What is the initial dose and frequency of Tricor (fenofibrate) for a 37-year-old patient with hypertriglyceridemia?

From the Guidelines

For a 37-year-old with a triglyceride level of 347 mg/dL, the initial recommended dose of Tricor (fenofibrate) would be 145 mg once daily, taken with food, as this standard starting dose is appropriate for most adults with moderate hypertriglyceridemia, according to the most recent guidelines 1.

Key Considerations

• The patient's triglyceride level falls into the moderate hypertriglyceridemia category, which may be a risk factor for cardiovascular disease, as noted in the guidelines 1.
• Lifestyle modifications, including a low-fat diet, regular exercise, weight management, and alcohol limitation, should be combined with Tricor therapy to enhance its effectiveness, as recommended by the 2021 ACC expert consensus decision pathway 1.
• Fenofibrate works by activating peroxisome proliferator-activated receptor alpha (PPAR-α), which increases lipoprotein lipase activity and reduces production of apoprotein C-III, ultimately enhancing triglyceride breakdown and clearance from the bloodstream.

Monitoring and Follow-up

• Liver function tests should be monitored before starting therapy and periodically thereafter, as fenofibrate can occasionally cause liver enzyme elevations, as cautioned in the guidelines 1.
• The patient should follow up with their healthcare provider after 4-8 weeks to assess treatment response and determine if dose adjustments are needed, ensuring optimal management of their hypertriglyceridemia and minimizing potential risks.

From the FDA Drug Label

2.3 Severe Hypertriglyceridemia The initial dose is 54 mg per day to 160 mg per day. Dosage should be individualized according to patient response and should be adjusted if necessary following repeat lipid determinations at 4 to 8 week intervals. The maximum dose is 160 mg once daily.

The initial dose of fenofibrate for a 37-year-old patient with a triglyceride level of 347 mg/dL is between 54 mg and 160 mg per day.

• The dosage should be individualized according to patient response.
• The dose may be adjusted after repeat lipid determinations at 4 to 8 week intervals.
• The maximum dose is 160 mg once daily 2.

From the Research

Tricor (Fenofibrate) Dosage

The initial dose and frequency of Tricor (Fenofibrate) for a 37-year-old patient with a triglyceride level of 347 mg/dL can be determined based on the available evidence.

• The recommended dosage of Fenofibrate is 200 to 400 mg daily, with substantial reductions in plasma triglyceride levels in hypertriglyceridemic patients 3.
• A new "suprabioavailable" tablet formulation of Fenofibrate is available, which has increased bioavailability and achieves equivalent plasma concentrations at lower doses 4.
• The 67- and 200-mg micronized capsules can be considered equivalent to the 54- and 160-mg suprabioavailable tablets, respectively 4.

Treatment of Hypertriglyceridemia

The treatment of hypertriglyceridemia typically involves lifestyle modifications, such as dietary changes and physical activity, as well as medication therapy if necessary.

• Lifestyle modifications, including cessation of alcohol consumption, reduced intake of rapidly metabolized carbohydrates, weight loss, and blood sugar control, are the most effective ways to lower triglyceride levels 5.
• Fibrates, such as Fenofibrate, can lower triglyceride concentrations, but their efficacy in combination with statins has not been clearly shown in endpoint studies 5.
• Long-chain omega-3 fatty acids may be a well-tolerated and effective alternative to fibrates and niacin for lowering triglyceride levels 6.

Specific Dosage Recommendations

Based on the available evidence, the initial dose of Tricor (Fenofibrate) for a 37-year-old patient with a triglyceride level of 347 mg/dL could be:

• 54-160 mg daily, using the suprabioavailable tablet formulation 4.
• 67-200 mg daily, using the micronized capsule formulation 3, 4.