Drug Profile

Gemfibrozil is given to people who have high levels of cholesterol or fats in their blood, to lower those levels in the hope of preventing heart disease. Although gemfibrozil does lower the level of fats in your blood, it has little effect on cholesterol levels. More importantly, there is no evidence that it decreases your risk of sickness or death from heart disease. In fact, there is no proof that gemfibrozil has any health benefit, such as lowering the chance of having a heart attack, for most people with high blood cholesterol or fat levels.  

Referring to a study in which some patients who had had a previous heart attack were given gemfibrozil, and some were given a placebo, an FDA physician summarized that the results showed higher rates of heart disease and death in the gemfibrozil group.The physician went on to say: 

Studies have repeatedly shown increased gallbladder toxicity and statistically increased appendectomies with gemfibrozil....We are concerned about the potential for human carcinogenesis induced by long-term treatment with fibrates [such as gemfibrozil] based on animal findings at doses equal to those used with humans.[1] 

Other serious problems with this drug are seen if it is used in combination with the statin drugs, such as  fluvastatin (LESCOL), rosuvastatin (CRESTOR), or simvastatin (ZOCOR). There are numerous reports of severe muscle damage, sometimes accompanied by life-threatening destruction of muscle and subsequent kidney damage.[2] Therefore, gemfibrozil and the statin drugs should not be used together. 

Gemfibrozil appears to share psychiatric risks with other cholesterol-lowering drugs. Aggressive behavior; memory impairment; mood changes; and cognitive, sleep and perception disorders, such as nightmares, have been reported with the use of many drugs used to treat high cholesterol: gemfibrozil, fenofibrate (TRICOR), ezetimibe (ZETIA), clofibrate and the statin drugs.[3],[4] Though researchers have not yet established a direct link between these reports and the use of the cholesterol-lowering drugs listed, patients should be alert to this possibility and report unexpected changes to their doctor.

The use of cholesterol-lowering drugs in people 70 or older should be limited to patients with very high cholesterol levels (greater than 300 milligrams) and those with a previous history of heart attack or angina.[5] (See section on elevated cholesterol levels.) 

The first, safer, and less costly measure to lower cholesterol for people under 70 is to eat a low-fat diet, using mostly polyunsaturated fats (such as canola, corn, safflower, and sunflower oils) or monounsaturated fats (such as olive oil). A change from animal to vegetable proteins often corrects high cholesterol. However, it is inadvisable to go on a very low-fat diet. The main focus on cholesterol-lowering diets has been on saturated fat and cholesterol content, not soluble fiber. (When added to the diet, psyllium or oat bran is a safe, effective way of lowering cholesterol.) Exercise and weight reduction are also recommended. Conditions that aggravate high cholesterol, such as dependence on alcohol or tobacco, diabetes, high blood pressure, low magnesium or potassium, and thyroid disease, should be corrected before adding a cholesterol-reducing drug. If cholesterol remains high despite diet, add 10 grams of psyllium (METAMUCIL, PERDIEM) a day.