EFFECT OF A COMBINATION OF GEMFIBROZIL AND NIACIN ON LIPID-LEVELS

To determine the effect of the combination of niacin and gemfibrozil o n the lipid profile, a retrospective review was conducted of 161 patie nts who were prescribed a combination of gemfibrozil and niacin for 6 to 12 months at a community-based lipid clinic. Low density lipoprotei n (LDL) and high-density lipoprotein (HDL) cholesterol, total choleste rol, triglycerides, ratio of total cholesterol to HDL, alanine aminotr ansferase (ALT), and weight were measured at entry to the clinic, 2 mo nths after dietary instruction, during single-agent therapy, and durin g combination therapy. Mean doses of niacin and gemfibrozil were 1,229 mg/day and 1,200 mg/day, respectively. Patient weight decreased signi ficantly after dietary instruction and after institution of combinatio n therapy. There were no significant changes in ALT levels with either single-agent therapy or with combination therapy. The combination of niacin and gemfibrozil produced marked and significant changes in lipi d levels: total cholesterol and LDL decreased by 14%, HDL increased by 24%, the ratio of total cholesterol to HDL decreased by 30%, and trig lycerides decreased by 52%. The combination of niacin and gemfibrozil in the setting of dietary instruction has a marked beneficial effect o n serum lipid levels, and was most effective in patients with initial levels of HDL <40 mg/dL, triglycerides >250 mg/dL, and LDL >160 mg/dL. No episodes of ALT elevation or symptomatic myositis were seen.