Fibric acids

Fibric Acid Derivatives. Fibtic acid derivatives have been used since the 1960s for control of blood Upid levels. The four most well-known compounds in this class ate fenofibrate, gemfibrozil, clofibrate, and bezafibrate, shown in Table 5. Fenofibrate has been the most popular fibtic acid derivative in Europe, and has mote tecentiy been investigated extensively in clinical trials in the United States (153). Bezafibrate is stmcturaHy related to clofibrate, and has tecentiy been reviewed by Western European and AustraUan clinical trials (154). 

Fibric acid derivatives, the third group of antihyperlipi-demic drugs, work in a variety of ways. Clofibrate (Atromid-S), acts to stimulate the liver to increase breakdown of very-low-density lipoproteins (VLDL) to low-density lipoproteins (LDL), decreasing liver synthesis of... 

While the fibric acid derivatives have antihyperlipidemic effects, their use varies depending on the drug. For example, Clofibrate (Atromid-S) and gemfibrozil (Lopid) are used to treat individuals with very high serum triglyceride levels who present a risk of abdominal pain and pancreatitis and who do not experience a response to diet modifications. Clofibrate is not used for the treatment of other types of hyperlipidemia and is not thought to be effective for prevention of coronary heart disease. Fenofibrate (Tricor) is used as adjunctive treatment for the reduction of LDL, total cholesterol, and triglycerides in patients with hyperlipidemia. 

When administering the HMG-CoA reductase inhibitors and the fibric acid derivatives, the nurse monitors the patient s fiver function by obtaining serum transaminase levels before the drug regimen is started, at 6 and 12 weeks, then periodically thereafter because of the possibility of liver dysfunction with the drugs. If aspartate aminotransferase (AST) levels increase to three times normal, the primary care provider in notified immediately because the HMG-CoA reductase inhibitor therapy may be discontinued. 

Gemfibrozil 600 mg tablets 1200 mg/day in two doses, 30 minutes before meals abdominal pain, and rash. Increased risk of rhabdomyolysis when given with a statin. Fibric acids are associated with gallstones, myositis, and hepatitis. 

The NKF suggests that CKD should be classified as a coronary heart disease (CHD) risk equivalent and the goal LDL-C level should be below 100 mg/dL in all patients with CKD.22 The most frequently used agents for the treatment of dyslipidemias in patients with CKD are the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors ( statins ) and the fibric acid derivatives. However, other treatments have been studied in patients with CKD and should be considered if first-line therapies are contraindicated. 

Fibric acid derivatives, antilipemic agents, 5 141t, 145-146... 

Drugs that may affect ezetimibe include antacids, cholestyramine, fibric acid derivatives, and cyclosporine. 

Gemfibrozil (Lopid) [Antilipemic/Fibric Acid Derivative]... 

Uses Hypertriglyceridemia, coronary heart Dz Action Fibric acid Dose 1200 mg/d PO bid 30 min ac am pm Caution [C, ] t Warfarin effect, sulfony-lureas t risk of myopathy w/ HMG-CoA reductase inhibitors X effects w/ cyclosporine Contra Renal/hepatic impair (SCr >2.0 mg/dL), gallbladder Dz, primary biliary cirrhosis, use w/ repaglinide (i glucose) Disp Tabs 600 mg SE Cholelithiasis, GI upset Interactions t Effects OF anticoagulants, sulfonylureas t risk of rhabdomyolysis W/ HMG-CoA reductase inhibitors X effects W/ rifampin X effects OF cyclosporine EMS t Effects of anticoagulants OD May... 

Brand Name(s) Antara, Lipidil Supra, Lofibra, Tricor, Triglide Chemical Class Fibric acid derivative... 

Rare genetic disorders, including Tangier disease and LCAT (lecithin cholesterol acyltransferase) deficiency, are associated with extremely low levels of HDL. Familial hypoalphalipoproteinemia is a more common disorder with levels of HDL cholesterol usually below 35 mg/dL in men and 45 mg/dL in women. These patients tend to have premature atherosclerosis, and the low HDL may be the only identified risk factor. Management should include special attention to avoidance or treatment of other risk factors. Niacin increases HDL in many of these patients. Reductase inhibitors and fibric acid derivatives exert lesser effects. 

FIBRIC ACID DERIVATIVES BILE ACID-BINDING RESINS... 

Zimetbaum P, Frishman WH, Kahn S. Effects of gemfibrozil and other fibric acid derivatives on blood lipids and lipoproteins. J Clin Pharmacol 1991 31(l) 25-37. 

Fibric acids or fibrates include clolibrate (Abitrate, Atromid) and gemfibrozil (Lopid). These drugs pri-... 

Other bothersome side effects are related to specific agents. Niacin, for instance, is often associated with cutaneous vasodilation and a sensation of warmth when doses are administered, but administering an extended-release form of this drug can reduce these sensations.71 99 Some fairly serious problems, including liver dysfunction, gallstones, and pancreatitis, can occur with many antihyperlipidemia drugs, but the incidence of these side effects is rare. Cardiovascular problems such as arrhythmias, blood dyscrasias, and angioneurotic syndrome may also occur with fibric acids. 

Despres JP, Lemieux I, Robins SJ. Role of fibric acid derivatives in the management of risk factors for coronary heart disease. Drugs. 2004 64 2177-2198. 

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