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fibrate

Also see individual agent. Indications: - used largely for treatment of hypertriglyceridemia - in combination with bile acid sequestrant resin for familial combined hyperlipidemia * lowers risk of non-fatal myocardial infarction in patients not taking statins [7] * does not lower risk of fatal myocardial infarctions, stroke or all-cause mortality in patients taking statins [7,10] * reduces risk for stroke, but not coronary events, in elderly without cardiovascular disease [8] Monitor: - liver function tests - serum triglycerides every 2 months [2] - renal function during 1st few months [5] Adverse effects: - nausea, abdominal pain - myositis [9] Mechanism of action: - 35% reduction in triglycerides - 10% reduction in LDL cholesterol - 10% increase in HDL cholesterol Clinical trials: - appears to lower the risk for coronary events (benefit modest but may be clinically significant for high risk patients) [3] - no benefit in terms of stroke, mortality, or heart failure - lack of evidence to support adjunct to statin therapy [4,10] - may result in improved lipid profiles in patients with mild-to-moderate chronic kidney disease (meta-analysis) [6] - does not lower cardiovascular mortality [10] - does not lower overall mortality - may slow progression of albuminuria - does not lower LDL cholesterol - may increase serum creatinine & decrease GFR [6]

Interactions

drug interactions drug adverse effects (more general classes) monitor with fibrates

Related

bile acid sequestrant

Specific

bezafibrate (Bezalip) clofibrate (Atromid-S) fenofibrate (Antara, TriCor, Triglide, Lofibra, Proctofene, Trilipix) gemfibrozil (Lopid) pemafibrate

General

anti-hyperlipidemic agent peroxisome proliferator; PPAR agonist; PPAR gamma agonist

References

  1. Principles of Geriatric Medicine & Gerontology, 4th ed, Hazzard et al (eds), McGraw-Hill, 1999
  2. deprecated reference
  3. Jun M et al, Effects of fibrates on cardiovascular outcomes: a systematic review and meta-analysis. The Lancet, Early Online Publication, 11 May 2010 PMID: 20462635 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60656-3/fulltext
  4. Jackevicius CA et al. Use of fibrates in the United States and Canada. JAMA 2011 Mar 23/30; 305:1217 PMID: 21427374
  5. Zhao YY et al New Fibrate Use and Acute Renal Outcomes in Elderly Adults A Population-Based Study Annals of Internal Medicine 2012 156(8):560-569 PMID: 22508733 http://www.annals.org/content/156/8/560.abstract
  6. Jun M et al. Effects of fibrates in kidney disease: A systematic review and meta-analysis. J Am Coll Cardiol 2012 Nov 13; 60:2061 PMID: 23083786 http://www.sciencedirect.com/science/article/pii/S0735109712043161 - McCullough PA and Di Loreto MJ. Fibrates and cardiorenal outcomes. J Am Coll Cardiol 2012 Nov 13; 60:2072. PMID: 23083778 http://www.sciencedirect.com/science/article/pii/S0735109712043148
  7. Keene D et al. Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: Meta-analysis of randomised controlled trials including 117,411 patients. BMJ 2014 Jul 18; 349:g4379 PMID: 25038074
  8. Mueller PS Lipid-Lowering Drugs for Primary Prevention in Older Adults NEJM Journal Watch. June 4, 2015 Massachusetts Medical Society (subscription needed) http://www.jwatch.org - Alperovitch A et al. Primary prevention with lipid lowering drugs and long term risk of vascular events in older people: Population based cohort study. BMJ 2015 May 19; 350:h2335 PMID: 25989805
  9. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  10. Boswoth T Triglyceride Lowering Fails to Show CV Benefit in Large Fibrate Trial. Twenty-Five Percent Reduction Has No Effect. Medscape. Nov 5, 2022 https://www.medscape.com/viewarticle/983610 - Das Pradhan A et al. Triglyceride lowering with pemafibrate to reduce cardiovascular risk. N Engl J Med 2022 Nov 5; [e-pub]. PMID: 36342113 https://www.nejm.org/doi/10.1056/NEJMoa2210645