Combined treatment of hypercholesterolemia of renal transplant allograft recipients with fluvastatin and gemfibrozil

Abstract

The aim of this study was to investigate the safety and efficacy of combined treatment with fluvastatin (F) and gemfibrozil (G) in hypercholesterolemic renal transplant recipients (RTR). Ten hypercholesterolemic (total cholesterol [TC] > 220 mg/dl) RTR (7 men) with mean age 44 years (range 25-56 years) who remained hypercholesterolemic after 3 months of treatment (period A) with fluvastatin (40 mg/d) continued taking the same dose of F plus G (600 mg/dl) for another 3-month period (B). Serum total cholesterol, high density lipoprotein cholesterol (HDL-C), LDL cholesterol (LDL-C), triglyceride, serum creatinine (creatinine phosphokinase (CPK), serum glutamic-oxaloacetic transaminase (SGOT), and serum glutamate pyruvate transaminase (SGPT) were measured before treatment and at the end of periods A and B. Mean TC levels were 360.30 +/- 62.42 mg/dl, 324.10 +/- 100.53 mg/dl, 270.80 +/- 67.77 mg/dl; mean LDL-C levels were 259.33 +/- 71.43 mg/dl, 219.60 +/- 81.31 mg/dl, 189.70 +/- 65.51 mg/dl; mean HDL-C levels were 37.10 +/- 11.68 mg/dl, 39.80 +/- 13.21 mg/dl, 41.00 +/- 12.94 mg/dl; mean triglyceride levels were 354.60 +/- 183.29 mg/dl, 349.30 +/- 242.94 mg/dl, 207.00 +/- 85.35 mg/dl before treatment and at the end of periods A and B, respectively. There was a statistically significant fall of serum TC (P = 0.002), LDL-C (P = 0.016), and triglyceride (P = 0.029) levels at the end of periods A and B. Kidney and liver function did not change. F and G combined treatment is safe and useful in patients who do not respond satisfactorily to monotherapy with F. Gemfibrozil augments the effect of F on TC, LDL-C, and triglyceride levels.

Cardiovascular risk factors following orthotopic liver transplantation: predisposing factors, incidence and management

“…Comparing lovastatin with another fibrate class drug, bezafibrate, has shown that both drugs reduce total cholesterol and LDL levels, while bezafibrate also increases HDL levels (51). Therefore, in patients who remain dyslipidaemic on statin therapy alone, a fibrate medication should be added to improve control of hyperlipidaemia (52).…”

Combined Organ Failure with Combination Antihyperlipidemic Treatment: A Case of Hepatic Injury and Acute Renal Failure

“…Using the Naran-jo probability scale, we determined that the use of lipidlowering drugs was the probable cause of the combined toxicity because rhabdomyolysis and liver enzyme elevation appeared after the suspected drugs were administered, improved when the drugs were discontinued, and had no apparent alternative cause." The mechanism of this combined toxicity is difficult to clarify, although, as of November 22,2006, in vivo and in vitro studies have revealed considerable data concerning antihyperlipidemic drug interactions. In vitro studies indicate that gemfibrozil is a potent inhibitor of CYP2C9 in clinically relevant concentrations.…”

PPAR? agonists improve renal preservation in kidneys subjected to chronic in vitro perfusion: interaction with mannitol

“…When given chronically to patients with dyslipidemias, PPAR α agonists, such as gemfibrozil, lower plasma triglycerides and increase high‐density lipoprotein cholesterol levels. Consequently, PPAR α agonists are widely prescribed for post‐transplant hyperlipidemia and appear entirely safe in such a setting [15–18]. In fact, therapy with PPAR α agonists may provide renoprotection from the damaging effects of chronic dyslipidemia [19].…”