Gemfibrozil Side Effects
Some side effects of gemfibrozil may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to gemfibrozil: oral capsule, oral tablet
Along with its needed effects, gemfibrozil may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking gemfibrozil:Rare
- Cough or hoarseness
- fever or chills
- lower back or side pain
- painful or difficult urination
- stomach pain (severe) with nausea and vomiting
Check with your doctor as soon as possible if any of the following side effects occur while taking gemfibrozil:Rare
- Muscle pain
- unusual tiredness or weakness
Some side effects of gemfibrozil may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:More common
- Stomach pain, gas, or heartburn
- nausea or vomiting
- skin rash
For Healthcare Professionals
Applies to gemfibrozil: compounding powder, oral tablet
Gemfibrozil is generally well tolerated. The most common side effects are those relating to the gastrointestinal tract.
Gastrointestinal side effects of gemfibrozil include dyspepsia (19.6%), abdominal pain (9.8%), diarrhea (4.8%), nausea (4.0%), vomiting (1.2%), and dry mouth.
Hepatic side effects of gemfibrozil include alterations in liver function tests and increased risk of gallstone formation. Cholestatic jaundice and cases of cholelithiasis have also been reported.
Gemfibrozil decreases bile acid and increases cholesterol secretion thus increasing lithogenicity of the bile and promoting gallstone formation. If a patient develops evidence of gallstones during gemfibrozil therapy, gemfibrozil should be discontinued. In general, gemfibrozil is considered contraindicated in patients with a history of gallbladder disease.
Renal side effects of gemfibrozil include acute renal failure associated with myositis and rhabdomyolysis.
Gemfibrozil is reported to cause rhabdomyolysis and subsequent renal failure. In one review, all patients in whom outcome was reported either significantly improved or completely recovered.
Musculoskeletal side effects of gemfibrozil include arthralgia, myopathy, myalgia, polyarthritis, and rhabdomyolysis. Myositis induced compartment syndrome is reported in one patient.
Gemfibrozil has been associated with severe myopathy and rhabdomyolysis. This is accompanied by elevations in creatine kinase, myoglobinuria, and proteinuria, as well as renal failure. Elevations in creatine kinase are more marked when gemfibrozil has been combined with another agent which is also capable of causing myopathy (i.e., HMG CoA reductase inhibitors, niacin). One review noted a case report with a creatine kinase level of 148,000 units/mL in a 79-year-old woman taking both gemfibrozil and lovastatin. Additional studies have confirmed that the combination of gemfibrozil and a HMG CoA reductase inhibitor increases the incidence and severity of myotoxicity.
Patients should be instructed to report symptoms of muscle pain, weakness, or tenderness. If such symptoms develop, creatine kinase should be measured, and, if elevated, gemfibrozil should be discontinued.
Gemfibrozil is associated with a higher incidence of myotoxicity (i.e., rhabdomyolysis) than fenofibrate when used in combination with any HMG CoA reductase inhibitor (statin). Fenofibrate is primarily metabolized by glucuronidation, whereas gemfibrozil undergoes extensive oxidative metabolism which results in higher plasma levels of statins. This pharmacokinetic difference may account for the differences in the rates of myotoxicity.
Hematologic side effects of gemfibrozil include minor, transient decreases in hemoglobin, hematocrit, and white blood cell count which occur occasionally when gemfibrozil therapy is initiated but normalize with continued use. Leukopenia, leukocytosis, anemia, and eosinophilia are also reported. In addition, gemfibrozil may alter blood coagulation.
Nervous system side effects of gemfibrozil include dizziness, somnolence, headache, vertigo, hyperesthesia, paresthesias, taste perversion, and confusion.
Cardiovascular side effects of gemfibrozil include rare cases of atrial fibrillation, vasculitis, and Raynaud's phenomenon.
Dermatologic side effects of gemfibrozil include rash, dermatitis, pruritus, psoriasis, and exfoliative dermatitis.
Genitourinary side effects of gemfibrozil include impotence and decreased male fertility.
A 56-year-old women with a one month history of progressive, watery diarrhea and lower abdominal cramps was admitted to the hospital for evaluation. The only change noted in the patient's history was the initiation of gemfibrozil two weeks before the diarrhea and mild abdominal cramping began. Initial laboratory values revealed an elevated eosinophil count of 1820/mm3 and a serum IgE level of 1990 intl units/mL. The gemfibrozil was discontinued and it was later determined that the patient's presentation was consistent with eosinophilic gastroenteritis. Methylprednisolone was initiated and the patient gradually recovered. On two subsequent follow-up visits, the patient was challenged with gemfibrozil and experienced the return of mild diarrhea and peripheral eosinophilia.
Hypersensitivity reactions are reported rarely with gemfibrozil and include urticaria, angioedema, laryngeal edema, and anaphylaxis. In addition, at least one case of eosinophilic gastroenteritis associated with gemfibrozil use has been reported.
Immunologic effects of gemfibrozil include a Lupus-like syndrome and positive antinuclear antibody tests; causality is not established.
Ocular side effects of gemfibrozil include blurred vision, retinal edema, and cataracts.
Metabolic side effects of gemfibrozil include a case report of gout of the acromioclavicular joint.
Psychiatric side effects of gemfibrozil include decreased libido and depression.
Many lipid-lowering drugs have been associated with tumor growth in rodents. Gemfibrozil has been specifically associated with liver tumors and Leydig cell tumors. Long-term clinical trials are needed to define the risk of cancer in humans.
More gemfibrozil resources
- gemfibrozil MedFacts Consumer Leaflet (Wolters Kluwer)
- gemfibrozil Concise Consumer Information (Cerner Multum)
- gemfibrozil Advanced Consumer (Micromedex) - Includes Dosage Information
- Gemfibrozil Prescribing Information (FDA)
- Gemfibrozil Professional Patient Advice (Wolters Kluwer)
- Gemfibrozil Monograph (AHFS DI)
- Lopid Prescribing Information (FDA)
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