Drug interactions
Gemfibrozil + Siponimod
Severity: Major
Gemfibrozil and Siponimod: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Gemfibrozil inhibits both CYP2C8 and CYP2C9, which together metabolize siponimod. Exposure to siponimod can rise considerably, increasing the risk of dose-related adverse effects such as bradyarrhythmia, lymphopenia and liver injury.
What this interaction means in plain words
Gemfibrozil and Siponimod can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Gemfibrozil belongs to Cardiovascular; Siponimod belongs to Central Nervous System.
Why it happens
Gemfibrozil inhibits CYP2C8 and CYP2C9, the main enzymes clearing siponimod.
What to do
Avoid the combination and choose another lipid-lowering agent such as fenofibrate. If it cannot be avoided, monitor heart rate, lymphocyte count and liver tests closely.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Gemfibrozil and Siponimod, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 14 days on the web. No card needed.
Other interactions of Gemfibrozil
- Daprodustat + Gemfibrozil Contraindicated
- Elagolix + Gemfibrozil Contraindicated
- Gemfibrozil + Mavacamten Contraindicated
- Gemfibrozil + Metformin-repaglinide Contraindicated
- Gemfibrozil + Ombitasvir / paritaprevir / ritonavir and dasabuvir Contraindicated
- Gemfibrozil + Repaglinide Contraindicated
Other interactions of Siponimod
- Cladribine + Siponimod Contraindicated
- Fingolimod + Siponimod Contraindicated
- Fluconazole + Siponimod Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Siponimod Contraindicated
- Ponesimod + Siponimod Contraindicated
- Siponimod + Thioridazine Contraindicated
Frequently asked questions
Can I take Gemfibrozil with Siponimod?
MediHelp rates the interaction as major. Gemfibrozil and Siponimod can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Gemfibrozil inhibits both CYP2C8 and CYP2C9, which together metabolize siponimod. Exposure to siponimod can rise considerably, increasing the risk of dose-related adverse effects such as bradyarrhythmia, lymphopenia and liver injury.
How serious is the interaction between Gemfibrozil and Siponimod?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination and choose another lipid-lowering agent such as fenofibrate. If it cannot be avoided, monitor heart rate, lymphocyte count and liver tests closely.
What other medicines interact with Gemfibrozil?
MediHelp also lists interactions of Gemfibrozil with, for example, Daprodustat, Elagolix, Mavacamten. The full list is on the Gemfibrozil page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
