Gallstone clofibrate

GI complaints occur in 3% to 5% of patients, rash in 2%, dizziness in 2.4%, and transient elevations in transaminase levels and alkaline phosphatase in 4.5% and 1.3%, respectively. Clofibrate and, less commonly, gemfibrozil may enhance the formation of gallstones. 

The fibrates are generally well tolerated, with GI distress being the most likely complaint. Other adverse effects include myositis and erectile dysfunction, particularly with clofibrate. There is ongoing concern about the fibrates increasing the risk of gallstones, although the extent of risk is unclear. Because clofibrate was associated with increased mortality in early clinical trials, it should be considered as a second-line drug. 

Fibrates produce bile that is supersaturated with cholesterol. Although gallstones are common with clofi-brate, no excess frequency has been observed with fenofibrate (23). In the WHO study, 59 patients taking clofibrate had to be operated on for gallstones, compared with 24 and 25 respectively in the two placebo groups (29). 

Owing to the greater sensitivity of PBC patients to pharmaceutical preparations, different pharmacons, e. g. phenothiazines, contraceptives, oestrogens and anabolic steroids, can reinforce cholestasis and the clinical symptoms, thus aggravating the course of disease. Gallstones are frequently detectable (35-40%) as a rule, they are pigment gallstones. Administration of clofibrate is con-... 

Fibrates produce bile that is supersaturated with cholesterol. Although gallstones are common with clofibrate, no excess frequency has been observed with fenofibrate (22). 

In the WHO study, 59 patients taking clofibrate had to be operated on for gallstones, compared with 24 and 25 respectively in the two placebo groups (27). 

Fibric adds Clofibrate Gemfibrozil Fenofibrate Increase VLtt-catabolism PPAR , agonist LDLi 5-20% HDL t 10%-20% TG i 20%-S0% Gl upset, dyspepsia, gallstones, T LFTs, myopathy Nonmetabolism Warfarin Cyclosporine Statins Liver or severe renal disease primary biliary cirrhosis preexisting gallbladder disease... 

Chronic administration increases the incidence of cholesterolic gallstones twofold. It also causes a small increase in thromboembolic phenomenon, pulmonary embolism, intermittent claudication, and angina pectoris. The drug may increase the incidence of bowel cancer. Overall, clofibrate cannot be classified as carcinogenic in humans. 

All of the fibrates increase the lithogenicity of bile. Clofibrate use has been associated with increased risk of gallstone formation gemfibrozil and fenofibrate reportedly do not increase biliary tract disease. 

All fibrates increase the lithogenicity of bile. Clofibrate has been associated with increased risk of gallstone formation gemfibrozil and fenofibrate reportedly do not increase biliary tract disease. Renal failure and hepatic dysfunction are relative contraindications to fibrate therapy. Combined statin-fibrate therapy should be avoided in patients with impaired renal function. Gemfibrozil should be used with caution and at a reduced dosage to treat the hyperlipidemia of renal failure. Fibrates should not be used by children or pregnant women. 

Clofibrate is not used for long-term treatment because of its many side effects such as cardiac dysrhythmias, angina, thromboembolism, and gallstones. 

In cases of biliary cirrhosis, clofibrate may increase cholesterol levels and promote xanthoma development (SED VIII, p. 934). It is possible that in one case, reported by Suimnerfield and Sherlock (8 ), this process led to the development of intr epatic gallstones. Patients with an impaired bile flow... 

Summerfield, J. A., Elias, E. and Sherlock, S. (1975) Effects of clofibrate in primary biliary cirrhosis hypercholesterolemia and gallstones. Gastroenterology, 69,998. 

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