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Gemfibrozil
Clinical data
Trade names	Lopid, others
AHFS/Drugs.com	Monograph
MedlinePlus	a686002
License data	US DailyMed: Gemfibrozil;
Pregnancy; category	AU: B3; ;
Routes of; administration	By mouth
ATC code	C10AB04 (WHO) ;
Legal status
Legal status	CA: ℞-only; US: WARNINGRx-only; In general: ℞ (Prescription only);
Pharmacokinetic data
Bioavailability	Close to 100%
Protein binding	95%
Metabolism	Liver (CYP3A4)
Elimination half-life	1.5 hours
Excretion	Kidney 94% ; Feces 6%
Identifiers
	IUPAC name 5-(2,5-dimethylphenoxy)-2,2-dimethyl-pentanoic acid;
CAS Number	25812-30-0 ;
PubChem CID	3463;
IUPHAR/BPS	3439;
DrugBank	DB01241 ;
ChemSpider	3345 ;
UNII	Q8X02027X3;
KEGG	D00334 ;
ChEBI	CHEBI:5296 ;
ChEMBL	ChEMBL457 ;
CompTox Dashboard (EPA)	DTXSID0020652 ;
ECHA InfoCard	100.042.968
Chemical and physical data
Formula	C15H22O3
Molar mass	250.338 g·mol−1
3D model (JSmol)	Interactive image;
Melting point	61 to 63 °C (142 to 145 °F)
	SMILES O=C(O)C(C)(C)CCCOc1cc(ccc1C)C;
	InChI InChI=1S/C15H22O3/c1-11-6-7-12(2)13(10-11)18-9-5-8-15(3,4)14(16)17/h6-7,10H,5,8-9H2,1-4H3,(H,16,17) ; Key:HEMJJKBWTPKOJG-UHFFFAOYSA-N ;
	(verify)

Gemfibrozil, sold under the brand name Lopid among others, is a medication used to treat abnormal blood lipid levels.^[3] It is generally less preferred than statins.^[3]^[4] Use is recommended together with dietary changes and exercise.^[3] It is unclear if it changes the risk of heart disease.^[3] It is taken by mouth.^[3]

Common side effects include headache, dizziness, feeling tired, and intestinal upset.^[3] Serious side effects may include angioedema, gallstones, liver problems, and muscle breakdown.^[3] Use in pregnancy and breastfeeding is of unclear safety.^[5] It belongs to the fibrates group of medications and works by decreasing the breakdown of lipids in fat cells.^[3]

Gemfibrozil was patented in 1968, and came into medical use in 1982.^[6] It is available as a generic medication.^[4] In 2022, it was the 231st most commonly prescribed medication in the United States, with more than 1 million prescriptions.^[7]^[8]

Medical uses

Hyperlipidemia (Type III)
Hypertriglyceridemia (Type IV): Gemfibrozil, though not as effective as niacin (nicotinic acid, a form of Vitamin B3), is better tolerated.^{[citation needed]}
Reduce triglyceride levels ^[9]
Reduce very low density lipoprotein (VLDL) levels
Modest reduction of low density lipoprotein (LDL) levels
Moderate increase in high density lipoprotein (HDL) levels

Side effects

GI distress
Musculoskeletal pain
Increased incidence of gallstone
Hypokalemia (low blood potassium)
Increased risk of cancer

Contraindications

Gemfibrozil should not be given to these patients:^{[citation needed]}
- Hepatic dysfunction
Gemfibrozil should be used with caution in these higher risk categories:^{[citation needed]}
- Biliary tract disease
- Renal dysfunction
- Pregnant women
- Obese patients

Drug interactions

Anticoagulants: Gemfibrozil potentiates the action of warfarin and indanedione anticoagulants.^{[citation needed]}
Statin drugs: Concomitant administration of fibrates (including gemfibrozil) with statin drugs increases the risk of muscle cramping, myopathy, and rhabdomyolysis.^[10]
Gemfibrozil inhibits the activation of the liver's Cytochrome P450 system and CYP2C8, reducing hepatic metabolism of many drugs, and prolonging their half lives and duration of action.
- Drugs metabolized by the Cytochrome P450 system include:
  - Many antidepressants
  - Many antipsychotics
  - Many antiepileptics
  - Theophylline and other methylxanthine drugs
  - Several anesthetic agents
  - Oral contraceptive pills
  - Statins
  - Warfarin
  - Selexipag

