Possible increased risk of rhabdomyolysis during concomitant use of simvastatin and gemfibrozil

Puijenbroek, Eugène P van; Buf-Vereijken, Peggy W. G. du; Spooren, P. F. M. J.; Doormaal, Jasper J. van

doi:10.1046/j.1365-2796.1996.48879000.x

Cited by 55 publications

(22 citation statements)

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“…It has been suggested that the incidence of myopathy with combination therapy may be lowered considerably if statin and niacin doses are limited [28], and this may also be the case for statin-fibrate combinations [56,57]. Thus, doses of each drug should be carefully titrated and kept to a minimum.…”

Section: Combination Therapy In Practicementioning

confidence: 99%

Statins: Monotherapy or Combination Strategy for the Treatment of Dyslipidemia

Carmena¹

2002

Heart Drug

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Statins are the drug of first choice for the treatment of most dyslipidemias. They have excellent efficacy in reducing the concentration of low-density lipoprotein cholesterol (LDL-C) and have been proven to reduce the incidence of cardiovascular events, although differences exist in the lipid-modifying properties of these agents. Combination therapy may be considered for patients who do not achieve their lipid goal despite optimization of statin treatment. In severely hypercholesterolemic patients, combinations of statins with bile acid sequestrants, plant sterols or specific cholesterol absorption inhibitors may provide additional reductions in LDL-C and extend the therapeutic options in these difficult-to-treat patients. In patients with mixed dyslipidemias, combination of a statin with niacin or a fibrate may be necessary to fully correct lipid abnormalities. Although these combinations may be associated with an increased incidence of adverse effects, particularly myopathy and hepatotoxicity, recent clinical trials suggest that the benefit of enhanced efficacy across the lipid profile out weighs the risk of toxicity. Nevertheless, statin-niacin or statin-fibrate combinations should only be considered after careful risk-benefit assessment, and patients should be well informed of potential side effects. Doses of each drug should be kept to a minimum in order to reduce the risk of adverse effects. Combination treatment with statins and fish oil has shown promising improvements in several lipid parameters without an increase in systemic toxicity, and this combination may be a useful addition to the options available for treatment of refractory patients who cannot tolerate statin-niacin or statin-fibrate combinations.

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Section: Combination Therapy In Practicementioning

confidence: 99%

Statins: Monotherapy or Combination Strategy for the Treatment of Dyslipidemia

Carmena¹

2002

Heart Drug

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“…The fibrate gemfibrozil in combination with statins has been associated with increased risk of myopathy [256]. It has however been proposed that the adverse effects of gemfibrozil and statin combination therapy may be due to a pharmacological interaction between these two drugs and that other fenofibrates may be more suitable for combination therapy with statins [257].…”

Section: Lipid Lowering Drugsmentioning

confidence: 99%

Myocardial Insulin Resistance: An Overview of Its Causes, Effects, and Potential Therapy

Toit¹,

Donner²

2012

Insulin Resistance

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“…Although not a common side effect, severe myopathy has been reported with use of fibrates alone and rhabdomyolysis has been reported with concurrent use of some statins. 61,62 Because the fibrates are extensively eliminated by the kidneys, those patients with renal impairment are at higher risk for adverse effects, particularly myopathy. 63 Finally, all the fibrates can increase biliary cholesterol levels with a reported 1% to 2% increase in incidence of cholelithiasis.…”

Section: Safety and Aesmentioning

confidence: 99%