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1. Lipid lowering effects are additive.
2. Drug combinations reduce toxicity when used together in low doses.

Combinations Evaluated for Efficacy and Safety in Clinical Trials

1. Niacin and Sequestrants
2. Niacin and Statins
3. Niacin and Gemfibrozil
4. Statins and Sequestrants
5. Statins and Gemfibrozil*
6. Sequestrants and Gemfibrozil

Question: Can statins and gemfibrozil be prescribed together safely?

Yes..............but be careful! Incidence of severe myopathy 3-5%.

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Important hints for combined statin/gemfibrozil therapy

1. Keep statin doses low:

• (lovastatin/pravastatin/fluvastatin <40mg, simvastatin <20mg)

1. Avoid using combination in:

• renal failure/with cyclosporine/immunosuppressives ?niacin-anecdotal data may not be convincing

1. Tell patient to stop therapy first if new onset myalgias or weakness, then contact you.
2. Routine CK monitoring not mandatory, but suggested.

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