How to use Fenofibrate (Fibric acid derivative)?

From the Guidelines

Fenofibrate should be taken exactly as prescribed by your healthcare provider, typically once daily with meals, with a standard dosage ranging from 48 mg to 145 mg daily, depending on the specific formulation and medical condition, as recommended by the 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults 1. The medication works best when combined with a low-fat diet and regular exercise, as it helps reduce triglycerides and increase "good" HDL cholesterol by activating peroxisome proliferator-activated receptors (PPARs) that regulate fat metabolism. Some key points to consider when taking fenofibrate include:

• Swallowing the capsule or tablet whole without crushing or chewing it
• Taking fenofibrate consistently at the same time each day to maintain steady blood levels
• Regular blood tests to monitor cholesterol levels and liver function while taking fenofibrate
• Common side effects include stomach pain, nausea, and muscle pain
• Contacting your doctor immediately if you experience severe muscle pain or weakness, as this could indicate a rare but serious side effect
• Informing your doctor about all medications you're taking, as fenofibrate may interact with blood thinners and certain other medications It's also important to note that fenofibrate should not be used in individuals with moderate or severe renal impairment, defined as eGFR <30 mL/min per 1.73 m2, and the dose should not exceed 54 mg/day if eGFR is between 30 and 59 mL/min per 1.73 m2, as stated in the 2013 ACC/AHA guideline 1. Additionally, the management of dyslipidemia in adults with diabetes, as outlined in the 2003 Diabetes Care study, suggests that fenofibrate may be considered concomitantly with a low- or moderate-intensity statin only if the benefits from ASCVD risk reduction or triglyceride lowering when triglycerides are 500 mg/dL are judged to outweigh the potential risk for adverse effects 1.

From the FDA Drug Label

2.1 General Dosing Information

The dosage of fenofibrate tablets should be individualized according to patient response, and tolerability.

The FDA drug label does not answer the question.

From the Research

Dosage and Administration

• The recommended dosage of fenofibrate is 200 to 400 mg daily, as stated in the study 2.
• Fenofibrate can be used to treat severe hypertriglyceridaemia and mixed dyslipidaemia in patients who have not responded to nonpharmacological therapies, according to the study 3.

Effectiveness

• Fenofibrate has been shown to significantly reduce triglyceride levels, with a median change of -60% after median follow-up of 4 months, as reported in the study 4.
• Fenofibrate also reduces low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) levels, as stated in the study 5.
• The study 5 found that fenofibrate reduced C-reactive protein levels by more than 39% from baseline.

Safety and Tolerability

• Fenofibrate is generally well tolerated when administered alone or in combination with a statin, according to the study 3.
• Common adverse reactions to fenofibrate include gastrointestinal disturbances, headache, and muscle cramps, as reported in the study 2.
• Transient elevations in transaminase and creatine phosphokinase levels commonly occur, and isolated cases of hepatitis with substantially elevated transaminase levels have been reported, as stated in the study 2.

Special Considerations

• Fenofibrate may be of greatest benefit in decreasing cardiovascular events in patients with atherogenic dyslipidaemia, according to the study 3.
• The study 4 found that female sex, non-diabetic status, coronary artery disease, lower baseline triglyceride, and no statin use were independently associated with achievement of triglyceride <150 mg/dL.
• Fenofibrate increased liver and pancreas volumes, and total liver fat volume, compared to omega-3 carboxylic acids, as reported in the study 6.