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Hyperlipidemia

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Fibric AcidAka: Gemfibrozil, Clofibrate, Fenofibrate, Tricor, Trilipix

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  1. Effects
    1. Decreases Triglycerides (20-50%)
    2. Increases LDL Cholesterol (10-15%)
    3. Decreases VLDL Cholesterol
    4. Increases HDL Cholesterol (10-15%)
  2. Adverse effects
    1. Higher rate of Gastrointestinal Disease
      1. Cholecystitis
      2. Appendicitis
    2. May potentiate effects of:
      1. Coumadin
      2. Oral Hypoglycemic Agents
  3. Contraindications
    1. Absolute
      1. 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
  4. 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. Increased mortality from malignant and GI disease

Clofibrate (C0009002)

Definition (MSH)A fibric acid derivative used in the treatment of HYPERLIPOPROTEINEMIA TYPE III and severe HYPERTRIGLYCERIDEMIA. (From Martindale, The Extra Pharmacopoeia, 30th ed, p986)
Definition (CSP)fibric acid derivative used in the treatment of hyperlipoproteinemia and hypertriglyceridemia.
Definition (PDQ)An aryloxyisobutyric acid derivate with antihyperlipidemic activity. Although the exact mechanism of action has not been fully characterized, clofibrate may enhance the conversion of very-low-density lipoprotein (VLDL) to low-density lipoprotein (LDL), decreasing the production of hepatic VLDL, inhibiting cholesterol production, and increasing fecal excretion of neutral sterols. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42108&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42108&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C378" NCI Thesaurus)
Definition (NCI)An aryloxyisobutyric acid derivate with antihyperlipidemic activity. Although the exact mechanism of action has not been fully characterized, clofibrate may enhance the conversion of very-low-density lipoprotein (VLDL) to low-density lipoprotein (LDL), decreasing the production of hepatic VLDL, inhibiting cholesterol production, and increasing fecal excretion of neutral sterols.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD002994
EnglishCFB, Clofibrate, CLOFIBRATE PREPARATION, Ethyl Chlorophenoxyisobutyrate, Ethyl p-Chlorophenoxyisobyturate
Spanishclofibrato
Parent ConceptsAntilipemic Agents (C0003367), chlorophenoxyacetate (C0596330), Butyrates (C0006521), Clofibric Acid (C0009003), Antilipidemic Agent (C1516000), Fibrate antihyperlipidemic (C0358700), Fibrates (C1449704)
SourcesCSP, LCH, LNC, MSH, MTH, NCI, NDFRT, PDQ, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Gemfibrozil (C0017245)

Definition (MSH)A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol. These decreases occur primarily in the VLDL fraction and less frequently in the LDL fraction. Gemfibrozil increases HDL subfractions HDL2 and HDL3 as well as apolipoproteins A-I and A-II. Its mechanism of action has not been definitely established.
Definition (CSP)lipid regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol.
Definition (NCI)A fibric acid derivative with hypolipidemic effects. Gemfibrozil interacts with peroxisome proliferator-activated receptors (PPARalpha) resulting in PPARalpha-mediated stimulation of fatty acid oxidation and an increase in lipoprotein lipase (LPL) synthesis. This enhances triglyceride-rich lipoprotein clearance and reduces the expression of apolipoprotein C-III (apoC-III). The reduction in hepatic production of apoC-III results in subsequent reduction of serum levels of very-low-density-lipoprotein cholesterol (VLDL-C). In addition, gemfibrozil-mediated PPARalpha stimulation of apoA-I and apoA-II expression results in an increase in high-density lipoprotein cholesterol (HDL-C).
ConceptsLipid (T119) , Pharmacologic Substance (T121)
MSHD015248
EnglishGemfibrosil, Gemfibrozil, GEMFIBROZIL PREPARATION, Gemfibrozil product
Spanishgemfibrozil, gemfibrozilo, genfibrocil
Parent ConceptsAnticholesteremic Agents (C0003277), carboxylate (C0178528), Clofibric Acid (C0009003), Pentanoic Acids (C0030869), Antilipidemic Agent (C1516000), Antilipemic Agents (C0003367), Fibrates (C1449704)
SourcesCSP, LNC, MSH, MTHSPL, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)



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