Fenofibrate Dosing for Triglycerides 371 mg/dL
Start fenofibrate 160 mg once daily with meals, provided renal function is normal (eGFR ≥60 mL/min/1.73m²). 1, 2
Initial Assessment Required Before Starting
Before initiating fenofibrate, you must obtain:
- Renal function: Both serum creatinine and eGFR 3, 4
- Liver function tests: ALT, AST, and total bilirubin 4
- Fasting lipid panel: To confirm triglyceride level 3
Dose Selection Based on Renal Function
The starting dose depends entirely on kidney function:
- eGFR ≥60 mL/min/1.73m²: Start 160 mg once daily 1, 2
- eGFR 30-59 mL/min/1.73m²: Start 54 mg once daily; do not exceed this dose 3, 2
- eGFR <30 mL/min/1.73m²: Fenofibrate is contraindicated 3, 2
Rationale for This Triglyceride Level
Your patient's triglyceride level of 371 mg/dL falls into the moderate hypertriglyceridemia range (200-499 mg/dL), which warrants pharmacologic intervention beyond lifestyle modifications alone. 5 While this level is not immediately dangerous for pancreatitis (which typically occurs >500 mg/dL), it significantly exceeds the American Heart Association target of <150 mg/dL and requires treatment. 5
Administration Details
- Take with meals to optimize bioavailability 2
- Once daily dosing 1, 2
- The 160 mg dose can reduce triglycerides by up to 50% 5
Mandatory Monitoring Schedule
After initiating fenofibrate:
- Renal function: Recheck within 3 months, then every 6 months 3, 4
- Lipid panel: Recheck at 4-8 weeks to assess response 2
- Discontinue if: eGFR persistently drops to <30 mL/min/1.73m² during treatment 3, 4
Critical Safety Contraindications
Do not use fenofibrate if the patient has:
- Active liver disease or unexplained persistent transaminase elevations 2
- Preexisting gallbladder disease 2
- Severe renal impairment (eGFR <30) 2
- Current gemfibrozil use (never combine with statins due to rhabdomyolysis risk) 3
If Patient Is Already on a Statin
If combining fenofibrate with a statin:
- Use only low- or moderate-intensity statins 3
- Pravastatin or fluvastatin are safest options for combination therapy 1, 4
- Monitor closely for muscle symptoms and consider baseline CPK 5
- The combination has not been shown to reduce cardiovascular events in most patients, but remains effective for triglyceride lowering 1, 2
Expected Response and Follow-Up
- Reassess lipids at 4-8 weeks after starting therapy 2
- Withdraw therapy if no adequate response after 2 months at maximum dose (160 mg daily) 2
- Consider dose reduction if triglycerides fall significantly below target range 2
Common Pitfall to Avoid
The most common error is starting 160 mg in patients with mild-to-moderate renal impairment (eGFR 30-59). Always start at 54 mg in this population and only increase after evaluating renal function and lipid response at this lower dose. 3, 4, 2