Fenofibrate
fibrate · lipid-lowering
Our referenceBy the Layer Nutrition editorial team · How the atlas classifies the 664 molecules
What this medicine is for
Fenofibrate is a medicine in the 'fibrate (lipid-lowering)' category. Fibrates act mainly on triglycerides, a blood lipid distinct from cholesterol, and are taken as a single daily dose.
For Fenofibrate, in practice: Reduces triglycerides and cholesterol in the blood. It is generally taken over the long term, within regular monitoring, and is not stopped on your own initiative.
Under which brands it is found
In France, about 15 reimbursable presentations containing Fenofibrate are recorded. It is found under several brand names and as generics.
- Fegenor
- Fenofibrate Almus
- Fenofibrate Arrow
- Fenofibrate Arrow Lab
- Fenofibrate Biogaran
- Fenofibrate Cristers
- Fenofibrate Cristers Pharma
- Fenofibrate Eg
- and other presentations
Original brand-name products and generics deliver the same active substance; the choice between them is made with your doctor or pharmacist.
Our product for this treatment
Fenofibrate is one of the everyday treatments for which we have formulated a targeted supplement.
Layer Nutrition Statins
Riboflavin helps you reduce tiredness and protect your cells. Ubiquinol provides 50 mg of coenzyme Q10 in the form your body uses directly.
- Contributes to the reduction of tiredness (riboflavin)
- Contributes to the protection of your cells from oxidative stress (riboflavin)
- Provides 50 mg of ubiquinol, the reduced form of coenzyme Q10
Ubiquinol 50 mg · Riboflavin 4.2 mg
One bottle, one dose per day. Reduced price from the second box, free delivery from two boxes.
How fenofibrate works
Fenofibrate belongs to the fibrate family. It works by activating a receptor located in the cell nucleus, PPAR-alpha (peroxisome proliferator-activated receptor alpha), which is especially abundant in the liver. Once activated, this receptor increases the activity of lipoprotein lipase, the enzyme that breaks down the triglycerides circulating in the blood, and it reduces the hepatic production of apolipoprotein C, a protein that normally slows this breakdown. At the same time, it stimulates HDL synthesis and enhances fatty acid oxidation through acyl-CoA synthetase.
By lowering VLDL, the lipoproteins that carry triglycerides out of the liver, fenofibrate reduces plasma triglycerides by roughly 30 to 60 percent. Its action is not limited to triglycerides: it also lowers LDL and total cholesterol while raising HDL. This profile sets it apart from statins, which mainly target cholesterol production, whereas the fibrate works above all on the triglyceride side and on the lipoproteins that carry them.
Why it is prescribed
Fenofibrate is approved by the FDA in three situations: hypertriglyceridemia, meaning an excess of triglycerides in the blood, primary hypercholesterolemia, and mixed dyslipidemia, where cholesterol and triglycerides are elevated at the same time. It therefore addresses lipid abnormalities that statins alone do not always correct, particularly when triglycerides stay high. Its combined effect, lowering LDL, total cholesterol and triglycerides while raising HDL, makes it a tool for correcting the lipid profile.
The prescription aims to bring these circulating fats back toward values that protect the arteries and, in very high forms of triglycerides, to reduce a risk of pancreatitis that these marked excesses are known to promote. The physician chooses fenofibrate based on the lipid panel and the rest of the treatment. It is a decision meant for the long term: the effect is measured on blood tests, not on sensations, which explains why the treatment continues even when nothing is felt from day to day.
How to take it day to day
Fenofibrate is taken orally, once a day. For the 145 mg tablet, exposure to fenofibric acid, the active form, does not differ significantly whether taken while fasting or during a meal: it can therefore be taken with or without food, according to whatever helps you not forget it. Regularity matters more than the exact timing, because the effect depends on a stable concentration in the blood.
The half-life of fenofibric acid is 20 to 23 hours, and steady state, the point at which the concentration stabilizes, is reached after five days of regular intake. The molecule binds 99 percent to plasma proteins and is eliminated mainly through the urine, at around 60 percent. An occasional missed dose does not undo the balance, but stopping on your own makes the lipids rise again with no warning sign: any change should be discussed with the physician who monitors the panel.
The effects to know about
The liver is the first organ to monitor. In placebo-controlled trials, abnormal liver tests occurred in 8 percent of patients on fenofibrate, versus 1 percent on placebo. In detail, ALT rose in 3 percent of patients versus 2 percent on placebo, and AST in 3 percent versus 1 percent. Creatine phosphokinase (CPK), a marker of muscle, increased in 3 percent versus 1 percent on placebo, and rhinitis was reported in 2 percent versus 1 percent. These differences, measured on lab tests, guide the pace of follow-up.
Other effects are worth knowing. Serum creatinine, a reflection of kidney function, may rise on fenofibrate, then return to its starting value after the treatment is stopped. Mild to moderate decreases in hemoglobin, hematocrit and white blood cell count have been observed after initiation. Finally, fenofibrate increases cholesterol excretion in the bile, which can promote the formation of gallstones, and cases of pancreatitis have been reported: any intense abdominal pain should prompt a consultation.
