Medications and Drugs
Fibrates
(Fibric Acid)
Medical Author : Dennis Lee, M.D.
Medical Editor:
Daniel Kulick, M.D.
What are fibrates?
Fibric acid derivatives (fibrates) are a class of medications that lower blood
triglyceride levels. Fibrates lower blood triglyceride levels by reducing the
liver 's production of VLDL (the triglyceride-carrying particle that circulates in the blood) and by
speeding up the removal of triglycerides from the blood. Fibrates are also
modestly effective in increasing blood HDL cholesterol levels; however,
fibrates are not effective in lowering LDL cholesterol. Examples of fibrates available in
the United Sates include gemfibrozil (Lopid) and fenofibrate (Tricor).
Very high triglyceride levels (usually >1000 mg/dl)
can cause pancreatitis (inflammation of the pancreas that can result in
a serious illness with severe abdominal pain ). By lowering blood
triglycerides, fibrates are used to prevent pancreatitis.
Fibrates are not effective in lowering LDL cholesterol
; however, when a high risk
patient (see NCEP recommendations) also has high blood triglyceride or low
HDL cholesterol levels, doctors may consider combining a fibrate, such
as fenofibrate (Tricor), with a statin. Such a combination will not only lower
LDL cholesterol but will also lower blood triglycerides and increase HDL
cholesterol levels.
Fibrates have also been used alone to prevent heart
attacks especially in patients with elevated blood triglycerides and low HDL
cholesterol levels. In one large study, gemfibrozil decreased the risk of heart
attacks but did not affect the overall survival of persons with high cholesterol levels.
What are the side effects of fibrates?
The side effects of fibrates include nausea, stomach
upset, and sometimes
diarrhea. Fibrates can irritate (inflame) the liver. The liver irritation usually
is mild and reversible, but it occasionally can be severe enough to require
stopping the drug.
Fibrates can cause gallstones when used over several years.
Fibrates can increase the effectiveness of blood thinners, such as
warfarin (Coumadin), when both medications are used together. Thus, the dose of warfarin
should be adjusted to avoid over-thinning of the blood which can lead to
excessive bleeding.
Fibrates can cause muscle damage particularly when taken together with
statin medications. Gemfibrozil interferes with the breakdown of statins, resulting
in higher statin blood levels, and hence a higher likelihood of muscle toxicity from the
statin. Doctors generally avoid combining a statin with gemfibrozil because of
concern over the higher risk of muscle damage with the combination;
however, fenofibrate does not interfere
with the breakdown of statins and should be the safer fibrate to use whenever it is
necessary to use a fibrate with a statin. Furthermore, pravastatin
seems to have fewer muscle toxic effects than the other statins when combined with fibrates.
Reference: FDA Prescribing Information
Last Editorial Review: 4/5/2005
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
- gemfibrozil, Lopid - Explains the medication gemfibrozil (Lopid), a drug used for selected persons with either low HDL cholesterol and/or high triglyceride concentrations to reduce the risk of heart attacks and pancreatitis.
- Pancreatitis - Read about acute and chronic pancreatitis; including description, causes, symptoms, how it is diagnosed, and treated.
- fenofibrate-oral, Tricor - Consumer information about the medication FENOFIBRATE - ORAL (Tricor), includes side effects, drug interactions, recommended dosages, and storage information. Read more about the prescription drug FENOFIBRATE - ORAL.
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