Pravastatin and Gemfibrozil Alone and in Combination for the Treatment of Hypercholesterolemia

Risk-benefit of HMG-CoA reductase inhibitors in the treatment of HIV protease inhibitor-related hyperlipidaemia

“…Moreover, it is noteworthy that in large clinical trials the rates of elevated transaminases did not differ between statin and placebo groups [68]. Unlike myotoxicity, the risk of hepatotoxicity was not increased when statins were combined with gemfibrozil [80,81].…”

Current Lipid-lowering Strategies for the Treatment of Diabetic Dyslipidemia: An Integrated Approach to Therapy

“…Combination therapy with statins and fibrates is effective at decreasing LDL-C and triglycerides, while raising HDL-C in nondiabetic patients [130][131][132]. The drawback to this approach is that this combination has been associated with an increased incidence of adverse side effects, specifically myalgia and rhabdomyolysis, in diabetic and nondiabetic patients [133][134][135][136][137][138].…”

Risk assessment with statin therapy

“…Approximately 1% of patients on statin monotherapy show elevated liver transaminase levels (greater than 3 times normal); this seems to be independent of the statin used and is dose-independent. Myopathy was reported to occur, for example, in 0.5% of patients on lovastatin monotherapy [9]. The other major side effect is myopathy (which can lead to rhabdomyolysis and renal failure) and which appears to be dosedependent.…”

“…Most of the statins are highly protein-bound (>90%) apart from pravastatin (approximately 50%) which is therefore less likely to be involved in displacement interactions with other protein-bound drugs such as warfarin and digoxin. The incidence of myopathy in patients taking lovastatin, for example, increases from 0.5% on monotherapy to 5% when taken in combination with gemfibrozil, and 30% with cyclosporin [9]. Hence there are potential interactions between all the statins (except pravastatin) and inducers and inhibitors of the cytochrome P450 system.…”