From the Guidelines
Yes, fenofibrate and atorvastatin can be taken together, but this combination requires careful monitoring by a healthcare provider. This combination therapy is sometimes prescribed for patients with mixed dyslipidemia (elevated LDL cholesterol and triglycerides) when either medication alone doesn't adequately control lipid levels.
Key Considerations
- Typically, atorvastatin is started first at doses ranging from 10-80 mg daily, with fenofibrate (typically 48-145 mg daily depending on the formulation) added if triglycerides remain elevated.
- When taking these medications together, patients should be aware of an increased risk of muscle problems (myopathy) and liver issues.
- Regular blood tests to monitor liver function and muscle enzymes (CK levels) are essential, especially during the first year of combined therapy.
- Patients should immediately report any unexplained muscle pain, tenderness, or weakness to their doctor.
- Taking these medications with food may help reduce stomach upset, and maintaining consistent timing each day improves effectiveness.
- This combination works by targeting different aspects of lipid metabolism - atorvastatin primarily reduces cholesterol production in the liver, while fenofibrate enhances breakdown of triglycerides and increases HDL (good) cholesterol.
Evidence-Based Recommendations
The most recent and highest quality study, 1, supports the use of combination therapy with a statin and a fibrate, such as fenofibrate, for patients with mixed dyslipidemia. However, it emphasizes the importance of careful monitoring due to the increased risk of myopathy.
Important Warnings
- Patients with very high triglycerides should avoid consuming alcohol, and the use of bile acid sequestrants is relatively contraindicated when triglycerides are greater than 200 mg per dL, as noted in 1.
- The combination of high-dose statin plus fibrate can increase the risk for severe myopathy, and statin doses should be kept relatively low with this combination, as advised in 1.
From the Research
Combination Therapy of Fenofibrate and Atorvastatin
- The combination of fenofibrate and atorvastatin can be used to treat mixed dyslipidemia, as shown in a study published in 2007 2.
- This combination therapy has been found to be more efficacious than monotherapies with individual drugs, with no increase in adverse effects 2.
- A meta-analysis of randomized controlled trials found that combination therapy with fenofibrate and statins improves the blood lipid profile of patients, and appears to be as well tolerated as statin monotherapy 3.
Efficacy and Safety of Combination Therapy
- A study published in 2006 found that concomitant administration of a single dose of atorvastatin had no significant effect on the pharmacokinetics of a single dose of fenofibrate 4.
- Another study published in 2014 found that alternate day therapy with atorvastatin and fenofibrate combination is an effective and safe alternative to daily therapy in mixed dyslipidemia, with significant cost savings and a reasonable reduction in the incidence of adverse events 5.
- A 12-week, multicenter, double-blind, randomized, parallel-group study found that a fixed-dose combination tablet of atorvastatin and fenofibrate was generally well tolerated, with a tolerability profile consistent with those of atorvastatin and fenofibrate monotherapies 6.
Adverse Events
- The incidence of aminotransferase elevations was found to be significantly higher in the fenofibrate-statin therapy group compared to the statin monotherapy group 3.
- However, the incidence of elevated creatine kinase levels, muscle-associated adverse events, and withdrawals attributed to liver and muscle dysfunction did not differ significantly between the two groups 3.
- A study published in 2006 found that one subject experienced a serious adverse event (seizure) approximately 12-13 hours after administration of fenofibrate plus atorvastatin, which was deemed to be possibly related to the study drug 4.