Which medications in the drug class Fibric Acid Agents are used in the treatment of Hypertriglyceridemia?

Updated: Jul 23, 2021
  • Author: Mary Ellen T Sweeney, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Fibric Acid Agents

Fenofibrate is reported to lower LDL levels more reliably than either clofibrate or gemfibrozil, but none of the drugs in this class should be used for isolated LDL elevations. The fibrates are commonly used to treat hyperlipidemias types IV (high VLDL) and V (high VLDL and chylomicrons), as well as type III dysbetalipoproteinemia (IDL or VLDL remnant disease).

These agents can also be used to treat type IIb mixed hyperlipidemia if used in conjunction with an LDL-lowering medication such as a resin.

Gemfibrozil (Lopid)

Gemfibrozil lowers triglycerides, VLDL, and IDL, but raises HDL. LDL is usually is unaffected but may increase if it is initially low or decrease if it is initially high. This agent increases the activity of lipoprotein lipase, which hydrolyzes triglycerides in triglyceride-rich lipoproteins. Gemfibrozil reduces synthesis of VLDL in the liver and increases the clearance of remnant lipoproteins from blood.

Gemfibrozil is available in generic formulation, most cost-effective fibrate at this time. Its FDA-approved indications are for type IV and V hyperlipidemia (ie, elevations in VLDL only or both VLDL and chylomicrons).

Fenofibrate (Tricor, Lofibra, TriCor, Antara, Triglide)

Fenofibrate is similar to other fibric acid derivatives in triglyceride-lowering and HDL-raising effects. However, this agent differs in that modest LDL-lowering can be expected with greater frequency than with gemfibrozil.

The FDA-approved indications for fenofibrate are for hypertriglyceridemia and hypercholesterolemia, but this difference does not qualify fenofibrate for treatment of isolated LDL elevations. Fenofibrate is taken once a day, which may increase patient compliance. Patients with mild-to-moderate renal disease should receive a reduced dose (about one third of the usual dose), and it is contraindicated in severe renal impairment.


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