Fibrates (cont.)

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Fibrates also have 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 for 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 certain statins (for example, simvastatin [Zocor] or lovastatin [Mevacor, Altoprev]), resulting in higher statin blood levels, and hence a higher likelihood of muscle toxicity from the statin. Doctors generally avoid combining a statin with fibrates because of concern over the higher risk of muscle damage with the combination. Gemfibrozil should not be combined with simvastatin and if combined with lovastatin the dose of lovastatin should not exceed 20 mg daily. However, fenofibrate does not interfere with the breakdown of statins and should be the safer fibrate to use if it is necessary to use a fibrate with a statin. Furthermore, pravastatin (Pravachol) seems to have fewer muscle toxic effects than the other statins when combined with fibrates, but the risk still exists.

What are examples of fibrates available in the U.S.?

Examples of fibrates available in the U.S. include:

  • gemfibrozil, (Lopid) and
  • fenofibrate (Tricor, Fibricor).

REFERENCE: FDA Prescribing Information.

Previous contributing author: Dennis Lee, M.D.

Last Editorial Review: 3/12/2012

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