Gemfibrozil

Gemfibrozil

Clinical data
Trade names	Lopid
AHFS/Drugs.com	Monograph
MedlinePlus	a686002
Pregnancy category	Category C
Routes of administration	Oral
ATC code	C10AB04 (WHO)
Legal status
Legal status	In general: ℞ (Prescription only)
Pharmacokinetic data
Bioavailability	Close to 100%
Protein binding	95%
Metabolism	Hepatic (CYP3A4)
Elimination half-life	1.5 hours
Excretion	Renal 94% Feces 6%
Identifiers
IUPAC name 5-(2,5-dimethylphenoxy)-2,2-dimethyl-pentanoic acid
CAS Number	25812-30-0 Y
PubChem CID	3463
IUPHAR/BPS	3439
DrugBank	DB01241 Y
ChemSpider	3345 Y
UNII	Q8X02027X3
KEGG	D00334 Y
ChEBI	CHEBI:5296 Y
ChEMBL	CHEMBL457 Y
ECHA InfoCard	100.042.968
Chemical and physical data
Formula	C15H22O3
Molar mass	250.333 g/mol
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) Y Key:HEMJJKBWTPKOJG-UHFFFAOYSA-N Y
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Gemfibrozil is the generic name for an oral drug used to lower lipid levels. It belongs to a group of drugs known as fibrates. It is most commonly sold as the brand name, Lopid. Other brand names include Jezil and Gen-Fibro.

Development 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.^[1]

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.^[2]

Therapeutic effects

• Reduce triglyceride levels ^[3]
• 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 and toxicities

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

Indications

• Hyperlipidemia (Type III): Gemfibrozil is the drug of choice for therapy.
• Hypertriglyceridemia (Type IV): Gemfibrozil, though not as effective as niacin, is better tolerated.

Contraindications and precautions

• Gemfibrozil should not be given to these patients:
  • Hepatic dysfunction
• Gemfibrozil should be used with caution in these higher risk categories:
  • Biliary tract disease
  • Renal dysfunction
  • Pregnant women
  • Obese patients

Drug interactions

• Anticoagulants: Gemfibrozil potentiates the action of warfarin and indanedione anticoagulants.
• Statin drugs: Concomitant administration of fibrates (including gemfibrozil) with statin drugs increases the risk of muscle cramping, myopathy, and rhabdomyolysis.
• 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

Environmental data

Gemfibrozil has been detected in biosolids (the solids remaining after sewage treatment) at concentrations up to 2650 ng/g wet weight.^[4] 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.^[5]

References

External links

• DrugBank Gemfibrozil
• NIH Gemfibrozil Drug Info
• Lopid International Study
• Author (2004). "Safety of Statins". Circulation. 109: III-50–III-57. doi:10.1161/01.cir.0000131519.15067.1f. PMID 15198967.
• http://www.ihs.gov/nptc/documents/NPTC%20Lipid%20Review.pdf