Fenofibrate activates peroxisome proliferator-activated receptor alpha (PPAR-α), a nuclear receptor that regulates lipid metabolism. This activation:

1. Reduces Triglycerides: Enhances lipoprotein lipase activity, increasing clearance of triglyceride-rich particles (VLDL, chylomicrons).
2. Modifies LDL Cholesterol: Shifts LDL particles to larger, less atherogenic forms.
3. Raises HDL Cholesterol: Stimulates apolipoprotein A-I and A-II synthesis (Lippincott Textbook of Pharmacology).

1. Hypertriglyceridemia:
   • Management of severe hypertriglyceridemia (Fredrickson type IV/V) to prevent pancreatitis.
2. Mixed Dyslipidemia:
   • Adjuvant therapy in patients with elevated triglycerides and low HDL cholesterol, particularly when statins are insufficient (BNF).
3. Primary Prevention:
   • May reduce cardiovascular risk in select patients with type 2 diabetes and dyslipidemia (Lange Basic & Clinical Pharmacology).

• Adults:
  • Standard Dose: 145 mg once daily (micronized formulation).
  • Non-Micronized Formulations: 67–200 mg daily, depending on brand.
• Renal Impairment:
  • eGFR 30–60 mL/min: Reduce dose by 50%.
  • eGFR <30 mL/min: Contraindicated.
• Administration:
  • Take with food to enhance absorption.

Avoid concomitant bile acid sequestrants (e.g., cholestyramine); administer 1 hour before or 4–6 hours after

• Common (≥1%):
  • Gastrointestinal disturbances (nausea, abdominal pain, diarrhea).
  • Headache, elevated liver enzymes (ALT/AST).
• Serious (Rare):
  • Myopathy/Rhabdomyolysis: Risk increases with concurrent statins.
  • Pancreatitis: Linked to rapid triglyceride reduction.
  • Cholelithiasis: Due to increased biliary cholesterol excretion.

Hepatotoxicity: Discontinue if ALT/AST >3× ULN

• Contraindications:
  • Severe hepatic or renal impairment (eGFR <30 mL/min).
  • Gallbladder disease, hypersensitivity to fibrates.
  • Pregnancy/lactation (avoid unless essential; potential fetal harm).
• Monitoring:
  • Baseline LFTs and renal function: Repeat LFTs at 3–6 months.
  • Lipid Profile: Assess efficacy at 2–3 months.
  • Muscle Symptoms: Check CK if myalgia occurs.

1. Statins (e.g., simvastatin): ↑ Risk of myopathy (avoid combination if possible).
2. Warfarin: Fenofibrate ↑ anticoagulant effect (monitor INR closely).
3. Cyclosporine: ↑ Risk of nephrotoxicity.
4. Bile Acid Sequestrants: Reduce fenofibrate absorption (dose separation required).

• Generic Name: Fenofibrate.
• Brand Names:
  • UK: Lipantil, Supralip.

US: Tricor, Fenoglide, Antara