From the Guidelines
Fenofibrate is primarily used to lower elevated triglyceride or non-HDL-C levels, particularly in patients with diabetes, as evidenced by the FIELD trial which showed a 19% reduction in total cardiovascular events in patients without prior cardiovascular disease 1. The use of fenofibrate, a fibric acid derivative, is supported by studies such as the FIELD trial, which demonstrated its effectiveness in reducing cardiovascular events in patients with type 2 diabetes mellitus 1. Key points to consider when prescribing fenofibrate include:
- Dosage: typically ranges from 48 mg to 145 mg once daily, depending on the formulation and individual patient factors
- Administration: should be taken with food to enhance absorption
- Side effects: common issues include digestive problems, muscle pain, and potential liver enzyme elevations, with a notable concern being the risk of myositis and rhabdomyolysis when used in combination with statins 1
- Monitoring: regular checks of liver function and kidney function are recommended while taking this medication
- Interactions: caution is advised when combining fenofibrate with statins or blood thinners like warfarin, and it is generally not recommended during pregnancy or breastfeeding
- Lifestyle modifications: fenofibrate works best when combined with a low-fat diet, regular exercise, and avoiding excessive alcohol consumption
- Contraindications: patients with severe kidney disease, liver disease, or gallbladder problems should use fenofibrate with caution or avoid it altogether, due to potential adverse effects such as a rise in creatinine levels, as observed in the FIELD trial 1.
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, a fibric acid derivative, 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
Mechanism of Action
The lipid-modifying effects of fenofibrate are mediated by the activation of peroxisome proliferator-activated receptor-α 3, 4, 5. Fenofibrate also has nonlipid, pleiotropic effects, such as reducing levels of fibrinogen, C-reactive protein, and various pro-inflammatory markers, and improving flow-mediated dilatation 3, 4, 5.
Clinical Efficacy
Fenofibrate has been shown to improve the lipid profile, particularly triglyceride and high-density lipoprotein-cholesterol levels, in patients with dyslipidaemia 3, 4, 5. Combination therapy with a statin plus fenofibrate generally improves the lipid profile to a greater extent than monotherapy with either agent in patients with dyslipidaemia and/or type 2 diabetes mellitus or the metabolic syndrome 3.
Benefits
The benefits of fenofibrate include:
- Reducing the risk of some nonfatal macrovascular events and certain microvascular outcomes 3, 5
- Slowing the progression of diabetic retinopathy 3, 5
- Improving microvascular outcomes 3, 4, 5
- Reducing the risk of total cardiovascular disease events 4
Patient Populations
Fenofibrate is particularly useful in patients with: