From the Guidelines
Fenofibrate is a medication used primarily to lower high triglyceride levels and increase HDL (good) cholesterol in the blood, and it is particularly effective for patients with very high triglycerides (over 500 mg/dL) and should be used cautiously in patients with kidney disease. The medication belongs to a class of drugs called fibrates and works by reducing the production of triglycerides in the liver while enhancing the breakdown of fatty acids 1. The typical dosage ranges from 48 mg to 145 mg once daily, with the specific dose depending on the formulation and individual patient factors, and it is recommended to take fenofibrate with food to enhance absorption 1. Common side effects include digestive issues, muscle pain, and potential liver enzyme elevations, and regular blood tests are necessary to monitor liver function and lipid levels while taking this medication 1. Fenofibrate is often prescribed alongside statins for comprehensive lipid management, however, this combination requires careful monitoring due to increased risk of muscle problems 1. Some key points to consider when using fenofibrate include:
- The medication typically takes several weeks to show its full effect on cholesterol levels
- Dosage adjustments may be necessary for patients with kidney disease
- Fenofibrate should not be used in individuals with moderate or severe renal impairment, defined as eGFR <30 mL/min per 1.73 m2 1
- The combination of statins with fenofibrate may carry an increased risk of myositis, and the risk of myositis may be increased with the combination of gemfibrozil and cerivastatin or in patients with renal disease 1. Overall, fenofibrate is a useful medication for managing high triglyceride levels and increasing HDL cholesterol, but it should be used with caution and under the guidance of a healthcare professional.
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. (1.1) For treatment of adult patients with severe hypertriglyceridemia. (1.2)
The use of Fenofibrate is to:
- 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 2
From the Research
Use of Fenofibrate
Fenofibrate is a fibric acid derivative used in the treatment of various lipid disorders, including:
- Severe hypertriglyceridaemia
- Mixed dyslipidaemia
- Primary hypercholesterolaemia
- Hypertriglyceridaemia (types IV and V hyperlipidemia)
Mechanism of Action
The lipid-modifying effects of fenofibrate are mediated by the activation of peroxisome proliferator-activated receptor-α, which leads to:
- Reduction in triglyceride (TG) levels
- Increase in high-density lipoprotein cholesterol (HDL-C) levels
- Reduction in low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) levels
- Promotion of a shift from small, dense LDL particles to larger, less dense LDL particles
Clinical Efficacy
Fenofibrate has been shown to be effective in improving lipid profiles and reducing the risk of certain cardiovascular events, particularly in patients with:
- Atherogenic dyslipidaemia
- Type 2 diabetes mellitus
- Metabolic syndrome
- Studies have demonstrated that fenofibrate can reduce the risk of nonfatal macrovascular events, such as nonfatal myocardial infarction and coronary revascularisation 3, 4, 5
Combination Therapy
Fenofibrate can be used in combination with other lipid-lowering agents, such as:
- Statins: to improve lipid profiles and reduce cardiovascular risk
- Bile acid sequestrants: to improve metabolic parameters in patients with mixed hyperlipidemia
- Ezetimibe: to improve overall lipid profiles in patients with mixed hyperlipidemia
- N-3 fatty acids: to reduce triglyceride levels in patients with severe hypertriglyceridaemia
- Studies have shown that combination therapy with fenofibrate can be effective in improving lipid profiles and reducing cardiovascular risk 6
Safety and Tolerability
Fenofibrate is generally well tolerated, with common adverse events including:
- Increases in transaminase levels
- Gastrointestinal signs and symptoms
- Fenofibrate has been associated with increases in serum aminotransferase levels, and clinical monitoring of these markers of liver function should be performed regularly 7