What is the recommended dose of fenofibrate (Fibric acid derivative) for a patient with hypertriglyceridemia?

Fenofibrate Dosing for Hypertriglyceridemia

For a patient with triglyceride levels of 300 mg/dL, the recommended dose of fenofibrate is 54-160 mg once daily, with 160 mg being the most effective dose for most patients. 1, 2

Dosing Recommendations Based on Triglyceride Levels

For Moderate Hypertriglyceridemia (150-499 mg/dL)

• Initial dose: 160 mg once daily with meals 1
• This is the optimal dose for most patients with triglyceride levels around 300 mg/dL 1
• Take with meals to optimize bioavailability 1

For Severe Hypertriglyceridemia (≥500 mg/dL)

• Initial dose: 54-160 mg once daily 1
• Titrate based on response after 4-8 weeks 1
• Maximum dose: 160 mg once daily 1

Dose Adjustments for Special Populations

Renal Impairment

• Normal or mild-moderate CKD: 96 mg/day 2
• Moderate CKD (eGFR 30-59 mL/min): ≤54 mg/day 2
• Severe renal impairment: Avoid use (contraindicated) 1, 2

Elderly Patients

• Dose selection should be based on renal function 1
• Start at lower doses and titrate as needed 2

Efficacy and Monitoring

• Fenofibrate typically reduces triglycerides by 29-38% at standard doses 3, 4
• Assess response after 4-8 weeks of therapy 1
• Monitor lipid profiles, renal function, liver function tests, and CPK levels regularly 2
• Consider discontinuing therapy if inadequate response after 2 months at maximum dose 1

Important Considerations

• Fenofibrate is more effective than omega-3 fatty acids for triglyceride reduction (29% vs 21% reduction) 3
• The 160 mg dose has been shown to be the most effective dose for lipid lowering 5
• Fenofibrate should be taken with meals to optimize absorption 1
• Combination with statins increases risk of myopathy and should be used with caution 6, 2

Lifestyle Modifications to Implement Alongside Medication

• Reduce saturated fat intake to <7% of total calories 6, 2
• Limit dietary cholesterol to <200 mg/day 6
• Minimize or eliminate alcohol consumption 6, 2
• Increase physical activity and promote weight management 6, 2
• Limit added sugars if triglycerides are elevated 2

Contraindications

• Severe renal impairment
• Active liver disease
• Preexisting gallbladder disease
• Known hypersensitivity to fenofibrate 1

Fenofibrate is an effective treatment for hypertriglyceridemia, with dosing that should be tailored based on triglyceride levels and renal function. For a patient with triglyceride levels of 300 mg/dL, the 160 mg daily dose is typically most appropriate, unless renal impairment necessitates dose reduction.