Fibrate Pregnancy: No adequate data; should not be used during pregnancy unless clearly necessary. Breast-feeding: no data; should not be used when breast-feeding.

Gemfibrozil

Brand names: Lopid

Gemfibrozil is a fibrate used to treat hypertriglyceridaemia and mixed dyslipidaemia, particularly where triglycerides are markedly raised.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 900–1200 mg daily. 1200 mg taken as 600 mg twice daily (half an hour before breakfast and half an hour before the evening meal); the 900 mg dose taken as a single dose half an hour before the evening meal.

Route: Oral

Frequency: Twice daily (1200 mg regimen) or once daily (900 mg regimen)

Max: 1200 mg daily

Applies to adults and elderly (over 65 years). Only the 1200 mg daily dose has documented effect on morbidity. Before starting, control other problems (e.g. hypothyroidism, diabetes) and place patient on a standard lipid-lowering diet, continued during treatment. Paediatric: not investigated in children — use not recommended.

Dose adjustments

Renal

Mild to moderate renal impairment (GFR 50–80 and 30–50 mL/min/1.73 m²): start at 900 mg daily and assess renal function before increasing the dose. Contraindicated in severe renal impairment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or any ingredient
Hepatic impairment
Severe renal impairment
History of or pre-existing gall bladder or biliary tract disease including gallstones
Previous history of photoallergy or phototoxic reaction during treatment with fibrates
Concomitant use of repaglinide, dasabuvir, selexipag, simvastatin, or rosuvastatin at 40 mg

Side effects

Dyspepsia (very common)
Diarrhoea, vomiting, nausea, abdominal pain, constipation, flatulence (common)
Eczema, rash (common)
Vertigo, headache (common); fatigue (common)
Rhabdomyolysis, myopathy, myositis (rare)

Interactions

Repaglinide, dasabuvir, selexipag — concomitant use contraindicated
Simvastatin, and rosuvastatin at 40 mg — concomitant use contraindicated
HMG-CoA reductase inhibitors (statins) generally — increased risk of severe myositis, rhabdomyolysis and myoglobinuria; combine only when benefit outweighs risk, with clinical/CPK monitoring

Clinical monograph

How it works

As a PPAR-alpha agonist it enhances lipoprotein lipase activity and fatty-acid oxidation, lowering plasma triglycerides and VLDL while modestly raising HDL-cholesterol.

Prescribing in practice

It must not be co-administered with statins because of a substantially increased risk of myopathy and rhabdomyolysis, and is contraindicated with certain other drugs such as repaglinide.
It is contraindicated in significant hepatic impairment, severe renal impairment and pre-existing gallbladder disease.
It may potentiate the effect of coumarin anticoagulants, so anticoagulation should be reviewed if used together.

Monitoring

Monitor the lipid profile for response and check liver function and creatine kinase if muscle symptoms occur.

Counselling the patient

Take the dose as directed, usually before food.
Report any unexplained muscle pain, tenderness or weakness promptly.
Report upper abdominal pain, which could indicate gallbladder problems.

Evidence & guidelines

Fibrates lower triglycerides effectively, and current prescribing references caution strongly against combining gemfibrozil with statins owing to myotoxicity.

Reference: NICE CG181; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Drugs

Fenofibrate · Fibrate

Pathways