Discussions that mention gemfibrozil

High Cholesterol board


Case reports
Cases of ED were first reported after clofibrate. Those described by Schneider showed recovery after drug withdrawal and recurrence on rechallenge. Five reports identified seven cases of ED following gemfibrozil. Rechallenge confirmed the effect in two. Therapy with bezafibrate was without adverse effect in three of these patients, but clofibrate had a similar effect in one.

ED in association with statins was first reported by Halkin et al. where both lovastatin and pravastatin separately caused ED in a 57-year-old man. Jackson reported five cases of ED with simvastatin at doses of 10 and 20 mg. Sexual function was restored within 1 week of stopping the drug. Two patients were rechallenged and impotence recurred. Alternative lipid-lowering therapies (fluvastatin or fenofibrate) did not cause this effect in these patients.

Information from regulatory agencies
The Australian Adverse Drug Reaction Advisory Committee (ADRAC) reports 11 cases of ED due to clofibrate, six due to gemfibrozil and 42 cases of ED in association with simvastatin. The men affected by simvastatin ranged in age from 43 to 72 years (median 57) and the onset occurred from 48 hours to 27 months (median 6 weeks) after the drug was started. Simvastatin was the only drug implicated in 35 of the reports and, in four rechallenged, the symptom recurred. Of the 29 reports in which recovery was mentioned, 14 had recovered after discontinuing the drug whereas in the other 15 there had been no recovery at the time the report was submitted. ADRAC also lists 11 reports of gynaecomastia in association with simvastatin.

Statins inhibit the rate-limiting step of cholesterol synthesis (HMG-CoA reductase) and hence potentially may inhibit the synthesis of steroid hormones derived from cholesterol, including tetosterone. There is evidence that simvastatin causes minor changes in circulating androgen concentrations in asymptomatic men.