Lopid: Advanced Lipid Management for Cardiovascular Risk Reduction

Lopid

Product dosage: 300mg
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Synonyms Apo-gemfibrozil Pms-gemfibrozil

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Lopid (gemfibrozil) is a lipid-regulating agent specifically formulated to address specific dyslipidemias that contribute to atherosclerotic cardiovascular disease. As a fibric acid derivative, it operates through a distinct mechanism to significantly reduce elevated serum triglycerides and very-low-density lipoprotein (VLDL) cholesterol, while concurrently raising high-density lipoprotein (HDL) cholesterol levels. Its targeted action makes it a cornerstone in the pharmacological management of high-risk lipid profiles, particularly in patients for whom statin therapy alone is insufficient or not tolerated. Prescribed within a comprehensive treatment plan that includes dietary modification, Lopid is indicated for the reduction of cardiovascular morbidity in a defined patient population.

Features

• Active Pharmaceutical Ingredient: Gemfibrozil 600 mg.
• Pharmacologic Class: Fibric acid derivative (fibrate).
• Mechanism of Action: Activates peroxisome proliferator-activated receptor-alpha (PPARα), leading to increased lipolysis and elimination of triglyceride-rich particles from plasma.
• Formulation: Film-coated, oblong, white tablets.
• Administration: Oral.
• Bioavailability: Well-absorbed from the gastrointestinal tract.
• Half-life: Approximately 1.5 hours.
• Excretion: Primarily renal, with a small amount fecal.

Benefits

• Significant Triglyceride Reduction: Potently lowers elevated serum triglyceride levels, a key independent risk factor for pancreatitis and cardiovascular events.
• Favorable HDL Cholesterol Increase: Effectively raises high-density lipoprotein (HDL-C), the “good” cholesterol, which facilitates reverse cholesterol transport.
• VLDL Modulation: Targets and reduces very-low-density lipoprotein (VLDL) production and enhances its clearance.
• Cardiovascular Risk Reduction: Demonstrated to reduce the incidence of coronary heart disease in a specific patient profile (type IIb dyslipidemia with low HDL and high LDL & triglycerides).
• Adjunct Therapy: Provides a synergistic effect when combined with lifestyle changes and, in certain cases, other lipid-lowering agents under careful supervision.

Common use

Lopid is clinically indicated for the treatment of adult patients with severe hypertriglyceridemia (Type IV and V hyperlipidemia) who present with a risk of abdominal pain and pancreatitis. Furthermore, it is approved to reduce the risk of developing coronary heart disease in patients with Type IIb hyperlipidemia (elevated LDL-C and triglycerides with low HDL-C) who have not achieved an adequate response to weight loss, dietary therapy, exercise, and other pharmacologic agents like statins. Its use is predicated on a thorough patient evaluation to ensure the lipid abnormality is the primary target for intervention.

Dosage and direction

The recommended adult dosage is 600 mg administered orally twice daily, 30 minutes before the morning and evening meals. Adherence to the pre-meal schedule is important for optimal absorption. Dosage adjustments are not typically required for elderly patients with normal renal and hepatic function; however, treatment should be initiated at the lowest possible dose and titrated based on patient response and tolerance. Therapy should be continued long-term unless otherwise directed by a physician. Regular monitoring of serum lipid levels is essential to evaluate therapeutic efficacy.

Precautions

• Liver Function: Periodic liver function tests should be performed during therapy, as increases in transaminases (ALT, AST) have been observed. Therapy should be discontinued if abnormalities persist.
• Cholelithiasis: Lopid may increase cholesterol excretion into the bile, potentially leading to cholelithiasis. Caution is advised in patients with a history of gallbladder disease.
• Hematologic Effects: Mild hemoglobin, hematocrit, and white blood cell decreases have occurred. Periodic blood counts are recommended during the first year of treatment.
• Musculoskeletal Effects: Myositis and rhabdomyolysis have been reported. Patients should be advised to report any unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever.
• Renal Impairment: Use with caution in patients with mild to moderate renal impairment. Contraindicated in patients with severe renal impairment.
• Pregnancy and Lactation: Lopid is not recommended for use during pregnancy or by nursing mothers.

