DEAR DR. ROACH: My doctor has had me on gemfibrozil, simvastatin and metoprolol for more than five years. My pharmacist called the other day saying that new studies are out and that gemfibrozil and simvastatin should not be taken together. My doctor has never mentioned it. Should I be concerned? — S.F.W.
ANSWER: Yes, there is a potential for increased toxicity of the simvastatin when taking gemfibrozil at the same time, and it isn’t recommended. I certainly would recommend that you discuss it with your doctor.
Gemfibrozil, a fibric acid derivative that lowers triglycerides, is not used very often anymore, although there are some situations in which it makes sense. If someone needs a statin and also needs further lowering of triglycerides, most experts use fenofibrate (Tricor). Triglycerides can be elevated from excess carbohydrate intake, so a careful diet that minimizes simple sugars might help. I rarely prescribe either gemfibrozil or fenofibrate.
DEAR DR. ROACH: My wife was diagnosed with cirrhosis of the liver a little over a year ago. She never consumed any alcohol. I am concerned because her platelet count is very low — it should be 130 to 400, and hers is 54. What is your advice to my wife to keep her platelet count up? She regularly visits the gastroenterologist, and she has had her veins banded twice. — N.M.
ANSWER: Liver cirrhosis is the end stage of many different liver diseases, such as alcohol, viral hepatitis, autoimmune hepatitis, hemochromatosis and nonalcoholic fatty liver disease. In cirrhosis, the liver becomes fibrotic and is unable to do its many jobs, including removing toxins and making proteins. The fibrosis leads to high pressure in the veins going into the liver, which can cause dilation in other veins, especially those in the esophagus. If these dilated veins rupture, they cause a life-threatening bleed, so banding is one way of preventing this dreaded complication.
Low platelets are common in people with liver cirrhosis. Fortunately, these usually need treatment only during bleeding events or if a surgery or procedure is planned, in which case the goal usually is over 50,000. However, surgery is quite risky in people with cirrhosis, and it should never be undertaken lightly.
I occasionally hear from people who haven’t heard some important rules for safety in people with cirrhosis. Vaccinations are critically important, especially to hepatitis A and B, but all the recommended vaccines are more important in a person with cirrhosis. Hepatitis A, a foodborne infection that is rarely dangerous in healthy adults, can be fatal in someone with cirrhosis.
Many over-the-counter and prescription medications and supplements build up to dangerous levels and need to be avoided or taken at much lower levels (especially Tylenol). Her liver doctor should be very carefully examining all of her medications and supplements. Food safety is an issue; about once a year I see a person with cirrhosis admitted after eating raw oysters (or other shellfish) with a life-threatening or fatal infection (Vibrio vulnificus). These shouldn’t be consumed. Alcohol, in any amount, is very dangerous for anyone with cirrhosis, even if they never used alcohol.
The booklet on hepatitis explains the three different kinds. Readers can obtain a copy by writing: Dr. Roach — No. 503, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.
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