Issue 175 Item 4 A New Interaction Between Gemfibrozil and Avandia

Many times these drugs are combined so patients will get gemfibrozil (Lopid, etc) to lower triglycerides and increase HDL. But gemfibrozil inhibits the CYP450 enzyme that metabolizes Avandia which will boost Avandia levels which, increases Avandia’s glucose lowering effects. This can lead to hypoglycemia in patients who use Avandia along with a sulfonylurea (glyburide, etc) or insulin.

This interaction is similar to the recently discovered interaction between gemfibrozil and Prandin (repaglinide). You might suggest that patients on Avandia (rosiglitazone) get fenofibrate (Tricor, Lofibra) instead of gemfibrozil.

Switching from Avandia to Actos (pioglitazone) probably won’t help…gemfibrozil might also interact with Actos. If a patient has to use gemfibrozil and Avandia, suggest lowering the Avandia dose by 50% to 70% and have them monitor their blood glucose more frequently.

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DID YOU KNOW: The prevalence of diabetes and hypertriglyceridaemia is higher among patients with psychosis, compared with the general population, an American chart review has suggested. However, the study did not associate elevated prevalence with any one antipsychotic medication. American Journal of Therapeutics 2003;10:5:348-55.