Cardiovascular
Fibrates
e.g. fenofibrate — Mainly lower triglycerides — used in specific lipid problems rather than as routine cholesterol drugs.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
What it is
Fibrates are lipid-lowering drugs used mainly to reduce high triglycerides, including the very high levels that can cause pancreatitis, and in some mixed lipid disorders. They are not a routine substitute for statins.
How it works
They activate a cell receptor (PPAR-alpha) that ramps up the breakdown of triglyceride-rich particles and changes how the liver handles fats, substantially lowering triglycerides and modestly raising "good" HDL cholesterol.
In practice
In practice fibrates are not first-line cholesterol drugs (that is the statins) but are used where triglycerides are the main problem — particularly very high levels that risk pancreatitis — and sometimes added in specific mixed lipid disorders. The practical cautions centre on muscle and kidney: combining a fibrate with a statin increases the risk of muscle toxicity (and gemfibrozil in particular should not be combined with a statin), and the dose is adjusted in renal impairment. They can also raise liver enzymes and slightly increase the risk of gallstones, and they enhance the effect of warfarin. Lifestyle measures — alcohol, weight, diabetes control — are central in the high-triglyceride states fibrates are used to treat.
Examples
Practical use
How to take it & use it well
- Take fenofibrate as prescribed, usually once a day, and follow your pharmacist's advice on whether to take it with food.
- Swallow the capsule or tablet whole with water unless told otherwise, and keep to the same product if you can.
- Keep up healthy eating, regular activity and limiting alcohol, as these strongly affect triglyceride levels alongside the medicine.
- Report unexplained muscle pain, tenderness or weakness, especially with fever or dark urine, as this can signal a muscle problem.
- Attend blood tests to check your fats, liver and sometimes kidney function while on treatment.
- Tell your prescriber about all other medicines, particularly statins and blood thinners, before starting.
Common uses
- High triglycerides (including pancreatitis-risk levels)
- Some mixed dyslipidaemias
- Adjunct where statins alone do not control triglycerides
Monitoring
- Lipid profile (especially triglycerides)
- Renal and liver function; muscle symptoms
- INR if taken with warfarin
Weighing it up
Advantages & disadvantages
Advantages
- Particularly effective at lowering high triglyceride levels in the blood.
- Can help reduce the risk of pancreatitis caused by very high triglycerides.
- May modestly raise the protective HDL cholesterol in some people.
- Useful for people whose main lipid problem is raised triglycerides rather than LDL cholesterol.
Disadvantages
- Can cause muscle problems, and this risk increases when combined with a statin.
- May cause stomach upset, and can occasionally affect the liver, so blood tests are needed.
- Can slightly increase the risk of gallstones in some people.
- May affect kidney function readings, so monitoring is sometimes required.
Key safety principles
What to watch for
- Increased muscle-toxicity risk with statins — gemfibrozil in particular should not be combined with a statin.
- Adjust the dose in renal impairment; can raise liver enzymes and the risk of gallstones.
- Enhances the effect of warfarin — monitor INR.
Key interactions
What to avoid or check alongside
- Combining fenofibrate with a statin increases the risk of muscle damage; the combination with gemfibrozil in particular is avoided and any combination needs caution.
- Fibrates can strengthen the effect of warfarin and other blood thinners, raising bleeding risk, so clotting is monitored more closely.
- Gemfibrozil can raise levels of some diabetes medicines such as repaglinide, increasing the risk of low blood sugar.
- Combining with medicines that can harm the kidneys may add to kidney strain.
- Tell your pharmacist about all your medicines so any overlap, especially with statins, can be reviewed.
Patient & carer advice
- These mainly target triglycerides rather than ordinary cholesterol
- Report muscle pain, weakness or dark urine
- Diet, alcohol and weight matter a great deal alongside the tablets
Use with
Related clinical calculators
Dose and risk decisions for this class often depend on renal function, weight or bleeding/stroke risk. These tools help:
Answers
Fibrates: frequently asked questions
What are fibrates mainly used for?
Fibrates such as fenofibrate are mainly used to lower high triglyceride levels in the blood. This can also help reduce the risk of pancreatitis when triglycerides are very high.
Can I take a fibrate with a statin?
Sometimes, but with caution, because combining them raises the risk of muscle damage. The combination with gemfibrozil is particularly avoided. Report any muscle pain, tenderness or weakness promptly.
Why should I report muscle pain on a fibrate?
Fibrates can rarely cause muscle damage, especially alongside a statin. Unexplained muscle pain, tenderness or weakness, particularly with fever or dark urine, needs prompt medical review.
Do fibrates interact with warfarin?
Yes. Fibrates can increase the effect of warfarin and other blood thinners, raising bleeding risk. Your team will usually check your clotting more closely when starting or changing the dose.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
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