Fenofibrate

Fibrate, Lipid-lowering agent, PPAR-α agonist

Fenofibrate

Tricor, Lipofen, Antara, Fenoglide, Lofibra, Triglide, Trilipix (fenofibric acid)

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Summary

Classes

Fibrate, Lipid-lowering agent, PPAR-α agonist

Pharmacy

Starting dose

Varies by salt form and brand; e.g., Tricor 145 mg PO daily; reduce to 48 mg in renal impairment

Preparations

Multiple non-bioequivalent fenofibrate and fenofibric acid formulations: 48-200 mg

US FDA Max

Formulation-specific (e.g., 145 mg/d Tricor, 200 mg/d Lipofen)

Pharmacology

Routes

Oral

Onset

Triglyceride lowering at 4-8 weeks

Duration

24 hours

Half-life

~20 hours (fenofibric acid, the active metabolite)

Bioavailability

Increased with food (varies by formulation; the micronized and nanocrystal forms are less food-dependent)

Pregnancy

Limited data; generally avoided unless triglyceride pancreatitis risk is high.^{[citation needed]}

Legal status

Rx-only in US

Purported mechanism

Fenofibrate is a prodrug hydrolyzed to fenofibric acid, a peroxisome proliferator-activated receptor α (PPARα) agonist; PPARα activation upregulates lipoprotein lipase and apolipoprotein A-I/A-II expression and downregulates apolipoprotein C-III, accelerating VLDL clearance and lowering plasma triglycerides 30-50%.▲0▼ Modest HDL rise; LDL effects mixed. Renally cleared; combination with statin carries elevated myopathy risk (greater for gemfibrozil than fenofibrate, but caution still warranted).