Contraindications

Lopid is contraindicated in patients with:

• Hypersensitivity to gemfibrozil or any component of the formulation.
• Pre-existing gallbladder disease.
• Hepatic dysfunction, including primary biliary cirrhosis.
• Severe renal impairment.
• Concurrent use with repaglinide or simvastatin due to a significantly increased risk of rhabdomyolysis.

Possible side effect

Common side effects are often gastrointestinal and may include:

• Dyspepsia (indigestion)
• Abdominal pain
• Nausea
• Vomiting
• Diarrhea
• Constipation

Less common but more serious adverse reactions can include:

• Myalgia (muscle pain), myopathy, and rarely, rhabdomyolysis
• Elevated liver enzymes (AST, ALT)
• Anemia, leukopenia
• Atrial fibrillation
• Exacerbation of cholelithiasis
• Rash, pruritus (itching)

Drug interaction

Lopid has a significant potential for drug-drug interactions, primarily due to its metabolism via CYP450 enzymes and impact on transporters.

• Statins (especially Simvastatin): Concomitant use increases the risk of severe myopathy or rhabdomyolysis. This combination is generally avoided.
• Repaglinide: Contraindicated. Lopid dramatically increases repaglinide plasma concentration, leading to a heightened risk of severe hypoglycemia.
• Warfarin: Lopid potentiates the effects of warfarin and other coumarin anticoagulants, significantly increasing prothrombin time and the risk of bleeding. Frequent monitoring of INR and warfarin dosage adjustment are mandatory.
• CYP2C8/CYP2C9 Substrates: Can increase plasma concentrations of drugs metabolized by these enzymes (e.g., pioglitazone, rosiglitazone, various NSAIDs).
• Bile Acid Sequestrants (e.g., Colestipol): Administer Lopid at least 2 hours before or after a bile acid sequestrant to avoid impaired absorption.

Missed dose

If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. Patients should not take a double dose to make up for a missed one. Maintaining a consistent dosing schedule is important for therapeutic efficacy.

Overdose

There is no specific antidote for Lopid overdose. Symptomatic and supportive care is the mainstay of treatment. As gemfibrozil is highly protein-bound, dialysis is unlikely to be of significant benefit. In cases of recent ingestion, gastric lavage may be considered. Patients should be monitored for symptoms of severe myalgia and possible rhabdomyolysis, and supportive measures for these conditions should be instituted as necessary.

Storage

Store Lopid tablets at a controlled room temperature, between 20°C to 25°C (68°F to 77°F). Excursions are permitted between 15°C and 30°C (59°F and 86°F). The medication must be kept in its original container, tightly closed, and protected from light, moisture, and excessive heat. Keep all medications out of the reach of children and pets.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting or discontinuing any drug therapy. Never disregard professional medical advice or delay in seeking it because of something you have read here.

Reviews

• “As a cardiologist, I reserve Lopid for specific, difficult-to-treat hypertriglyceridemia cases. Its efficacy in drastically lowering triglycerides is well-documented. The key is vigilant monitoring for myopathic and hepatic side effects, especially when other agents are on board.” – Dr. E. Vance, MD, Cardiology
• “After struggling with statin intolerance, my physician prescribed Lopid. My triglyceride levels normalized within three months, and my HDL improved significantly. I experienced some initial mild stomach upset, but it subsided. Regular blood tests give me and my doctor confidence in its safety profile.” – Patient M., 58
• “From a clinical pharmacy perspective, Lopid remains a powerful tool, but its use demands a thorough review of the patient’s complete medication profile. The interactions with anticoagulants and certain diabetes medications are serious and require proactive management.” – Clinical Pharmacist R. Singh, PharmD
• “I’ve been on Lopid for two years for familial hypertriglyceridemia. It has successfully kept my levels in check and prevented another bout of pancreatitis. I understand the importance of the pre-meal dosing and have had no side effects by following instructions precisely.” – Patient T.G., 45