Pharm

Fibric Acid

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Fibric Acid, Fibrate, Gemfibrozil, Clofibrate, Fenofibrate, Tricor, Trilipix

  • Efficacy
  1. Lipid effects
    1. Decreases Triglycerides (20-50%)
    2. Increases LDL Cholesterol (10-15%)
    3. Decreases VLDL Cholesterol
    4. Increases HDL Cholesterol (10-15%)
  2. Outcome effects
    1. No effect on all cause mortality
    2. NNT to prevent one coronary event: 46-125
  • Adverse effects
  1. Gastrointestinal effects
    1. Gastrointestinal upset
    2. Abdominal Pain
    3. Higher rate of Gastrointestinal Disease
      1. Cholecystitis (increased risk by 2-3%)
      2. Appendicitis
  2. Miscellaneous
    1. Rash
    2. Renal dysfunction (rare)
    3. Myopathy (rare)
  • Drug Interactions
  1. May potentiate effects of:
    1. Coumadin
    2. Oral Hypoglycemic Agents
  • Contraindications
  1. Absolute
    1. Severe Hepatic or renal disease
    2. Preexisting Gallstones
  2. Relative
    1. Concurrent Statin due to Myopathy risk
      1. Exercise caution when using these together
      2. Tricor is commonly used with Statins (Gemfibrozil is higher risk)
    2. Concurrent Coumadin use
    3. Avoid as a single agent in Coronary Artery Disease
  • Preparations
  1. Gemfibrozil (Lopid)
    1. Dose: 600 mg bid ($75/month)
  2. Fenofibrate (Tricor)
    1. Less likely to cause Rhabdomyolysis with Statin
  3. Fenofibrate (Trilipix)
    1. Rebranded version of Tricor in time for generic Fenofibrate release in 2011
  4. Clofibrate
    1. Discontinued in 2002
    2. Increased mortality from malignant and GI disease
  • References
  1. Last (2011) Am Fam Physician 84(5): 551-8 [PubMed]
  2. Studer (2005) Arch Intern Med 165(7): 725-30 [PubMed]
  3. Sharma (2009) Ann Intern Med 151(9):622-30 [PubMed]