Indanediones Fibrates

Rare adverse effects of fibrates include rashes, gastrointestinal symptoms, myopathy, arrhythmias, hypokalemia, and high blood levels of aminotransferases or alkaline phosphatase. A few patients show decreases in white blood count or hematocrit. Both agents potentiate the action of coumarin and indanedione anticoagulants, and doses of these agents should be adjusted. Rhabdomyolysis has occurred rarely. Risk of myopathy increases when fibrates are given with reductase inhibitors. The use of fenofibrate with rosuvastatin appears to minimize this risk. Fibrates should be avoided in patients with hepatic or renal dysfunction. There appears to be a modest increase in the risk of cholesterol gallstones. 

Clofibrate increases the effects of coumarin and indanedione anticoagulants. This has been fatal in some cases. Other fibrates appear to interact similarly, although data in many cases is limited to case reports. 

Information about other fibrates is much less conelusive, and limited to case reports in many instances. Nevertheless, overall the evidenee suggests that it would be prudent to monitor the INR in any patient taking a coumarin or indanedione with a fibrate. 

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See also in sourсe #XX -- [ ]

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