II. Efficacy

  1. Lipid effects
    1. Decreases Triglycerides (20-50%)
    2. Increases LDL Cholesterol (10-15%)
    3. Decreases VLDL Cholesterol
    4. Increases HDL Cholesterol (10-15%)
  2. Outcome effects
    1. No effect on all cause mortality
    2. NNT to prevent one coronary event: 46-125

III. Adverse effects

  1. Gastrointestinal effects
    1. Gastrointestinal upset
    2. Abdominal Pain
    3. Higher rate of Gastrointestinal Disease
      1. Cholecystitis (increased risk by 2-3%)
      2. Appendicitis
  2. Miscellaneous
    1. Rash
    2. Renal dysfunction (rare)
    3. Myopathy (rare)

IV. Drug Interactions

  1. May potentiate effects of:
    1. Coumadin
    2. Oral Hypoglycemic Agents

V. Contraindications

  1. Absolute
    1. Severe 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

VI. 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. Discontinued in 2002
    2. Increased mortality from malignant and GI disease

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Related Studies

Cost: Medications

gemfibrozil (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
GEMFIBROZIL 600 MG TABLET Generic $0.09 each
fenofibrate (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
FENOFIBRATE 130 MG CAPSULE Generic $2.94 each
FENOFIBRATE 134 MG CAPSULE Generic $1.01 each
FENOFIBRATE 145 MG TABLET Generic $0.58 each
FENOFIBRATE 150 MG CAPSULE Generic $5.56 each
FENOFIBRATE 160 MG TABLET Generic $0.52 each
FENOFIBRATE 200 MG CAPSULE Generic $1.75 each
FENOFIBRATE 43 MG CAPSULE Generic $1.14 each
FENOFIBRATE 48 MG TABLET Generic $0.42 each
FENOFIBRATE 50 MG CAPSULE Generic $2.31 each
FENOFIBRATE 54 MG TABLET Generic $0.39 each
FENOFIBRATE 67 MG CAPSULE Generic $0.62 each
tricor (on 3/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
TRICOR 145 MG TABLET Generic $0.58 each
TRICOR 48 MG TABLET Generic $0.42 each
trilipix (on 3/8/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
TRILIPIX DR 135 MG CAPSULE Generic $1.61 each
TRILIPIX DR 45 MG CAPSULE Generic $0.89 each

Ontology: Clofibrate (C0009002)

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.
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)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D002994
SnomedCT 387439004, 77035009
LNC LP16082-7, MTHU016298
English clofibrate, Chlorophenoxyisobutyrate, Ethyl, Ethyl Chlorophenoxyisobutyrate, Propanoic acid, 2-(4-chlorophenoxy)-2-methyl-, ethyl ester, 2-(4-Chlorophenoxy)-2-methylpropanoic acid ethyl ester, Ethyl 2-(4-Chlorophenoxy)-2-methylpropanoate, Ethyl p-Chlorophenoxyisobyturate, Clofibrate, CFB, clofibrate (medication), Clofibrate [Chemical/Ingredient], clofibrates, Clofibric Acid, Ethyl Ester, Clofibrate (product), Clofibrate (substance), CLOFIBRATE
Swedish Klofibrat
Czech klofibrát
Finnish Klofibraatti
Russian KLOFIBRAT, КЛОФИБРАТ
Italian Etil clorofenossi isobutirrato, Clofibrato
Croatian KLOFIBRAT
Polish Klofibrat
Japanese クロフィブレート, クロフィブラート
Spanish clofibrato (producto), clofibrato (sustancia), clofibrato, Clofibrato
French Clofibrate
German Clofibrat
Portuguese Clofibrato

Ontology: Gemfibrozil (C0017245)

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).
Definition (MSH) A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol.
Definition (CSP) lipid regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol.
Concepts Pharmacologic Substance (T121) , Lipid (T119)
MSH D015248
SnomedCT 35282000, 387189002
LNC LP15168-5, MTHU002557
English Gemfibrozil, Gemfibrosil, Pentanoic acid, 5-(2,5-dimethylphenoxy)-2,2-dimethyl-, gemfibrozil, gemfibrozil (medication), gemfibrozil (Lopid), GEMFIBROZIL, Gemfibrozil [Chemical/Ingredient], gemfibrosil, Gemfibrozil product, Gemfibrozil (product), Gemfibrozil (substance)
Swedish Gemfibrozil
Czech gemfibrozil
Finnish Gemfibrotsiili
Russian GEMFIBROZIL, ГЕМФИБРОЗИЛ
Japanese ジェムフィブロジィル, ゲムフィブロジル, ゲンフィブロジル
Spanish genfibrocil (producto), gemfibrozilo (producto), genfibrocil, Gemfibrozil, gemfibrozilo (sustancia), gemfibrozilo, gemfibrozil, genfibrocil (sustancia), Gemfibrozilo
Italian Gemfibrosil, Gemfibrozil
French Gemfibrosil, Gemfibrozil
Polish Gemfibrozil
Croatian Gemfibrozil
Portuguese Genfibrozil, Genfibrozila
German Gemfibrozil

Ontology: Fenofibrate (C0033228)

