Drug Interactions of Fibrates

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· Contraindicated Combinations of Fibrates include Fibrates & Ciprofibrate, Gemfibrozil & Repaglinide, Gemfibrozil & Dasabuvir and Gemfibrozil & Simvastatin. · Major Interactions of Fibrates include Fibrates & Ezetimibe, Fibrates & Sulfonylurea Antidiabetics (Glyburide, Glipizide, Glimepiride, etc), Gemfibrozil & Other Statins (Lovastatin, Atorvastatin, Fluvastatin, Pravastatin), Gemfibrozil & Colchicine, Fenofibrate & Anticoagulants, Bezafibrate & Bile acid Sequestrants (Cholestyramine, Colestipol, Colesevelam).

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Drug Interactions of Antihyperlipidemics Part 2 (Drug Interactions of Fibrates):

Drug Interactions of Antihyperlipidemics Part 2 ( Drug Interactions of Fibrates ) D r . P.Naina Mohamed P h D P harmacologist

Introduction:

Introduction An adverse drug interaction is defined as an interaction between one or more coadministered medications which leads to alteration of the effectiveness or toxicity of any of the coadministered medications. Drug interactions can be caused by P rescription and Over-the-counter (OTC) medications, herbal products or vitamins, foods, diseases, and genetics (family history). It is estimated that people over 65 take an average of seven drugs at any one time to treat a variety of illnesses including higher cholesterol, diabetes, hypertension, etc. With this amount of medicine use, the probability that a person will take two prescribed drugs that may interact with one another is very high.

Antihyperlipidemics:

Antihyperlipidemics Statins (HMG CoA Reductase Inhibitors) Fibrates Bile acid sequestrants Niacin Ezetimibe Lomitapide Orlistat

Fibrates (Fibric acid derivatives) :

Fibrates ( Fibric acid derivatives ) Gemfibrozil Clofibrate Ciprofibrate Fenofibrate Bezafibrate

Contraindicated Combinations of Fibrates:

Contraindicated Combinations of Fibrates Fibrates + Ciprofibrate Gemfibrozil + Repaglinide Gemfibrozil + Dasabuvir Gemfibrozil + Simvastatin

Major Interactions of Fibrates:

Major Interactions of Fibrates Fibrates + Ezetimibe Fibrates + Sulfonylurea Antidiabetics (Glyburide, Glipizide, Glimepiride, etc ) Gemfibrozil + Other Statins (Lovastatin, Atorvastatin, Fluvastatin , Pravastatin) Gemfibrozil + Colchicine Fenofibrate + Anticoagulants Bezafibrate + Bile acid Sequestrants ( Cholestyramine, Colestipol , Colesevelam )

Fibrates & Ciprofibrate:

Fibrates & Ciprofibrate The combined use of Fibrates and Ciprofibrate is contraindicated due to an increased risk of rhabdomyolysis and myoglobulinuria . https :// www.medicines.org.uk/emc/medicine/22264

Fibrates & Ezetimibe:

Fibrates & Ezetimibe The coadministration of Ezetimibe and fibrates, other than fenofibrate , is not recommended. http ://www.webmd.com/drugs/2/drug-11423/gemfibrozil-oral/details/list-interaction-details/dmid-1219/dmtitle-fibrates-ezetimibe/intrtype-drug

Fibrates & Sulfonylureas:

Fibrates & Sulfonylureas Closely monitor for hypoglycemia, if concomitant use is required. http :// onlinelibrary.wiley.com/doi/10.1002/cpt.297/abstract

Gemfibrozil & Repaglinide :

Gemfibrozil & Repaglinide Repaglinide dose should be reduced and blood glucose concentrations carefully monitored, if the combination is considered clinically necessary. http ://onlinelibrary.wiley.com/doi/10.1111/j.1365-2125.2010.03772.x/abstract;jsessionid=48F9DF92C02827B672F706A516086D2B.f03t03

Gemfibrozil & Dasabuvir :

Gemfibrozil & Dasabuvir Concomitant use of dasabuvir and gemfibrozil is contraindicated due to a 10-fold increase in dasabuvir exposure and an increased risk of QT prolongation. http ://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm175927.htm

Gemfibrozil & Simvastatin :

Gemfibrozil & Simvastatin The concomitant use of gemfibrozil and simvastatin may increase the risk of developing myopathy or rhabdomyolysis and is contraindicated. http ://www.ncbi.nlm.nih.gov/pubmed/17510000

Gemfibrozil & Other Statins:

Gemfibrozil & Other Statins The concomitant use of Gemfibrozil and Statins should be avoided. https://www.thieme-connect.com/DOI/DOI?10.1055/s-0031-1299815

Gemfibrozil & Colchicine :

Gemfibrozil & Colchicine Patients receiving Gemfibrozil and Colchicine should be monitored closely for signs and symptoms of myopathy or rhabdomyolysis. http://aop.sagepub.com/content/36/11/1719.long

Fenofibrate & Anticoagulants :

Fenofibrate & Anticoagulants Concomitant use requires the monitoring of INR value. Reduce the dose of anticoagulant by about one-third at the start of treatment, then gradually adjust the dose based on the results of INR monitoring. http ://aop.sagepub.com/content/32/7-8/765.long

Bezafibrate & Bile acid Sequestrants:

Bezafibrate & Bile acid Sequestrants The interaction can be avoided by separating the administration of the two drugs by at least 2 hours. http ://www.ncbi.nlm.nih.gov/pubmed/3301301

Conclusion:

Conclusion The occurrence of significant morbidity and mortality can be reduced by minimizing the risk for drug interactions. The hyperlipidemic patients should bring a list of all the drugs they are taking including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the doctor or pharmacist . The risk of adverse effects could be reduced and the quality of life for patients improved by healthcare professionals through the screening , education, and follow up on suspected drug interactions. If possible, the hyperlipidemic patients are recommended to fill all their prescriptions at one pharmacy.

References:

References Stockley’s Drug Interactions, 9e Karen Baxter Hurst's The Heart, 13e Valentin Fuster , Richard A. Walsh, Robert A. Harrington Basic & Clinical Pharmacology, 12e Bertram G. Katzung , Susan B. Masters, Anthony J. Trevor http :// www.micromedexsolutions.com

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