Mechanism of actions

The exact mechanism of action of gemfibrozil is unknown; however, several theories exist regarding the very low density lipoprotein (VLDL) effect; it can inhibit lipolysis and decrease subsequent hepatic fatty acid uptake as well as inhibit hepatic secretion of VLDL; together these actions decrease serum VLDL levels and increase HDL-cholesterol; the mechanism behind HDL elevation is currently unknown.

Gemfibrozil increases the activity of extrahepatic lipoprotein lipase (LL), thereby increasing lipoprotein triglyceride lipolysis. It does so by activating peroxisome proliferator-activated receptor alpha (PPARα) 'transcription factor ligand', a receptor that is involved in metabolism of carbohydrates and fats, as well as adipose tissue differentiation. This increase in the synthesis of lipoprotein lipase thereby increases the clearance of triglycerides. Chylomicrons are degraded, VLDLs are converted to LDLs, and LDLs are converted to HDL. This is accompanied by a slight increase in secretion of lipids into the bile and ultimately the intestine. Gemfibrozil also inhibits the synthesis and increases the clearance of apolipoprotein B, a carrier molecule for VLDL.^[11]

History

Gemfibrozil was selected from a series of related compounds synthesized in the laboratories of the American company Parke-Davis in the late 1970s. It came from research for compounds that lower plasma lipid levels in humans and in animals.^[12]

Environmental data

Gemfibrozil has been detected in biosolids (the solids remaining after sewage treatment) at concentrations up to 2650 ng/g wet weight.^[13] This indicates that it survives the wastewater treatment process. It is also detected as environmental persistent micropollutant in aquifers and in groundwaters in karstic areas.^[14]

References

^ "FDA-sourced list of all drugs with black box warnings (Use Download Full Results and View Query links.)". nctr-crs.fda.gov. FDA. Retrieved 22 October 2023.
^ "Product monograph brand safety updates". Health Canada. 7 July 2016. Retrieved 1 April 2024.
^ ^a ^b ^c ^d ^e ^f ^g ^h "Gemfibrozil Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019.
^ ^a ^b British National Formulary: BNF 76 (76 ed.). Pharmaceutical Press. 2018. pp. 198–199. ISBN 9780857113382.
^ "Gemfibrozil Use During Pregnancy". Drugs.com. Retrieved 3 March 2019.
^ Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 474. ISBN 9783527607495.
^ "The Top 300 of 2022". ClinCalc. Archived from the original on 30 August 2024. Retrieved 30 August 2024.
^ "Gemfibrozil Drug Usage Statistics, United States, 2013 - 2022". ClinCalc. Retrieved 30 August 2024.
^ "Gemfibrozil". WebMD.com. Retrieved 14 June 2014.
^ "Medicines Complete". Medicines Complete. British National Formulary. Retrieved 1 February 2020.
^ "Gemfibrozil". PubChem. U.S. National Library of Medicine.
^ Rodney G, Uhlendorf P, Maxwell RE (1976). "The hypolipidaemic effect of gemfibrozil (CI-719) in laboratory animals". Proceedings of the Royal Society of Medicine. 69 (2_suppl): 6–10. doi:10.1177/00359157760690S203. PMC 1864017. PMID 828263.
^ "Biosolids". U.S. Environmental Protection Agency. 23 April 2014.
^ Doummar J, Aoun M (August 2018). "Assessment of the origin and transport of four selected emerging micropollutants sucralose, Acesulfame-K, gemfibrozil, and iohexol in a karst spring during a multi-event spring response". Journal of Contaminant Hydrology. 215: 11–20. Bibcode:2018JCHyd.215...11D. doi:10.1016/j.jconhyd.2018.06.003. PMID 29983209. S2CID 51599602.