failure of appropriate dietary measures. Regular lipid level monitoring is essential, with dosage adjustments based on therapeutic response and tolerance. Therapy should be discontinued if significant improvement is not observed within three months.

Precautions

Complete lipid profile should be performed before initiation and periodically during therapy. Liver function tests should be monitored regularly, particularly during the first year of treatment. May cause cholelithiasis; evaluate patients for gallbladder disease. Monitor hematologic parameters periodically. Use with caution in patients with renal impairment (consider dosage reduction). May increase cholesterol excretion into bile; caution in patients with history of gallstones. Periodic eye examinations recommended due to potential cataract formation. Monitor patients for musculoskeletal pain, tenderness, or weakness.

Contraindications

Hypersensitivity to gemfibrozil or any component of the formulation; hepatic dysfunction including primary biliary cirrhosis; preexisting gallbladder disease; severe renal impairment; concurrent use with repaglinide or simvastatin due to increased risk of rhabdomyolysis. Should not be used in patients who exhibit significantly elevated LDL cholesterol as the sole lipid abnormality. Contraindicated in pregnancy and breastfeeding unless potential benefit justifies potential risk to fetus/infant.

Possible side effect

Common (≥1%): Dyspepsia, abdominal pain, diarrhea, nausea, vomiting, fatigue, headache, dizziness, rash, eczema. Less common: Constipation, acute appendicitis, atrial fibrillation, vertigo, somnolence, paresthesia, hypesthesia, depression, libido decreased, impotence, blurred vision, retinal edema, weight loss, taste disturbance. Rare but serious: Rhabdomyolysis with renal failure, hepatitis, cholestatic jaundice, cholelithiasis, pancreatitis, anemia, leukopenia, thrombocytopenia, bone marrow hypoplasia, vasculitis, lupus-like syndrome, anaphylaxis, angioedema.

Drug interaction

Strong CYP3A4 inhibitors (ketoconazole, ritonavir): May increase gemfibrozil levels. Statins (particularly simvastatin): Increased risk of myopathy/rhabdomyolysis. Warfarin: Enhanced anticoagulant effect requiring INR monitoring. Repaglinide: Contraindicated due to severe hypoglycemia risk. Bile acid sequestrants: May decrease gemfibrozil absorption (administer 2 hours apart). Cyclosporine: Increased risk of renal dysfunction. Oral contraceptives: Potential decreased efficacy. Insulin/sulfonylureas: May enhance hypoglycemic effects.

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for a missed dose. Resume the regular dosing schedule with the next dose. If multiple doses are missed, contact healthcare provider for guidance. Consistent administration relative to meals is important for optimal absorption and efficacy.

Overdose

Symptoms may include abdominal cramps, nausea, vomiting, diarrhea, headache, dizziness, and joint pain. Severe overdose could potentially lead to hepatic toxicity or renal impairment. There is no specific antidote. Treatment should be supportive and symptomatic. Gastric lavage may be considered if presented early. Hemodialysis is not effective due to high protein binding. Monitor liver and renal function, provide symptomatic care, and maintain hydration.

Storage

Store at controlled room temperature 20-25°C (68-77°F). Excursions permitted to 15-30°C (59-86°F). Keep container tightly closed. Protect from moisture and light. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Do not transfer tablets to other containers as original packaging provides moisture protection.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Lopid is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual results may vary. Patients should not discontinue or change dosage without consulting their physician. The full prescribing information should be consulted before initiating therapy.

Reviews

Clinical studies demonstrate Lopid reduces coronary heart disease events by 34% in specific patient populations with high triglycerides and low HDL cholesterol. The Helsinki Heart Study showed significant reduction in cardiac endpoints. Many clinicians report satisfactory triglyceride reduction in appropriate patients. Some patients report gastrointestinal discomfort that often diminishes with continued use. Regular monitoring is emphasized in most clinical experiences. Overall efficacy is well-established for its indicated uses when prescribed to appropriate patient populations.