Definition (NCI) A synthetic phenoxy-isobutyric acid derivate and prodrug with antihyperlipidemic activity. Fenofibrate is hydrolyzed in vivo to its active metabolite fenofibric acid that binds to and activates peroxisome proliferator activated receptor alpha (PPARalpha), resulting in the activation of lipoprotein lipase and reduction of the production of apoprotein C-III, an inhibitor of lipoprotein lipase activity. Increased lipolysis and a fall in plasma triglycerides, in turn, leads to the modification of the small, dense low density lipoporotein (LDL) particles into larger particles that are catabolized more rapidly due to a greater affinity for cholesterol receptors. In addition, activation of PPARalpha also increases the synthesis of apoproteins A-I, A-II, and high density lipoprotein (HDL)-cholesterol. Overall, fenofibrate reduces total cholesterol, LDL cholesterol, apolipoprotein B, total triglycerides and triglyceride rich lipoprotein (VLDL) while increasing HDL cholesterol.
Definition (NCI_NCI-GLOSS) A drug used to treat high levels of cholesterol and triglycerides in the blood. Fenofibrate is being studied in the treatment of advanced cancers in young patients and in the treatment of other conditions. It is a type of antilipidemic agent.
Definition (MSH) An antilipemic agent which reduces both CHOLESTEROL and TRIGLYCERIDES in the blood.
Definition (PDQ) A synthetic phenoxy-isobutyric acid derivate and prodrug with antihyperlipidemic activity. Fenofibrate is hydrolyzed in vivo to its active metabolite fenofibric acid that binds to and activates perioxisome proliferator activated receptor alpha (PPARalpha), resulting in the activation of lipoprotein lipase and reduction of the production of apoprotein C-III, an inhibitor of lipoprotein lipase activity. Increased lipolysis and a fall in plasma triglycerides, in turn, leads to the modification of the small, dense low density lipoporotein (LDL) particles into larger particles that are catabolized more rapidly due to a greater affinity for cholesterol receptors. In addition, activation of PPARalpha also increases the synthesis of apoproteins A-I, A-II, and high density lipoprotein (HDL)-cholesterol. Overall, fenofibrate reduces total cholesterol, LDL cholesterol, apolipoprotein B, total triglycerides and triglyceride rich lipoprotein (VLDL) while increasing HDL cholesterol. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=459750&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=459750&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C29047" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D011345
SnomedCT 108603001, 386879008
LNC LP171398-3
English Phenofibrate, Procetofene, Propanoic acid, 2-(4-(4-chlorobenzoyl)phenoxy)-2-methyl-, 1-methylethyl ester, fenofibrate, fenofibrate (medication), FENOFIBRATE, Procetofen, fenofibrates, phenofibrate, Fenofibrate [Chemical/Ingredient], Fenofibrate, Fenofibrate (product), Fenofibrate (substance)
Swedish Procetofen
Finnish Proketofeeni
Russian LIPANTIL, PROTSETOFEN, ПРОЦЕТОФЕН, FENOFIBRAT, ФЕНОФИБРАТ, ЛИПАНТИЛ
Japanese フェノフィブラート, フェノヒブレート, リパンチル, フェノフィブレート, プロセトフェン
French Fénofibrate, Procétofène
Czech fenofibrát, procetofen
Spanish Fenofibrato, Procetofeno, fenofibrato (producto), fenofibrato (sustancia), fenofibrato
Portuguese Fenofibrato, Procetofeno
Polish Lipantyl, Fenofibrat, Procetofen
Italian Fenofibrato
German Fenofibrat, Procetofen

Ontology: Fibrates (C1449704)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D058607
English Fibrates
French Fibrates
German Fibrate
Czech fibráty
Spanish Fibratos
Portuguese Fibratos

Ontology: Fibric Acids (C2936462)

Definition (MSH) Compounds that either share the structure of fibric acid in their molecular arrangement or are considered variants of the fibric acid structure.
Concepts Organic Chemical (T109)
MSH D058607
English 2 Phenoxy Isobutyric Acids, 2-Phenoxy-2-Methylpropionic Acid Derivatives, Methyl 2 Phenoxypropanoic Acid Derivatives, Fibric Acid Derivatives, Acid Derivatives, Fibric, Fibric Acids, Methyl-2-Phenoxypropanoic Acid Derivatives, Isobutyric Acids, 2-Phenoxy, 2-Phenoxy Isobutyric Acids, 2 Phenoxy 2 Methylpropionic Acid Derivatives, Fibric Acids [Chemical/Ingredient]
French Dérivés de l'acide fibrique, Acides fibriques
German Fibrische Saeuren, Fibrische Säurederivate, Fibric Saeure-Derivate, Fibric Saeurederivate, Fibric Säurederivate, Fibrische Saeure-Derivate, Fibrische Säuren, Fibric Säure-Derivate, Fibrische Säure-Derivate, Fibrische Saeurederivate
Czech kyselina fibrová - deriváty
Italian Acidi fibrici
Spanish Ácidos Fíbricos
Russian ФИБРОЕВЫЕ КИСЛОТЫ, ФИБРАТЫ, ФИБРОЕВОЙ КИСЛОТЫ ПРОИЗВОДНЫЕ, ФИБРОЕВОЙ КИСЛОТЫ СОЛИ, FIBROEVOI KISLOTY SOLI, FIBROEVYE KISLOTY, FIBRATY, FIBROEVOI KISLOTY PROIZVODNYE
Portuguese Ácidos Fíbricos
Croatian Not Translated[Fibric Acids]
Polish Kwasy fibrynowe