Antara® (Fenofibrate micronized)
Dosage forms
Capsule
- 43 mg
- 90 mg
- 130 mg
Dosing
Primary hypercholesterolemia and mixed dyslipidemia
- Dosing: 130 mg once daily
- Max: 130 mg once daily
- Do not open, crush, dissolve, or chew capsules
- Recheck lipids in 4 - 8 weeks
- May take without regard to food
Severe Hypertriglyceridemia
- Dosing: 43 - 130 mg once daily
- Max: 130 mg once daily
- Do not open, crush, dissolve, or chew capsules
- Recheck lipids in 4 - 8 weeks
- May take without regard to food
Kidney disease
- CrCl 30 - 89 ml/min: starting dose is 43 mg/day. Titrate as tolerated.
- CrCl < 30 ml/min: DO NOT USE
Liver disease
- Has not been studied. Contraindicated in active liver disease.
Generic / Price
- 90 mg dose: YES/$$$$
- 43 and 130 mg dose: YES/$
Fenoglide® (Fenofibrate)
Dosage forms
Tablet
- 40 mg
- 120 mg
Dosing
Primary hypercholesterolemia or mixed dyslipidemia
- Dosing: 120 mg once daily
- Max: 120 mg once daily
- Do not crush, dissolve, or chew tablets
- Recheck lipids in 4 - 8 weeks
- Take with food to increase absorption
Severe Hypertriglyceridemia
- Dosing: 40 - 120 mg once daily
- Max: 120 mg once daily
- Do not crush, dissolve, or chew tablets
- Recheck lipids in 4 - 8 weeks
- Take with food to increase absorption
Kidney disease
- CrCl 30 - 89 ml/min: starting dose is 40 mg/day. Titrate as tolerated.
- CrCl < 30 ml/min: DO NOT USE
Liver disease
- Has not been studied. Contraindicated in active liver disease.
Generic / Price
- 40 mg - YES/$$
- 120 mg - YES/$$$$
Lipofen® (Fenofibrate)
Dosage forms
Capsule
- 50 mg
- 150 mg
Dosing
Primary hypercholesterolemia or mixed dyslipidemia
- Dosing: 150 mg once daily
- Max: 150 mg once daily
- Do not open, crush, dissolve, or chew capsules
- Recheck lipids in 4 - 8 weeks
- Take with food to increase absorption
Severe Hypertriglyceridemia
- Dosing: 50 - 150 mg once daily
- Max: 150 mg once daily
- Do not open, crush, dissolve, or chew capsules
- Recheck lipids in 4 - 8 weeks
- Take with food to increase absorption
Kidney disease
- CrCl 30 - 89 ml/min: starting dose is 50 mg/day. Titrate as tolerated.
- CrCl < 30 ml/min: DO NOT USE
Liver disease
- Has not been studied. Contraindicated in active liver disease.
Generic / Price
- YES/$$-$$$Lofibra® capsule (Fenofibrate micronized)
Dosage forms
Capsule
- 67 mg
- 134 mg
- 200 mg
Dosing
Primary hypercholesterolemia or mixed dyslipidemia
- Dosing: 200 mg once daily
- Max: 200 mg once daily
- Take with meals to increase absorption
Severe Hypertriglyceridemia
- Dosing: 67 - 200 mg once daily
- Max: 200 mg once daily
- Take with meals to increase absorption
Kidney disease
- CrCl 30 - 89 ml/min: starting dose is 67 mg/day. Titrate as tolerated.
- CrCl < 30 ml/min: DO NOT USE
Liver disease
- Has not been studied. Contraindicated in active liver disease.
Generic / Price
- YES/$Lofibra® tablet (Fenofibrate)
Dosage forms
Tablet
- 54 mg
- 160 mg
Dosing
Primary hypercholesterolemia or mixed dyslipidemia
- Dosing: 160 mg once daily
- Max: 160 mg once daily
- May take without regard to food
Severe Hypertriglyceridemia
- Dosing: 54 - 160 mg once daily
- Max: 160 mg once daily
- May take without regard to food
Kidney disease
- CrCl 30 - 89 ml/min: starting dose is 54 mg/day. Titrate as tolerated.
- CrCl < 30 ml/min: DO NOT USE
Liver disease
- Has not been studied. Contraindicated in active liver disease.
