Gemfibrozil inhibits CYP2C8 and substantially increases repaglinide levels. Cases of myopathy, including rhabdomyolysis, have been reported with fibric acid derivatives coadministered with colchicine. Pexdartinib is a UGTA4 substrate. Minor (1)gemfibrozil will increase the level or effect of loperamide by decreasing metabolism. Comment: OATP1B1 and OATP1B3 transport inhibitors may increase systemic exposure of revefenacin's active metabolite. (Moderate) Monitor blood glucose during concomitant SGLT2 inhibitor and fibric acid derivative use; a SGLT2 inhibitor dose adjustment may be necessary. Coadministration of ezetimibe with gemfibrozil is not recommended. The elimination half-life is approximately 1.5 hours. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid; coadministration of pirfenidone and moderate CYP1A2 inhibitors result in moderately increased exposure to pirfenidone; if unable to avoid, decrease dose of moderate CYP1A2 inhibitor. Gemfibrozil is also known to inhibit UDP-glucuronosyltransferase (UGT) 1A1 and 1A3. Contraindicated. Ask your healthcare professional how you should dispose of any medicine you do not use. If concomitant use is unavoidable, reduce the dose of tucatinib to 100 mg twice daily. Contraindicated (1)gemfibrozil will increase the level or effect of fezolinetant by affecting hepatic enzyme CYP1A2 metabolism. Strong CYP2C8 inhibitors may increase dabrafenib levels. (Major) The safety and effectiveness of ezetimibe when coadministered with gemfibrozil have not been established. Contraindicated. Sulfonylureas: (Moderate) There is an increased risk for hypoglycemia when gemfibrozil is used with sulfonylureas. Gemfibrozil helps reduce cholesterol and triglycerides (fatty acids) in the blood. Use Caution/Monitor. In a pharmacokinetic study, concomitant fenofibrate or gemfibrozil administration increased total ezetimibe concentrations by approximately 1.5- or 1.7-fold, respectively. Use Caution/Monitor. Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Minor) Coadministration of valsartan and gemfibrozil may increase systemic exposure to valsartan. Gemfibrozil inhibits OATP1B1. Avoid or Use Alternate Drug. Reduce pexdartinib dose if concomitant use of UGT inhibitors cannot be avoided (refer to drug monograph dosage modifications). Repaglinide is a CYP2C8 substrate. Modify Therapy/Monitor Closely. gemfibrozil will increase the level or effect of rosiglitazone by decreasing metabolism. Monitor Closely (1)gemfibrozil increases levels of letermovir by decreasing metabolism. Elagolix is a substrate of CYP3A, P-gp, and OATP1B1. Applies only to oral form of both agents. Coadministration of flibanserin with strong CYP2C19 inhibitors may increase flibanserin exposure and increase the risk of hypotension, syncope, and CNS depression. Sacubitril; Valsartan: (Minor) Coadministration of valsartan and gemfibrozil may increase systemic exposure to valsartan. Gemfibrozil is also an inhibitor of OATP1B1 and OATP2B1. Gemfibrozil is a potent inhibitor of CYP2C8 and rosiglitazone is primarily metabolized via CYP2C8. Myopathy or rhabdomyolysis with or without acute renal failure have been reported as early as 3 weeks after initiation of combined therapy or after several months. Coadministration of ozanimod (a CYP2C8 substrate) with strong CYP2C8 inhibitors increases the exposure of the active metabolites (CC112273 and CC1084037) of ozanimod, which may increase the risk of ozanimod adverse reactions. Fibric acid derivatives may enhance the hypoglycemic effects of antidiabetic agents through increased insulin sensitivity and decreased glucagon secretion. Inhibits peripheral lipolysis; decreases hepatic uptake of free fatty acids, which may in turn inhibit secretion of VLDL; may increase HDL-cholesterol (mechanism unknown). Contraindicated (1)gemfibrozil increases toxicity of pravastatin by Other (see comment). Data from a clinical drug interaction study involving montelukast and gemfibrozil (a CYP2C8 and 2C9 inhibitor) demonstrated that gemfibrozil, at a therapeutic dose, increased the systemic exposure of montelukast by 4.4-fold. R.C.L. Bempedoic Acid; Ezetimibe: (Major) The safety and effectiveness of ezetimibe when coadministered with gemfibrozil have not been established. Use Caution/Monitor. Rifampin: (Moderate) Coadministration may result in an increase in rifampin exposure. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure. commonly, these are "non-preferred" brand drugs or specialty Concurrent use may increase atogepant exposure and the risk of adverse effects. commonly, these are "non-preferred" brand drugs. Both drugs decrease blood glucose. Rhabdomyolysis (especially with admin with statin), Coadministration with repaglinide, simvastatin, selexipag, or dasabuvir, If response inadequate after 3 months, discontinue gemfibrozil, Risk for myopathy/rhabdomyolysis increases with renal impairment, Risk for myopathy/rhabdomyolysis increases with concurrent HMG-CoA reductase inhibitors use (eg, atorvastatin, pravastatin), If coadministered with anticoagulants, reduce anticoagulant dose and monitor prothrombin time until stabilized, Coadministration with bile acid resin binding agents decreases gemfibrozil AUC by 30%, Rule out secondary causes of hyperlipidemia prior to initiating therapy; discontinue if lipid response not seen, Use with caution in patients taking warfarin; adjustments in warfarin may be required, Cases of cholelithiasis reported with gemfibrozil therapy; gemfibrozil may increase cholesterol excretion into bile; if cholelithiasis suspected, perform gallbladder studies; discontinue therapy if gallstones found, Coadministration