Gemfibrozil
Fibrate — PPARα agonist · “The dangerous statin partner”
The Clinical Case
Male, 55 yo. Low HDL 0.8 mmol/L, TG 4.1 mmol/L, statin-intolerant (confirmed myalgia on two statins). GP starts a fibrate for mixed dyslipidaemia. Six weeks later, the GP also restarts a low-dose statin at a colleague's suggestion. The patient is admitted with CK 45,000 U/L, dark urine, and AKI. Which fibrate created this catastrophic interaction?
The Answer
Played on: 9 Jan 2026 · 23 Jan 2026 · 6 Feb 2026 · 20 Feb 2026 · 6 Mar 2026 · 20 Mar 2026 · 3 Apr 2026 · 17 Apr 2026 · 1 May 2026 · 15 May 2026 · 29 May 2026 · 12 Jun 2026 · 26 Jun 2026 · 10 Jul 2026 · 24 Jul 2026 · 7 Aug 2026 · 21 Aug 2026
Clinical Pearl
Mechanism: PPARα agonist but also inhibits statin glucuronidation via UGT1A3 → dramatically raises statin plasma levels
All Hints
Mechanism: PPARα agonist but also inhibits statin glucuronidation via UGT1A3 → dramatically raises statin plasma levels
Fatal risk: Contraindicated with most statins — cerivastatin/gemfibrozil combination caused multiple fatal rhabdomyolysis cases; FDA warning
Efficacy: Helsinki Heart "Study": 34% RRR non-fatal MI; VA-"HIT": reduced CHD in low-HDL men without high LDL
Dosing: 500 mg twice daily; must be taken 30 min before breakfast and dinner — timing critical for absorption
Practical: Superseded by fenofibrate in statin combinations; still used in statin-intolerant patients requiring TG reduction
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