Generic / Price
- YES/$Tricor® (Fenofibrate)
Dosage forms
Tablet
- 48 mg
- 145 mg
Dosing
Primary hypercholesterolemia or mixed dyslipidemia
- Dosing: 145 mg once daily
- Max: 145 mg once daily
- May take without regard to food
Severe hypertriglyceridemia
- Dosing: 48 - 145 mg once daily
- Max: 145 mg once daily
- May take without regard to food
Kidney disease
- CrCl 30 - 89 ml/min: starting dose is 48 mg/day. Titrate as tolerated.
- CrCl < 30 ml/min: DO NOT USE
Liver disease
- Has not been studied. Contraindicated in active liver disease.
Generic / Price
- YES/$Triglide® (Fenofibrate)
Dosage forms
Tablet
- 160 mg
Dosing
Primary hypercholesterolemia or mixed dyslipidemia
- Dosing: 160 mg once daily
- Max: 160 mg once daily
- Do not crush, break, dissolve, or chew tablets
- Recheck lipids in 8 weeks
- May take without regard to food
Severe Hypertriglyceridemia
- Dosing: 160 mg once daily
- Max: 160 mg once daily
- Do not crush, break, dissolve, or chew tablets
- Recheck lipids in 8 weeks
- May take without regard to food
Kidney disease
- CrCl ≤ 89 ml/min - DO NOT USE
Liver disease
- Has not been studied. Contraindicated in active liver disease.
Generic / Price
- NO/$$$$Trilipix® (Choline fenofibrate | Fenofibric acid)
Dosage forms
Capsule, delayed-release
- 45 mg
- 135 mg
- Each capsule contains choline fenofibrate, equivalent to 45 mg or 135 mg of fenofibric acid
Dosing
Primary hypercholesterolemia or mixed dyslipidemia
- Dosing: 135 mg once daily
- Max: 135 mg once daily
- Do not open, crush, dissolve, or chew capsules
- Recheck lipids in 4 - 8 weeks
- May take without regard to food
Severe Hypertriglyceridemia
- Dosing: 45 - 135 mg once daily
- Max: 135 mg once daily
- Do not open, crush, dissolve, or chew capsules
- Recheck lipids in 4 - 8 weeks
- May take without regard to food
Kidney disease
- CrCl 30 - 89 ml/min: starting dose is 45 mg/day. Titrate as tolerated.
- CrCl < 30 ml/min: DO NOT USE
Liver disease
- Has not been studied. Contraindicated in active liver disease.
Generic / Price
- YES/$Lopid® (Gemfibrozil)
Dosage forms
Tablet
- 600 mg
Dosing
High cholesterol
- Dosing: 600 mg twice daily
- Max: 600 mg twice daily
- Take 30 minutes before the morning and evening meal
Severe Hypertriglyceridemia
- Dosing: 600 mg twice daily
- Max: 600 mg twice daily
- Take 30 minutes before the morning and evening meal
Kidney disease
- CrCl 30 - 89 ml/min: has not been studied
- CrCl < 30 ml/min: DO NOT USE
Liver disease
- Has not been studied. Contraindicated in liver disease.
Generic / Price
- YES/$- Kidney disease
- AHA recommendations
- The AHA 2013 cholesterol treatment guidelines state that serum creatinine should be checked before, within 3 months of initiation, and every 6 months thereafter in patients receiving fenofibrates. If GFR is < 30 ml/min, fenofibrates should not be used. If GFR is 30 - 59 ml/min, the dose of fenofibrate should not exceed 54 mg/day [19]
- Antara®
- CrCl 30 - 89 ml/min: starting dose is 43 mg/day. Titrate as tolerated.
- CrCl < 30 ml/min: DO NOT USE
- Fenoglide®
- CrCl 30 - 89 ml/min: starting dose is 40 mg/day. Titrate as tolerated.
- CrCl < 30 ml/min: DO NOT USE
- Lipofen®
- CrCl 30 - 89 ml/min: starting dose is 50 mg/day. Titrate as tolerated.
- CrCl < 30 ml/min: DO NOT USE
- Lofibra® capsule
- CrCl 30 - 89 ml/min: starting dose is 67 mg/day. Titrate as tolerated.
- CrCl < 30 ml/min: DO NOT USE
- Lofibra® tablet
- CrCl 30 - 89 ml/min: starting dose is 54 mg/day. Titrate as tolerated.
- CrCl < 30 ml/min: DO NOT USE
- Lopid®
- CrCl 30 - 89 ml/min: has not been studied
- CrCl < 30 ml/min: DO NOT USE
- Tricor®
- CrCl 30 - 89 ml/min: starting dose is 48 mg/day. Titrate as tolerated.
