What is the recommended dose of fenofibrate for treating hypertriglyceridemia?

Fenofibrate Dosing for Hypertriglyceridemia

For severe hypertriglyceridemia (≥500 mg/dL), the recommended initial dose of fenofibrate is 54-160 mg once daily, with a maximum dose of 160 mg daily. 1, 2

Dosing Recommendations Based on Severity

Severe Hypertriglyceridemia (≥500 mg/dL)

• Initial dose: 54-160 mg once daily 1, 2
• Maximum dose: 160 mg daily 2
• Take with meals to improve absorption 2

Moderate Hypertriglyceridemia (150-499 mg/dL)

• Initial dose: 160 mg once daily 2
• For primary hypercholesterolemia or mixed dyslipidemia: 160 mg once daily 2

Dosing Adjustments for Special Populations

Renal Impairment

• Normal or mild-moderate CKD (CKD stages 1-2): 96 mg/day 1
• Moderate CKD (CKD stage 3): 48 mg/day 1
• eGFR 30-59 mL/min per 1.73 m²: ≤54 mg/day 1
• eGFR <30 mL/min per 1.73 m²: Avoid use (contraindicated) 1, 2

Geriatric Patients

• Select dose based on renal function 2
• Initial dose of 54 mg once daily may be appropriate 2

Administration

• Should be given with meals to enhance absorption 2
• Available as oral tablets: 54 mg and 160 mg 2

Monitoring During Treatment

Regular monitoring is essential when using fenofibrate:

• Lipid profiles: to assess efficacy
• Renal function: fenofibrate can reversibly increase serum creatinine levels 2
• Liver function tests: monitor for hepatotoxicity 2
• Complete blood count
• Creatine phosphokinase (CPK) levels: especially when combined with statins 2

Contraindications

• Severe renal dysfunction, including dialysis patients 2
• Active liver disease 2
• Gallbladder disease 2
• Known hypersensitivity to fenofibrate 2
• Nursing mothers 2

Important Considerations

Combination Therapy

When fenofibrate alone is insufficient:

• For patients with residual elevated LDL-C: consider adding a statin with caution due to increased risk of myopathy 1
• Fenofibrate is preferred over gemfibrozil when combined with statins due to lower risk of myopathy 1

Safety Concerns

• Hepatotoxicity: Serious drug-induced liver injury has been reported; monitor liver function tests 2
• Myopathy and rhabdomyolysis: Risk increases with statin co-administration 2
• Cholelithiasis: Fenofibrate increases cholesterol excretion into bile 2
• Coumarin anticoagulants: Use caution and monitor INR closely 2

Fenofibrate is an effective treatment for hypertriglyceridemia, with studies showing triglyceride reductions of 21-36% 3. The optimal dosage appears to be 54-160 mg daily depending on severity and patient factors, with 400 mg/day showing the best lipid-lowering effects in some older studies 4.