Overview
Fenofibrate is a fibric acid derivative (fibrate) used primarily to treat hyperlipidemia, specifically to reduce elevated levels of triglycerides, LDL cholesterol, and to increase HDL cholesterol. It is indicated as an adjunct to diet and other non-pharmacological measures.
Mechanism of Action
Fenofibrate activates peroxisome proliferator-activated receptor alpha (PPAR-α), which increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase and reducing apoprotein C-III production. It also increases synthesis of apoproteins A-I and A-II, raising HDL cholesterol levels.
Indications
- Hypertriglyceridemia (Fredrickson types IV and V hyperlipidemia)
- Mixed dyslipidemia (Fredrickson type IIb)
- Primary hypercholesterolemia (as adjunct to diet)
Dosage
Initial dose: 145 mg once daily with meals. Dosage may be adjusted based on lipid response and tolerability, typically ranging from 48 mg to 200 mg daily depending on formulation. Renal impairment requires dosage reduction.
Contraindications
- Severe renal dysfunction
- Active liver disease
- Pre-existing gallbladder disease
- Hypersensitivity to fenofibrate or other fibrates
- Nursing mothers
Side Effects
- Abdominal pain
- Nausea
- Increased liver enzymes
- Headache
- Back pain
- Respiratory disorders
- Increased creatine phosphokinase
- Rash
- Muscle pain/weakness
Interactions
- Warfarin (increased anticoagulant effect)
- Cyclosporine (increased risk of renal toxicity)
- Statins (increased risk of myopathy)
- Bile acid sequestrants (reduce absorption - administer 1 hour before or 4-6 hours after)
- Oral anticoagulants (requires INR monitoring)