Fenofibrate Dosing for Severe Hypertriglyceridemia
For patients with severe hypertriglyceridemia (triglycerides ≥500 mg/dL), the recommended fenofibrate dosing is 54 mg to 160 mg once daily, with the maximum dose being 160 mg daily. 1
Dosing Guidelines
Initial Dosing
- For severe hypertriglyceridemia (≥500 mg/dL): 54-160 mg once daily 1
- Dosage should be individualized according to patient response
- Maximum dose: 160 mg once daily 1
- Should be taken with meals to optimize bioavailability 1
Dose Adjustments Based on Renal Function
- Normal renal function or mild-moderate CKD (stages 1-2): 96 mg daily 2
- Moderate renal impairment (CKD stage 3): 48 mg daily 2
- Severe renal impairment (CKD stages 4-5): Avoid use 2, 1
- For patients with mild to moderately impaired renal function: Start at 54 mg daily and increase only after evaluating effects on renal function and lipid levels 1
Monitoring
- Baseline lipid profile before starting therapy
- Follow-up lipid determinations at 4-8 week intervals to assess response and adjust dosing 1
- Monitor renal function:
- Before starting therapy
- Within 3 months after initiation
- Every 6 months thereafter 3
- Monitor liver function periodically
Clinical Considerations
Therapeutic Context
- Fenofibrate is indicated as adjunctive therapy to diet for treatment of severe hypertriglyceridemia 1
- For triglycerides ≥500 mg/dL, fibrates are recommended as first-line therapy before LDL-lowering to prevent pancreatitis 2
- Improving glycemic control in diabetic patients with fasting chylomicronemia may reduce the need for pharmacologic intervention 1
Important Precautions
- Patients with very high triglycerides should not consume alcohol 2
- The combination of high-dose statin plus fibrate increases risk for severe myopathy; statin doses should be kept relatively low with this combination 2
- Fenofibrate has a better safety profile for combination therapy with statins compared to gemfibrozil 3
- Discontinue fenofibrate if:
Special Populations
- Geriatric patients: Select dose based on renal function 1
- Contraindicated in:
- Severe renal impairment
- Active liver disease
- Preexisting gallbladder disease
- Nursing mothers
- Known hypersensitivity to fenofibrate 1
Efficacy Considerations
- Fenofibrate therapy can decrease triglycerides by approximately 30-36% 4, 5
- Combination with omega-3 fatty acids may provide additional triglyceride-lowering effects (41% reduction vs 30% with fenofibrate alone) 4
- The 160 mg daily dose has shown optimal lipid-lowering effects in clinical studies 6
Remember that the primary goal of treatment in severe hypertriglyceridemia is to reduce the risk of acute pancreatitis, with the secondary benefit of reducing cardiovascular risk through improved lipid profiles.