with repaglinide shown to increase repaglinide plasma concentrations (8-fold increase); prolongs hypoglycemic effect; may result in severe hypoglycemia, Gemfibrozil inhibits CYP2C8 enzyme activity; may increase exposure of CYP2C8 substrates; consider dose reduction of CYP2C8 substrates when administered concomitantly, Gemfibrozil may increase exposure of OATP1B1 drug substrates when administered concomitantly; consider dose reduction of OATP1B1 substrates when administered concomitantly, Myopathy, including rhabdomyolysis, reported with chronic administration of colchicine at therapeutic doses; use caution, especially in the elderly and patients with renal dysfunction, Rarely, severe anemia, leukopenia, thrombocytopenia, and bone marrow hypoplasia reported; periodic blood counts are recommended during first 12 months of therapy, Elevations in serum transaminases seen with use; periodic liver function studies recommended; therapy should be terminated if abnormalities persist, Worsening renal insufficiency upon addition of therapy in individuals with baseline plasma creatinine >2.0 mg/dL reported; in such patients, consider the use of alternative therapy against risks and benefits of a lower dose of metformin, Gemfibrozil may increase enzalutamide levels when administered concomitantly, which may increase risk of seizures; if coadministration necessary, reduce enzalutamide dose, There are no adequate and well-controlled studies in pregnant women; drug should be used during pregnancy only if potential benefit justifies potential risk to fetus, Drug has shown to produce adverse effects in rats and rabbits at doses between 0.5 and 3 times the human dose (based on surface area); administration to female rats at 2 times human dose (based on surface area) before and throughout gestation caused a dose-related decrease in conception rate, an increase in stillborns, and a slight reduction in pup weight during lactation; there were also dose-related increased skeletal variations; anophthalmia occurred, but rarely, Administration of 0.6 and 2 times the human dose (based on surface area) of LOPID to female rats from gestation day 15 through weaning caused dose-related decreases in birth weight and suppressions of pup growth during lactation, Administration of 1 and 3 times the human dose (based on surface area) to female rabbits during organogenesis caused a dose-related decrease in litter size and, at high dose, an increased incidence of parietal bone variations, It is not known whether drug is excreted in human milk; because many drugs are excreted in human milk and because of potential for tumorigenicity shown for drug in animal studies, a decision should be made whether to discontinue nursing or to discontinue drug, taking into account the importance of the drug to the mother. Avoid or Use Alternate Drug. The first look at the 'middle aged Love Island' set has been released, which has already been nicknamed the 'Viagra House' by locals after single parents searched for love Avoid or Use Alternate Drug. The serious risk of myopathy or rhabdomyolysis should be weighed carefully against the benefits of combined 'statin' and fibrate therapy; there is no assurance that periodic monitoring of CK will prevent the occurrence of severe myopathy and renal damage. If gemfibrozil is discontinued, resume the original tucatinib dose after 3 elimination half-lives of gemfibrozil. Modify Therapy/Monitor Closely. Safety and efficacy have not been established. Applies only to oral form of both agents. If concomitant use is unavoidable, reduce the dose of enzalutamide to 80 mg once daily; the original dose of enzalutamide may be resumed when gemfibrozil is discontinued. Monitor Closely (1)gemfibrozil will increase the level or effect of glecaprevir/pibrentasvir by decreasing metabolism. UGT1A1 inhibitors decrease irinotecan metabolism, Serious - Use Alternative (1)gemfibrozil will increase the level or effect of irinotecan liposomal by decreasing metabolism. If concomitant use cannot be avoided, monitor patients for dabrafenib toxicity (e.g., skin toxicity, ocular toxicity, and cardiotoxicity). colestipol decreases levels of gemfibrozil by inhibition of GI absorption. Comment: OATP1B1 inhibitors may increase risk of myopathy. Concomitant use may cause an increased blood glucose-lowering effect with risk of hypoglycemia. There is no assurance that periodic monitoring of creatinine phosphokinase (CPK) will prevent the occurrence of myopathy. If your dose is different, do not change it unless your doctor tells you to do so. The exposure to pioglitazone is increased approximately 3-fold when combined with gemfibrozil. The serious risk of myopathy or rhabdomyolysis should be weighed carefully against the benefits of combined statin and gemfibrozil therapy; there is no assurance that periodic monitoring of CK will prevent the occurrence of severe myopathy and renal damage. Recommended dosage of atogepant (an OATP1B1 substrate) with concomitant use of OATP inhibitors is 10 mg or 30 mg qDay. As a precautionary measure due to incomplete information on the metabolism of eluxadoline, use caution when coadministered with strong CYP2C9/10 inhibitors. Concomitant use may result in elevated plasma concentrations of dronabinol. Pravachol (pravastatin) is a prescription medicine used to treat high cholesterol in the blood. Avoid or Use Alternate Drug. Lumateperone is a UGT1A1 substrate; gemfibrozil is a UGT1A1 inhibitor. There is no assurance that periodic monitoring of creatine kinase will prevent the occurrence of severe myopathy and kidney damage. 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