Fenofibrate
A fibrate prodrug, turned into fenofibric acid, used mainly to lower very high triglycerides.
Drug card
- Class
- Fibrate
- How it works
- Activating PPAR-alpha, so triglyceride-rich particles are cleared faster
- Used for
- Severe high triglycerides
- High LDL cholesterol when usual LDL drugs cannot be used
- Known for
- Myopathy and rhabdomyolysis, more with a statin
- Gallstones
- Its name
- -fibrate means a fibrate (PPAR-alpha agonist)
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does fenofibrate work?
A phenoxy-isobutyric acid ester that is hydrolyzed to its active form, fenofibric acid, which activates PPAR-alpha. Lipoprotein lipase activity rises and apolipoprotein C-III falls, so VLDL and triglycerides are cleared faster, HDL and apoA-I rise, and LDL particles become larger and are removed more quickly.
Uses
What is fenofibrate used for?
- Severe high triglycerides
- High LDL cholesterol when usual LDL drugs cannot be used
Side effects
Side effects of fenofibrate
- Myopathy and rhabdomyolysis, more with a statinKnown forSerious
- GallstonesKnown for
- Abnormal liver tests; rarely serious liver injurySerious
- Raised serum creatinine
- PancreatitisSerious
- Deep vein thrombosis and pulmonary embolismSerious
- Mild falls in hemoglobin and white cells
- Anaphylaxis and angioedemaSerious
- Severe skin reactionsSerious
- Paradoxical fall in HDL cholesterol
- Abdominal pain
- Constipation
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Contraindicated in severe kidney impairment or dialysis, active liver disease and existing gallbladder disease.
- With a statin, weigh the extra risk of myopathy and watch for muscle symptoms; colchicine adds to the risk.
- Boosts warfarin and other coumarins: lower the anticoagulant dose and check the INR often.
- Monitor ALT, AST and bilirubin at the start and during treatment.
Good to know: It lowers triglycerides well, but it did not reduce heart attacks or deaths in two large trials of people with type 2 diabetes.
Remember it
A way to remember it
Fibrates fix fat in the blood: PPAR-alpha switches on lipoprotein lipase, which empties triglyceride-rich particles.
Triglycerides fall the most. The two classic harms are gallstones, because more cholesterol is sent into bile, and muscle damage, which is likelier when a statin is added.
Written for biofideX
Its name
-fibrate means fibrate (PPAR-alpha agonist)
Fenofibrate, bezafibrate and ciprofibrate are clofibrate relatives that activate PPAR-alpha and lower triglycerides.
- Every drug name stem
Its class
Fibrates
Fibrates (fenofibrate works as fenofibric acid) bind and activate the receptor PPAR-alpha. Lipoprotein lipase becomes more active and apolipoprotein C-III, which inhibits it, falls, so triglyceride-rich VLDL is broken down and cleared faster. Triglycerides fall most; HDL and apoA-I rise, and small dense LDL particles become larger.
Easily mixed up with statins and thiazolidinediones.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Blood clots and cholesterol
Fenofibrate is one of 19 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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