- CrCl < 30 ml/min: DO NOT USE
- Triglide®
- CrCl ≤ 89 ml/min: DO NOT USE
- Trilipix®
- CrCl 30 - 89 ml/min: starting dose is 45 mg/day. Titrate as tolerated.
- CrCl < 30 ml/min: DO NOT USE
- Liver disease
- Fibrates have not been studied in liver disease and are contraindicated in patients with active liver disease, including those with primary biliary cirrhosis and unexplained persistent liver function abnormalities
- DRUG INTERACTIONS
- NOTE: The drug interactions presented here are NOT all-inclusive. Other interactions may exist. Drug interaction checkers provide the most efficient and practical way to check for interactions among multiple medications. A free interaction checker is available from Drugs.com (see Drugs.com interactions checker).
- All fibrates
- Bile Acid Sequestrants (Questran®, Welchol®) - bile acid sequestrants may interfere with the absorption of fibrates. Fibrates should be taken 1 hour before or 4 hours after bile acid sequestrants. [5,6,7]
- Colchicine (Colcrys®) - muscle toxicity including rhabdomyolysis has been reported in patients taking fenofibrates with colchicine. Use caution when prescribing together.
- Ezetimibe (Zetia®) - ezetimibe and fibrates increase cholesterol excretion into the bile, raising the risk of gallstones in susceptible patients. Furthermore, gemfibrozil and fenofibrate increase ezetimibe exposure. Use caution when combining.
- Immunosuppressants - immunosuppressants such as cyclosporine and tacrolimus can be nephrotoxic and may reduce the elimination of fibrates. Use caution when combining.
- Warfarin (Coumadin®) - fibrates may interfere with warfarin therapy. Monitor INR levels when adding fibrates to warfarin. [5,6,7]
- Gemfibrozil (Lopid®)
- CYP2C8 substrates - gemfibrozil is a CYP2C8 strong inhibitor, and it may increase exposure to CYP2C8 substrates
- Dasabuvir (Viekira Pak™) - DO NOT COMBINE. Gemfibrozil increases dasabuvir exposure.
- Enzalutamide (Xtandi®) - gemfibrozil increases enzalutamide exposure, raising the risk of seizures. The enzalutamide dose should be reduced when taken with gemfibrozil.
- Glitazones (pioglitazone, rosiglitazone, Actos®, Avandia®) - gemfibrozil increases pioglitazone and rosiglitazone exposure. The pioglitazone dose should not exceed 15 mg when taken with gemfibrozil.
- OATP1B1 substrates - gemfibrozil is an OATP1B1 inhibitor, and it may increase exposure to OATP1B1 substrates.
- Repaglinide (Prandin®) - DO NOT COMBINE. Gemfibrozil increases repaglinide exposure.
- Selexipag (Uptravi®) - DO NOT COMBINE. Gemfibrozil has been shown to double selexipag levels and increase exposure to its active metabolite 11-fold.
- Statins (Lipitor®, Zocor®, Crestor®, etc)
- Simvastatin: DO NOT COMBINE
- Rosuvastatin: Gemfibrozil should not be taken with rosuvastatin. If concomitant use cannot be avoided, rosuvastatin dosing should start at 5 mg once daily and not exceed 10 mg/day.
- Other statins: combining gemfibrozil with a statin increases the risk of muscle toxicity (rhabdomyolysis) and should generally be avoided. If a statin-fibrate combination is necessary, fenofibrates are preferred, as they have been used safely with statins several trials. [1,2]
- Metabolism and clearance
- Gemfibrozil (Lopid®)
- CYP2C8 - strong inhibitor
- CYP2C9 - inhibitor
- CYP2C19 - inhibitor
- CYP1A2 - inhibitor
- OATP1B1 - inhibitor
- UGT1A1 and 1A3 - inhibitor
- Fenofibrate (Antara®, Fenoglide®, Lipofen®, Lofibra®, Tricor®, Triglide®)
- CYP2C9 - mild-moderate inhibitor
- CYP2C8 - weak inhibitor
- CYP2C19 - weak inhibitor
- CYP2A6 - weak inhibitor
- Fenofibric acid (Trilipix®)
- PRICE ($) INFO
Pricing legend
- $ = 0 - $50
- $$ = $51 - $100
- $$$ = $101 - $150
- $$$$ = > $150
- Pricing based on one month of therapy at standard dosing in an adult
- Pricing based on information from GoodRX.com®
- Pricing may vary by region and availability
- BIBLIOGRAPHY
- Manufacturer's Package insert
- 1 - PMID 16310551
- 2 - PMID 20228404