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Your Cholesterol Profile - In Depth (cont.)

What are fibric acid derivatives (fibrates)?

Fibric acid derivatives (fibrates) are effective medications in lowering blood triglyceride levels. Fibrates lower blood triglyceride levels by inhibiting the liver production of VLDL (the triglyceride-rich lip-protein fraction), 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 an illness with severe abdominal pain). By lowering the blood triglycerdes, fibrates are used to prevent pancreatitis.

Fibrates are not effective in lowering LDL cholesterol and cannot be used alone in lowering LDL cholesterol levels. However, when a high risk patient (see NCEP recommendations above) 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 the 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 also cause liver irritation. The liver irritation is usually mild and reversible, but it occasionally can be severe enough to require stopping the drug.

Fibrates can cause gallstones when used over several years.

The fibrates can increase the effectiveness of blood thinners, such as Coumadin, when both medications are used together. Thus, the dose of Coumadin should be adjusted to avoid over-thinning of the blood, which can lead to excessive bleeding.

Fibrates can cause muscle damage. Doctors generally avoid combining a statin with gemfibrozil because of concern over the added risk of muscle damage with the combination. Gemfibrozl interferes with the breakdown of statin, resulting in higher statin blood levels, and hence a higher likelihood of muscle toxicity. Fenofibrate does not interfere with the breakdown of a statin, and should be the safer fibrate to use whenever a fibrate-statin combination is necessary. Furthermore, pravastatin seems to have fewer muscle toxic effects than the other statins when combined with a fibrate.



Next: What are bile acid sequestrants? »

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