Cotherapy with Fibric Acids
The most recent ATP III goals for triglyceride levels make combination therapy very appealing.[5,27] However, adding fibric acid therapy, in particular gemfibrozil, to statin therapy may increase the incidence of significant muscle toxicity. Although some studies have found minimal risk,[8,28] others have found rates of significant myopathy as high as 5% with fibrate-statin combination therapy. Graham et al1 found greater than a 10-fold increase in the incidence of hospitalized rhabdomyolysis when a fibrate was added to statin therapy. Manufacturer package inserts have started indicating that statins should be used at a low dose when combined with gemfibrozil. Patients on combination therapy need to be counseled more extensively and should be monitored more closely for signs and symptoms of muscle problems.
Although the reason for the increased rate of adverse effects with combination therapy is not clear, one possible explanation is that gemfibrozil increases serum concentrations of active statin acids. In comparison, fenofibrate does not seem to increase serum statin concentrations, and may therefore pose a less significant risk than gemfibrozil when combined with a statin. An evaluation using the United States Food and Drug Administration's Adverse Event Reporting System revealed a 15-fold lower rate of reported cases of rhabdomyolysis in patients using fenofibrate combined with a statin compared with those taking gemfibrozil and a statin.
South Med J. 2006;99(3):250-254. © 2006 Lippincott Williams & Wilkins
Cite this: Primary Evaluation and Management of Statin Therapy Complications - Medscape - Mar 01, 2006.