Interactions and monitoring
Several combinations call for caution. Combined with a statin, fenofibrate increases the risk of myopathy and rhabdomyolysis, a serious muscle injury. It can potentiate coumarin-type anticoagulants such as warfarin, with a lengthening of the INR, which makes it necessary to monitor this parameter. Bile acid sequestrant resins reduce its absorption: it should be taken at least one hour before, or four to six hours after the resin. With cyclosporine or other immunosuppressants, the risk of kidney toxicity leads to using the lowest effective dose and monitoring kidney function.
Laboratory monitoring frames this treatment. It includes liver function (ALT, AST, total bilirubin) at the start and then periodically, kidney function, CPK, the blood count and a regular lipid panel. Fenofibrate is contraindicated in severe kidney failure, defined by a creatinine clearance below 30 mL/min, in active liver disease and in preexisting gallbladder disease; moderate kidney failure requires adjusting the dose. This framework explains why the treatment comes with regular blood draws.
On the plate
Fenofibrate shifts a precise blood marker: homocysteine. On treatment, this amino acid rises, with an increase of about 44 percent observed in a study published in the Lancet. This rise is specific to fenofibrate, whereas gemfibrozil does not cause it, and a direct comparison with atorvastatin and simvastatin showed that, among these molecules, only fenofibrate raises homocysteine significantly.
The body has a pathway to recycle homocysteine: it converts it back into methionine, a reaction that relies on folate, vitamin B9, with the help of vitamin B12. When folate is lacking, homocysteine accumulates. It is found in green leafy vegetables such as spinach and broccoli, in legumes and in citrus fruits such as the orange. This folate remains fragile: sensitive to heat, it loses a large part of its content with prolonged cooking. Folate supports this recycling pathway; when the plate struggles to cover the need for it, a targeted intake makes sense, in addition to your treatment, never in its place.
Sources
- Fenofibrate - StatPearls
- Fenofibrate tablet label
- Serum homocysteine increases after therapy with fenofibrate or bezafibrate
- Effects of fenofibrate and gemfibrozil on plasma homocysteine
- Comparative effects of atorvastatin, simvastatin, and fenofibrate on serum homocysteine levels
- Folic Acid Deficiency - StatPearls
Related molecules
To explore in the « Heart and lipids » family and its close relatives.
See the whole « Heart and lipids » family · Back to the atlas
Frequently asked questions
What is fenofibrate used for?
Fenofibrate is a fibrate, a lipid-lowering medicine. It is prescribed to lower a high level of fats in the blood, particularly triglycerides, sometimes alongside dietary measures. For your specific situation, refer to the package leaflet and to your doctor or pharmacist.
What are the most common fenofibrate side effects?
The package leaflet notably lists digestive problems, headaches and muscle pain. The full list and how often they occur are set out in the medicine's leaflet. If you notice a bothersome or unusual effect, talk to your doctor or pharmacist.
Fenofibrate and muscle pain: when should you be concerned?
Widespread muscle pain, weakness or cramps, especially when accompanied by fever or dark urine, should prompt you to seek medical advice without delay. These signs are among the warnings in the leaflet. Do not stop the treatment on your own initiative: see your doctor promptly.
Can you take fenofibrate together with a statin?
This combination is sometimes used when a statin alone is not enough, but it calls for closer monitoring because of the muscle risk. The decision and the follow-up are up to your doctor. Refer to the leaflet and to their prescription.
Does fenofibrate interact with blood thinners?
The leaflet notes that fenofibrate can strengthen the effect of oral anticoagulants, which calls for blood monitoring and sometimes a dose adjustment. Always tell your doctor and pharmacist about all of your treatments.
Should you take fenofibrate in the morning or at night?
The leaflet recommends taking the capsule with a meal, because taking it on an empty stomach changes how it is absorbed. The exact timing depends on your prescription. Follow the guidance of your doctor or pharmacist and the leaflet.
Can you drink alcohol while taking fenofibrate?
The leaflet advises limiting alcohol consumption, which can increase the risk to the liver and muscles. For advice suited to your situation, ask your doctor or pharmacist.
Is fenofibrate safe during pregnancy or breastfeeding?
For lack of sufficient data, the leaflet limits its use during pregnancy to cases the doctor judges essential, and advises against it while breastfeeding. If you are pregnant, planning to be, or breastfeeding, talk to your doctor before taking it.
Should older adults or people with kidney problems be more careful?
Yes. The leaflet identifies advanced age and kidney impairment among the situations with increased risk, particularly to the muscles, that warrant particular monitoring. The follow-up and any adjustment are up to your doctor.
Why are blood tests needed while taking fenofibrate?
The doctor orders tests to monitor liver and kidney function, as well as the muscles when needed. These checks are part of the usual follow-up. Keep to the schedule set by your doctor and refer to the leaflet.
Since fenofibrate is often combined with a statin, should you keep an eye on coenzyme Q10?
Fenofibrate is frequently co-prescribed with a statin, and research links statins to a drop in plasma coenzyme Q10 (Moosmann & Behl, FASEB J 2004). Supplementation trials remain mixed, however, with no firm conclusion. Our ST01 reference is built around this coenzyme Q10 angle; a blood test can be discussed with your doctor.
Which form of coenzyme Q10 is best in this case?
Coenzyme Q10 comes in two forms: oxidised ubiquinone and reduced ubiquinol, the directly active form that is often better absorbed, a point that matters more after the age of fifty. It is ubiquinol that we selected for our ST01 reference.
Ces réponses portent sur le volet nutritionnel. Pour toute question sur votre médicament, la notice et votre médecin ou pharmacien font foi.