Lipidil-Ter (Fenofibrate)

Fenofibrate is indicated for disorders of lipid metabolism that increase cardiovascular risk.

• Hypertriglyceridemia: reduces very‑low‑density lipoprotein triglycerides and lowers plasma triglyceride concentrations.
• Mixed dyslipidemia: improves the overall lipid profile by decreasing triglycerides and modestly raising HDL‑cholesterol.
• Primary hypercholesterolemia: contributes to lowering total cholesterol and LDL‑cholesterol when used as part of a comprehensive treatment plan.

• Fenofibrate activates peroxisome proliferator‑activated receptor alpha (PPARα), a nuclear transcription factor that up‑regulates genes involved in fatty‑acid oxidation, lipoprotein lipase activity, and reduces hepatic triglyceride synthesis, resulting in decreased plasma triglycerides and modest improvements in HDL‑cholesterol and LDL‑cholesterol levels.

Fenofibrate may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Abdominal pain: mild to moderate discomfort in the stomach area.
• Nausea: feeling of queasiness, sometimes leading to vomiting.
• Dyspepsia: indigestion or heartburn.
• Headache: mild to moderate head pain.
• Dizziness: sensation of light‑headedness.
• Elevated liver enzymes: mild increase in hepatic transaminases.

Serious or Rare Side Effects

• Rhabdomyolysis: severe muscle breakdown that can lead to kidney injury.
• Severe liver injury: marked elevation of liver enzymes or hepatic failure.
• Pancreatitis: inflammation of the pancreas.
• Allergic reactions: rash, itching, or anaphylaxis.
• Myopathy: muscle pain or weakness.
• Gallstones: formation of biliary calculi.

Before initiating therapy, consider the following safety measures.

• Monitor liver function: obtain baseline and periodic liver enzyme tests.
• Monitor renal function: assess serum creatinine and eGFR, especially in patients with existing kidney disease.
• Assess lipid profile: evaluate triglyceride and cholesterol levels to gauge therapeutic response.
• Review concomitant medications: avoid strong CYP2C9 inhibitors and drugs that increase myopathy risk.
• Evaluate for gallbladder disease: fenofibrate may promote gallstone formation.
• Store at ambient temperature: keep in the original container, protect from moisture and direct sunlight.

Fenofibrate can interact with several medicines, requiring careful management.

Major Interactions (Avoid)

• Cyclosporine: increased risk of myopathy and renal toxicity.
• Gemfibrozil: additive risk of severe muscle toxicity, including rhabdomyolysis.
• Strong CYP2C9 inhibitors (e.g., fluconazole): may raise fenofibrate plasma concentrations.

Moderate Interactions (Monitor Closely)

• Anticoagulants (warfarin): potential enhancement of anticoagulant effect, requiring INR monitoring.
• Statins: increased likelihood of muscle-related adverse events.
• Bile‑acid sequestrants: may reduce fenofibrate absorption, lowering efficacy.
• Thiazide diuretics: possible rise in serum creatinine.
• ACE inhibitors: may affect renal function when combined.