ADVERSE REACTIONS
In the double-blind controlled phase of the primary prevention component of the Helsinki Heart Study, 2046 patients received LOPID for up to five years. In that study, the following adverse reactions were statistically more frequent in subjects in the LOPID group:
| LOPID (N = 2046) | PLACEBO (N = 2035) | |
|---|---|---|
| Frequency in percent of subjects | ||
| Gastrointestinal reactions | 34.2 | 23.8 |
| Dyspepsia | 19.6 | 11.9 |
| Abdominal pain | 9.8 | 5.6 |
| Acute appendicitis | 1.2 | 0.6 |
| (histologically confirmed in most cases where data were available) | ||
| Atrial fibrillation | 0.7 | 0.1 |
| Adverse events reported by more than 1% of subjects, but without a significant difference between groups: | ||
| Diarrhea | 7.2 | 6.5 |
| Fatigue | 3.8 | 3.5 |
| Nausea/Vomiting | 2.5 | 2.1 |
| Eczema | 1.9 | 1.2 |
| Rash | 1.7 | 1.3 |
| Vertigo | 1.5 | 1.3 |
| Constipation | 1.4 | 1.3 |
| Headache | 1.2 | 1.1 |
Gallbladder surgery was performed in 0.9% of LOPID and 0.5% of placebo subjects in the primary prevention component, a 64% excess, which is not statistically different from the excess of gallbladder surgery observed in the clofibrate group compared to the placebo group of the WHO study. Gallbladder surgery was also performed more frequently in the LOPID group compared to the placebo group (1.9% versus 0.3%, p=0.07) in the secondary prevention component. A statistically significant increase in appendectomy in the gemfibrozil group was seen also in the secondary prevention component (6 on gemfibrozil versus 0 on placebo, p=0.014).
Nervous system and special senses adverse reactions were more common in the LOPID group. These included hypesthesia, paresthesias, and taste perversion. Other adverse reactions that were more common among LOPID treatment group subjects but where a causal relationship was not established include cataracts, peripheral vascular disease, and intracerebral hemorrhage.
From other studies it seems probable that LOPID is causally related to the occurrence of MUSCULOSKELETAL SYMPTOMS (see WARNINGS), and to ABNORMAL LIVER FUNCTION TESTS and HEMATOLOGIC CHANGES (see PRECAUTIONS).
Reports of viral and bacterial infections (common cold, cough, urinary tract infections) were more common in gemfibrozil treated patients in other controlled clinical trials of 805 patients. Additional adverse reactions that have been reported for gemfibrozil are listed below by system. These are categorized according to whether a causal relationship to treatment with LOPID is probable or not established:
| CAUSAL RELATIONSHIP PROBABLE | CAUSAL RELATIONSHIP NOT ESTABLISHED | |
|---|---|---|
| General: Cardiac: | weight loss extrasystoles | |
| Gastrointestinal: | cholestatic jaundice | pancreatitis hepatoma colitis |
| Central Nervous | ||
| System: | dizziness somnolence paresthesia peripheral neuritis decreased libido depression headache | confusion convulsions syncope |
| Eye: | blurred vision | retinal edema |
| Genitourinary: | impotence | decreased male fertility renal dysfunction |
| Musculoskeletal: | myopathy myasthenia myalgia painful extremities arthralgia synovitis rhabdomyolysis (see WARNINGS and Drug Interactions under PRECAUTIONS) | |
| Clinical | ||
| Laboratory: | increased creatine phosphokinase increased bilirubin increased liver transaminases (AST, ALT) increased alkaline phosphatase | positive antinuclear antibody |
| Hematopoietic: | anemia leukopenia bone marrow hypoplasia eosinophilia | thrombocytopenia |
| Immunologic: | angioedema laryngeal edema urticaria | anaphylaxis Lupus-like syndrome vasculitis |
| Integumentary: | exfoliative dermatitis rash dermatitis pruritus | alopecia photosensitivity |
Additional adverse reactions that have been reported include cholecystitis and cholelithiasis (see WARNINGS).