Fibric acid derivatives for high cholesterol

Examples

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Brand Name	Chemical Name
Tricor	fenofibrate

Brand Name	Chemical 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 LDL, low HDL, and high triglycerides.

How Well It Works

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• HDL may be increased by 20%.¹
• Triglycerides may be lowered by 40% to 50%.¹

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

Test results show fenofibrate reduces the progression of CAD in people who have type 2 diabetes.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

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 cholesterol, but they are useful for those who have metabolic syndrome with high triglycerides, low HDL, and low LDL.⁵

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 any muscle problems or pain, report it immediately to your doctor.

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.⁶

Gemfibrozil is usually taken twice per 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. Grundy SM, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486–2497.

2. Rubins HB, et al. (1999). Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. New England Journal of Medicine, 341(6): 410–418.

3. Steiner G, et al. (2001). Effect of fenofibrate on progression of coronary artery disease in type 2 diabetes: The Diabetes Atherosclerosis Intervention Study, a randomised study. Lancet, 357(9260): 905–910.

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.

5. Frick MH, et al. (1987). Helsinki heart study: Primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. New England Journal of Medicine, 317(20): 1237–1245.

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

Credits

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Author	Ralph Poore
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Associate Editor	Terrina Vail
Primary Medical Reviewer	Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer	Neil J. Stone, MD, FACC, FACP - Internal Medicine, Cardiology
Last Updated	July 20, 2006