II. Efficacy

  1. Lipid effects
    1. Decreases Triglycerides (20-50%)
    2. Increases LDL Cholesterol (10-15%)
    3. Decreases VLDL Cholesterol
    4. Increases HDL Cholesterol (10-15%)
  2. Outcome effects
    1. No effect on all cause mortality
    2. NNT to prevent one coronary event: 46-125

III. Adverse effects

  1. Gastrointestinal effects
    1. Gastrointestinal upset
    2. Abdominal Pain
    3. Higher rate of Gastrointestinal Disease
      1. Cholecystitis (increased risk by 2-3%)
      2. Appendicitis
  2. Miscellaneous
    1. Rash
    2. Renal dysfunction (rare)
    3. Myopathy (rare)

IV. Drug Interactions

  1. May potentiate effects of:
    1. Coumadin
    2. Oral Hypoglycemic Agents

V. Contraindications

  1. Absolute
    1. Severe Hepatic or renal disease
    2. Preexisting Gallstones
  2. Relative
    1. Concurrent Statin due to Myopathy risk
      1. Exercise caution when using these together
      2. Tricor is commonly used with Statins (Gemfibrozil is higher risk)
    2. Concurrent Coumadin use
    3. Avoid as a single agent in Coronary Artery Disease

VI. Preparations

  1. Gemfibrozil (Lopid)
    1. Dose: 600 mg bid ($75/month)
  2. Fenofibrate (Tricor)
    1. Less likely to cause Rhabdomyolysis with Statin
  3. Fenofibrate (Trilipix)
    1. Rebranded version of Tricor in time for generic Fenofibrate release in 2011
  4. Clofibrate
    1. Discontinued in 2002
    2. Increased mortality from malignant and GI disease

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Related Studies

Cost: Medications

gemfibrozil (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
GEMFIBROZIL 600 MG TABLET Generic $0.09 each
fenofibrate (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
FENOFIBRATE 130 MG CAPSULE Generic $2.94 each
FENOFIBRATE 134 MG CAPSULE Generic $1.01 each
FENOFIBRATE 145 MG TABLET Generic $0.58 each
FENOFIBRATE 150 MG CAPSULE Generic $5.56 each
FENOFIBRATE 160 MG TABLET Generic $0.52 each
FENOFIBRATE 200 MG CAPSULE Generic $1.75 each
FENOFIBRATE 43 MG CAPSULE Generic $1.14 each
FENOFIBRATE 48 MG TABLET Generic $0.42 each
FENOFIBRATE 50 MG CAPSULE Generic $2.31 each
FENOFIBRATE 54 MG TABLET Generic $0.39 each
FENOFIBRATE 67 MG CAPSULE Generic $0.62 each
tricor (on 3/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
TRICOR 145 MG TABLET Generic $0.58 each
TRICOR 48 MG TABLET Generic $0.42 each
trilipix (on 3/8/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
TRILIPIX DR 135 MG CAPSULE Generic $1.61 each
TRILIPIX DR 45 MG CAPSULE Generic $0.89 each