From the Guidelines
Medications commonly used for hypertriglyceridemia include fibrates, statins, omega-3 fatty acids, and niacin, with fibrates being the first-line treatment for patients at risk of pancreatitis, as recommended by the most recent guidelines 1. The treatment of hypertriglyceridemia involves a combination of lifestyle modifications and pharmacological interventions.
- Lifestyle modifications include: + Weight loss in patients who are overweight or obese + Limiting alcohol consumption + Reducing simple carbohydrates + Increasing physical activity
- Pharmacological interventions include: + Fibrates, such as fenofibrate (typically 48-145 mg daily) and gemfibrozil (600 mg twice daily), which increase the breakdown of triglyceride-rich particles + Statins, such as atorvastatin (10-80 mg daily) or rosuvastatin (5-40 mg daily), which inhibit cholesterol synthesis and have a modest triglyceride-lowering effect + Prescription-strength omega-3 fatty acids, such as icosapent ethyl (2 g twice daily) or omega-3 ethyl esters (2-4 g daily), which reduce triglycerides by decreasing liver production of triglyceride-rich lipoproteins + Extended-release niacin (500-2000 mg daily), which may also be used, though side effects like flushing limit its tolerability + Icosapent ethyl, a new promising hypertriglyceridaemia treatment, that lowers risk of ischaemic events and cardiovascular death, and is well-tolerated, as reported in the most recent study 1 For patients with very high triglycerides (>500 mg/dL), combination therapy may be necessary, and medication adjustments may be needed based on response and tolerability, with regular monitoring of lipid panels to assess treatment effectiveness 1.
From the FDA Drug Label
Fenofibrate tablets are indicated as adjunctive therapy to diet for treatment of adult patients with severe hypertriglyceridemia. Fenofibrate tablets are also indicated as adjunctive therapy to diet to reduce elevated low-density lipoprotein cholesterol (LDL-C), total cholesterol (Total-C), Triglycerides and apolipoprotein B (Apo B), and to increase high-density lipoprotein cholesterol (HDL-C) in adult patients with primary hypercholesterolemia or mixed dyslipidemia.
Medications used to treat hypertriglyceridemia:
- Fenofibrate: used as adjunctive therapy to diet for treatment of adult patients with severe hypertriglyceridemia 2
- Gemfibrozil: although not directly stated for hypertriglyceridemia, it is used for dyslipidemia, which includes elevated triglycerides 3
Note: The use of these medications should be based on individual patient needs and under the guidance of a healthcare professional.
From the Research
Medications for Hypertriglyceridemia
The following medications are used to treat hypertriglyceridemia:
- Fibrates, which are the first-line treatment for patients with severe hypertriglyceridemia 4
- Omega-3 fatty acids, which are very useful for patients with hypertriglyceridemia 4, 5, 6, 7
- Niacin, which is useful for patients with hypertriglyceridemia 4, 5
- Statins, which exhibit significant hypotriglyceridemic activity in high doses 4
- Drugs that interfere with chylomicron production, such as orlistat, which are useful for hypertriglyceridemic patients 4
Combination Therapies
Combination therapies are often needed to maintain an acceptable triglyceride concentration in patients with severe hypertriglyceridemia 4, 6. For example:
- Combination of omega-3 fatty acids and fenofibrate 6
- Combination of statins and omega-3 fatty acids or fenofibrate 7, 8
Dosages and Effects
The dosages and effects of these medications vary: