MajorHMG-CoA reductase inhibitors (statins)×Lipid-lowering agent of the fibrate class
Updated · Methodology
Mechanism
The FDA label lists atorvastatin among OATP1B1 substrates whose exposure rises with gemfibrozil. The class-wide warning adds to that: combining a fibrate with any HMG-CoA reductase inhibitor raises the risk of skeletal muscle injury.
Symptoms
Muscle pain, weakness and tenderness, dark urine, rising creatine kinase up to rhabdomyolysis with renal failure.
Management
The combination is avoided. When both a statin and triglyceride lowering are needed, fenofibrate replaces gemfibrozil. If joint use still goes ahead, the atorvastatin dose is kept minimal and muscle complaints and creatine kinase are monitored.
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Sources
- ESC/EAS: 2019 ESC/EAS Guidelines for the management of dyslipidaemias (2019)– Mach F et al, Eur Heart J 2019;41:111-188
- FDA: LOPID (gemfibrozil tablets, USP) prescribing information (2024)– FDA DailyMed, LOPID (gemfibrozil), Parke-Davis Div of Pfizer, 2024
- AEMPS: Ficha técnica: Atorvastatina (nº registro 69536), sección 4.5 (2024)– AEMPS, CIMA, nº registro 69536, sección 4.5