From the Guidelines
Fenofibrate is a fibric acid derivative used to lower cholesterol and triglyceride levels in the blood.
Key Uses
- It is recommended for patients with high cholesterol, mixed dyslipidemia, and hypertriglyceridemia 1.
- The typical dose is 145 mg once daily, taken with or without food.
- Patients with renal impairment may require a reduced dose of 48-145 mg once daily 1.
Important Considerations
- Fenofibrate should be used with caution in patients with liver disease, gallbladder disease, and pancreatitis 1.
- Monitoring of liver function tests and creatinine kinase levels is recommended during treatment 1.
- It is essential to assess the patient's cardiovascular risk factors and adjust the treatment plan accordingly 1.
Special Populations
- In patients with chronic kidney disease (CKD), fenofibrate may be used with caution, but the dose should not exceed 54 mg/day if the estimated glomerular filtration rate (eGFR) is between 30-59 mL/min per 1.73 m2 1.
- Fenofibrate is contraindicated in individuals with eGFR < 30 mL/min/1.73 m2 1.
From the FDA Drug Label
Fenofibrate is a peroxisome proliferator-activated receptor (PPAR) alpha agonist indicated as an adjunct to diet: To reduce elevated LDL-C, Total-C, TG and Apo B, and to increase HDL-C in adult patients with primary hypercholesterolemia or mixed dyslipidemia. For treatment of adult patients with severe hypertriglyceridemia.
Fenofibrate is used to reduce elevated LDL-C, Total-C, TG, and Apo B, and to increase HDL-C in adult patients with primary hypercholesterolemia or mixed dyslipidemia, and for the treatment of adult patients with severe hypertriglyceridemia 2.
- Key uses:
- Reduce elevated LDL-C, Total-C, TG, and Apo B
- Increase HDL-C in adult patients with primary hypercholesterolemia or mixed dyslipidemia
- Treat adult patients with severe hypertriglyceridemia
From the Research
Indications for Fenofibrate
- Fenofibrate is indicated as an adjunct to dietary modification in adults with primary hypercholesterolemia or mixed dyslipidemia to reduce levels of low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides (TG), and apolipoprotein (apo) B, and to increase levels of high-density lipoprotein cholesterol (HDL-C) and apo A 3.
- It is also indicated as adjunctive therapy to diet for the treatment of hypertriglyceridemia (types IV and V hyperlipidemia) 3.
- Fenofibrate is used in the treatment of primary hypercholesterolaemia, mixed dyslipidaemia and hypertriglyceridaemia in adults who have not responded to nonpharmacological measures 4.
- It is also used in the treatment of severe hypertriglyceridaemia and mixed dyslipidaemia in patients who have not responded to nonpharmacological therapies 5.
Mechanism of Action
- The lipid-modifying effects of fenofibrate are mediated by the activation of peroxisome proliferator-activated receptor-alpha 4, 5.
- Fenofibrate also has nonlipid, pleiotropic effects, such as reducing levels of fibrinogen, C-reactive protein and various pro-inflammatory markers, and improving flow-mediated dilatation 4, 5.
Therapeutic Use
- Fenofibrate is effective in lowering TG levels and increasing HDL-C levels, and its LDL-C-lowering effect is greater than that of gemfibrozil 3.
- It is particularly well suited for use in atherogenic dyslipidaemia, which is commonly seen in patients with the metabolic syndrome and type 2 diabetes mellitus 4.
- Fenofibrate can be used in combination with an HMG-CoA reductase inhibitor (statin) or in combination with ezetimibe, which results in greater improvements in lipid levels compared to monotherapy with these agents 4, 5.