MajorLipid-lowering agent of the fibrate class×Vitamin K antagonist anticoagulants
Updated · Methodology
Mechanism
Gemfibrozil is highly bound to plasma proteins and displaces warfarin from that binding; in vitro studies additionally show inhibition of CYP2C9, the enzyme that metabolises warfarin. Anticoagulant effect intensifies.
Symptoms
Bleeding gums, nosebleeds, bruising after minor knocks, blood in urine and stool. Intracranial haemorrhage carries the greatest danger: sudden headache, limb weakness, speech disturbance.
Management
The FDA label requires reducing the warfarin dose and keeping prothrombin time at the target level. INR is measured frequently until it stabilises, and monitoring repeats with every change in the gemfibrozil dose.
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Sources
- FDA: LOPID (gemfibrozil tablets, USP) prescribing information (2024)– FDA DailyMed, LOPID (gemfibrozil), Parke-Davis Div of Pfizer, 2024
- AEMPS: Ficha técnica: Gemfibrozilo (nº registro 61831), sección 4.5 (2025)– AEMPS, CIMA, nº registro 61831, revisión 05/2025, sección 4.5