Fibric acid derivatives for high cholesterol

Examples

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Brand Name	Generic Name
Triglide	fenofibrate

Brand Name	Generic Name
Lopid	gemfibrozil

How It Works

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These drugs lower triglycerides and raise HDL ("good") cholesterol. They may have little effect on LDL ("bad") cholesterol levels.

Why It Is Used

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Gemfibrozil or fenofibrate is prescribed for people who have very high triglycerides or who have low HDL and high triglycerides.

Gemfibrozil may be used to reduce the risk of heart attack in people with coronary artery disease (CAD) who have low HDL, and high triglycerides.

How Well It Works

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• HDL may be increased by 10% to 35%.¹
• Triglycerides may be lowered by 25% to 50%.¹

Gemfibrozil may significantly reduce the risk of heart attack in people who have CAD and low HDL levels. It may also be helpful in people who have several risk factors for metabolic syndrome or who have metabolic syndrome.²

Side Effects

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Gemfibrozil

• The most common side effects are upset stomach, nausea, or vomiting.
• Abdominal pain is the second most common side effect.
• There is a slightly increased risk of gallstones.
• Gemfibrozil can interact with drugs that prevent blood clotting (anticoagulants), causing bleeding.

Fenofibrate

• The most common side effects are rash and gastrointestinal problems such as stomach upset.
• There is a slightly increased risk of gallstones, inflamed liver (hepatitis), and muscle inflammation (myositis).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Fibric acid derivatives do not significantly lower LDL cholesterol in most people. They may cause LDL levels to rise a bit. Usually, fibric acid derivatives are not useful for people who are at risk for coronary artery disease because of high LDL. But gemfibrozil may lower the risk of heart attack in people who have coronary artery disease and low HDL levels. It may also be helpful for people who have several risk factors for metabolic syndrome or who have metabolic syndrome.²

Fibric acid derivatives should be used with caution by people who are taking statins. There is a greater risk of developing a life-threatening muscle problem called rhabdomyolysis, which can lead to kidney failure. In order to take this combination of medicines, you must have normal kidney and liver function. If you have unusual muscle pain, weakness, or tenderness, report it to your doctor immediately.

Studies show that fenofibrate is safer than gemfibrozil when taken with a statin. Fenofibrate does not interfere with how liver metabolizes—or breaks down—the statin. Because of this, high and possibly harmful levels of statins do not develop.³

The results of one study show that fenofibrate should not be used instead of statins by people with diabetes if they are able to take a statin without any problems.⁴

Gemfibrozil is usually taken twice a day, 30 minutes before the morning and evening meals.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Drugs for lipids (2008). Treatment Guidelines From the Medical Letter, 6(66): 9–16.

2. Tenkanen L, et al. (2006). Gemfibrozil in the treatment of dyslipidemia. Archives of Internal Medicine, 166(7): 743–748.

3. Bellosta S, et al. (2004). Safety of statins: Focus on clinical pharmacokinetics and drug interactions. Circulation, 109(23, Suppl 1): III50–III57.

4. Keech A, et al. (2005). Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): Randomised controlled trial. Lancet, 366(9500): 1849–61.

Credits

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Author	Robin Parks, MS
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer	Robert A. Kloner, MD, PhD - Cardiology
Last Updated	July 11, 2008