From the Guidelines
The treatment for hypertriglyceridemia should focus on lifestyle modifications, including dietary changes, weight loss, and regular exercise, and medications such as fibrates, omega-3 fatty acids, and statins when necessary, particularly for triglyceride levels above 500 mg/dL to reduce pancreatitis risk. According to the most recent guidelines 1, hypertriglyceridemia should be addressed with nutritional and lifestyle changes, including weight loss and abstinence from alcohol. Some key points to consider in the treatment of hypertriglyceridemia include:
- Lifestyle interventions, such as weight loss, regular exercise, and smoking cessation, are essential components of treatment
- Dietary changes, such as reducing intake of refined carbohydrates, sugars, and alcohol, and increasing consumption of omega-3 fatty acids from fish, can help lower triglyceride levels
- Medications, such as fibrates (fenofibrate 145 mg daily or gemfibrozil 600 mg twice daily), omega-3 fatty acids (2-4 grams daily), and statins (particularly for mixed dyslipidemia), may be necessary for triglyceride levels above 500 mg/dL to reduce pancreatitis risk
- For severe hypertriglyceridemia (>1000 mg/dL), a very low-fat diet (<15% of calories) may be temporarily needed, and pharmacologic therapy (fibrin acid derivatives and/or fish oil) should be considered to reduce the risk of acute pancreatitis 1. It's also important to note that treatment effectiveness should be monitored with lipid panels every 4-12 weeks initially, then every 3-12 months once stable, as recommended by previous guidelines 1.
From the FDA Drug Label
Fenofibrate tablets are indicated as adjunctive therapy to diet for treatment of adult patients with 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 treatment for hypertriglyceridemia (elevated triglycerides) is fenofibrate.
- The initial dose of fenofibrate is 54 mg per day to 160 mg per day.
- Dosage should be individualized according to patient response.
- The maximum dose is 160 mg once daily. 2
From the Research
Treatment Options for Hypertriglyceridemia
The treatment for hypertriglyceridemia involves a combination of lifestyle changes and pharmacological interventions.
- Lifestyle changes include improved diet and increased physical activity 3.
- Therapeutic lifestyle changes (TLC) are the first line of treatment for hypertriglyceridemia, including a low saturated fat, carbohydrate-controlled diet, combined with alcohol reduction, smoking cessation, and regular aerobic exercise 4.
- High doses of omega-3 fatty acids from fish and fish oil supplements can lower triglyceride levels significantly 4, 5.
Pharmacological Treatment
Pharmacological treatment usually starts with statins, although associated triglyceride reductions are typically modest 3.
- Fibrates are currently the drugs of choice for hypertriglyceridemia, frequently in combination with statins 3, 6, 5.
- Niacin and omega-3 fatty acids can improve control of triglyceride levels when the above measures are inadequately effective 3, 4, 6, 5.
- Statins in high doses exhibit a significant hypotriglyceridemic activity 6.
- Drugs that interfere with chylomicron production, such as orlistat, are also useful for hypertriglyceridemic patients 6.
Management of Severe Hypertriglyceridemia
Patients with severe hypertriglyceridemia and abdominal pain or pancreatitis should be hospitalized and treated with hypolipidemic drugs and, if needed, with insulin/dextrose infusion or therapeutic apheresis 6.
- Fibrates are the first-line treatment in patients with severe hypertriglyceridemia 6.
- Omega-3 fatty acids and niacin are very useful drugs for patients with hypertriglyceridemia 6, 5.
- In most patients with severe hypertriglyceridemia, drug combinations are needed to maintain an acceptable triglyceride concentration 6.