Fenofibrate Patient Counseling
Counsel patients to take fenofibrate once daily with a meal, swallow tablets whole, and immediately report any unexplained muscle pain, weakness, dark urine, or abdominal pain, as these may signal serious adverse effects requiring prompt evaluation. 1
Dosing and Administration
- Take fenofibrate once daily with food at the prescribed dose (typically 160 mg for normal renal function, or 54 mg for moderate renal impairment), swallowing each tablet whole without crushing or chewing 2, 1
- The medication can be taken at any time of day, but consistency is helpful 2
- If taking bile acid sequestrants (cholestyramine, colestipol), fenofibrate must be taken at least 2 hours before or 4 hours after these medications to prevent absorption interference 2
Critical Warning Signs Requiring Immediate Medical Attention
- Muscle symptoms: Report any unexplained muscle pain, tenderness, weakness, or cramping immediately, as these may indicate myopathy or rhabdomyolysis, particularly if combined with a statin 3, 1
- Liver injury signs: Notify your physician of jaundice (yellowing of skin/eyes), severe abdominal pain, nausea with malaise, dark urine, pale stools, or itching 1
- Abdominal pain: New or worsening abdominal pain requires evaluation, as fenofibrate can increase gallstone risk 1
Expected Laboratory Changes and Monitoring
- Creatinine elevation is expected and typically benign: An increase in serum creatinine of approximately 0.13 mg/dL is normal with fenofibrate and does not represent kidney damage—this reverses completely after stopping the medication 3, 4
- Your physician will check kidney function before starting therapy, again within 3 months, then every 6 months thereafter 4
- Liver function tests and muscle enzyme levels will be monitored regularly 2
- If kidney function declines significantly (eGFR persistently <30 mL/min/1.73m²), the medication will be discontinued 4
Drug Interactions and Combination Therapy
- If taking warfarin or other blood thinners: Fenofibrate increases anticoagulant effects, requiring more frequent INR monitoring and possible dose adjustments 1
- Statin combinations require caution: If fenofibrate is prescribed with a statin, only low- or moderate-intensity statins should be used due to increased myopathy risk 5, 3
- Inform all healthcare providers that you are taking fenofibrate before they prescribe new medications 1
Lifestyle Modifications Must Continue
- Continue following your lipid-lowering diet (limiting saturated fat to <7% of calories, cholesterol to <200 mg/day, trans fats to <1% of energy) while on fenofibrate 5, 1
- Maintain regular physical activity and weight management efforts 5
- These lifestyle changes work synergistically with medication for optimal cardiovascular risk reduction 5
Special Populations and Contraindications
- Pregnancy and breastfeeding: Do not breastfeed during treatment with fenofibrate and for 5 days after the final dose 1
- Renal impairment: If you have moderate kidney disease, your dose will be reduced to 54 mg daily maximum; fenofibrate is contraindicated in severe kidney disease 4
- Inform your physician of all medical conditions, supplements, and herbal preparations you are taking 1
Additional Metabolic Effects
- Fenofibrate may increase uric acid levels and potentially trigger gout attacks in susceptible individuals 3
- The medication may affect blood sugar control in diabetic patients, requiring closer glucose monitoring 3
- Rare cardiovascular effects include increased risk of atrial fibrillation and bleeding 3
Long-Term Expectations
- Return for routine monitoring appointments as scheduled 1
- The lipid-lowering effects are sustained during long-term treatment (2-7 years demonstrated) 6
- In diabetes patients, fenofibrate may provide microvascular benefits including reduced risk of retinopathy progression and amputation 7, 8