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Fenofibrate Disease Interactions

There are 7 disease interactions with fenofibrate:

Major

Fenofibrate (Includes Fenofibrate) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

The use of fenofibrate is contraindicated in patients with active liver disease or unexplained, persistent elevations of serum transaminases. Fenofibrate therapy is associated with dose-related hepatotoxicity, including biochemical abnormalities of liver function, hepatitis (hepatocellular, chronic active, as well as cholestatic) and, rarely, cirrhosis. Therapy with fenofibrate should be administered cautiously in patients with a history of liver disease and/or heavy alcohol use. Liver function tests, including serum transaminase levels, should be performed at baseline and periodically throughout the duration of therapy. Patients who develop elevated ALT or AST levels during therapy should be monitored until abnormalities resolve. Therapy should be withdrawn if elevations persist above 3 times the upper limit of normal.

References

  1. Cayen MN "Disposition, metabolism and pharmacokinetics of antihyperlipidemic agents in laboratory animals and man." Pharmacol Ther 29 (1985): 157-204
  2. Miller DB, Spence JD "Clinical pharmacokinetics of fibric acid derivatives (fibrates)." Clin Pharmacokinet 34 (1998): 155-62
  3. Chapman MJ "Pharmacology of fenofibrate." Am J Med 83 (1987): 21-5
View all 7 references
Major

Fenofibrate (Includes Fenofibrate) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

The use of fenofibrate is contraindicated in patients with significantly impaired renal function. The rate of clearance of fenofibric acid has been shown to decrease substantially when CrCl is below 50 mL/min, with drug accumulation during chronic dosing. Increased adverse effects, including rhabdomyolysis (with or without secondary renal failure) and severe hyperkalemia, have been associated with the use of fibric acid derivatives in patients with renal insufficiency. Therapy with fenofibrate should be administered cautiously in patients with mild or moderate renal impairment. Close clinical monitoring is recommended during therapy.

References

  1. Thompson CH, Irish A, Kemp GJ, Taylor DJ, Radda GK "Skeletal muscle metabolism before and after gemfibrozil treatment in dialysed patients with chronic renal failure." Clin Nephrol 45 (1996): 386-9
  2. Balfour JA, McTavish D, Heel RC "Fenofibrate. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in dyslipidaemia." Drugs 40 (1990): 260-90
  3. "Product Information. Tricor (fenofibrate)." Abbott Pharmaceutical, Abbott Park, IL.
View all 10 references
Major

Fibric Acid Derivatives (Includes Fenofibrate) ↔ Biliary Cirrhosis

Severe Potential Hazard, High plausibility

Applies to: Biliary Cirrhosis

The use of fibric acid derivatives is contraindicated in patients with primary biliary cirrhosis. These agents may further raise the already elevated cholesterol in these patients.

References

  1. "Product Information. Lopid (gemfibrozil)." Parke-Davis, Morris Plains, NJ.
  2. "Product Information. Tricor (fenofibrate)." Abbott Pharmaceutical, Abbott Park, IL.
  3. "Product Information. Atromid-S (clofibrate)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
Major

Fibric Acid Derivatives (Includes Fenofibrate) ↔ Cholelithiasis

Severe Potential Hazard, High plausibility

Applies to: Gallbladder Disease

The use of fibric acid derivatives is contraindicated in patients with gallbladder disease. A significantly increased incidence of cholelithiasis has been observed in patients treated with the fibric acid derivative, clofibrate, presumably because of increased cholesterol excretion into the bile. Based on two separate studies (the WHO study and the Coronary Drug Project study), clofibrate use was associated with twice the risk of developing cholelithiasis and cholecystitis requiring surgery. Due to their structural and pharmacologic similarities, use of other fibric acid derivatives may be expected to carry the same risk.

References

  1. Roberts WC "Safety of fenofibrate--US and worldwide experience." Cardiology 76 (1989): 169-79
  2. "Product Information. Tricor (fenofibrate)." Abbott Pharmaceutical, Abbott Park, IL.
  3. Blane GF "Comparative toxicity and safety profile of fenofibrate and other fibric acid derivatives." Am J Med 83 (1987): 26-36
View all 5 references
Major

Fibric Acid Derivatives (Includes Fenofibrate) ↔ Hdl Cholesterol

Severe Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus, Hyperlipidemia

There have been reports of severe decreases in HDL cholesterol (HDL-C) levels (as low as 2 mg/dL) occurring in diabetic and non-diabetic patients initiated on fibric acid derivatives therapy. The decrease has been reported to occur within 2 weeks to years after initiation of therapy. It is recommended that HDL-C levels be checked within the first few months after initiation therapy and if a severely depressed HDL-C level is detected, therapy with these agents should be withdrawn. Monitor HDL-C level until it has returned to baseline, and therapy with these agents should not be re-initiated in these patients.

Major

Fibric Acid Derivatives (Includes Fenofibrate) ↔ Rhabdomyolysis

Severe Potential Hazard, Moderate plausibility

Applies to: Myoneural Disorder, Myopathy

Severe myopathy, including rhabdomyolysis with acute renal failure secondary to myoglobinuria, has been reported rarely with the use of fibric acid derivatives. The myopathy may be dose-related and is characterized by muscle aches and/or weakness in conjunction with increases in creatine phosphokinase (CPK) values exceeding 10 times the upper limit of normal. Therapy with fibric acid derivatives should be administered cautiously in patients with preexisting myopathy or a myoneural disorder, since it may delay the recognition or confound the diagnosis of a drug-induced musculoskeletal effect. Patients should be advised to report promptly any unusual muscle pain, tenderness or weakness, particularly if accompanied by malaise or fever. Periodic CPK determinations may be considered in some patients, although the value of such monitoring is uncertain. Therapy should be withdrawn if markedly elevated CPK levels occur or if drug-related myopathy is diagnosed or suspected.

References

  1. Pogson GW, Kindred LH, Carper BG "Rhabdomyolysis and renal failure associated with cerivastatin-gemfibrozil combination therapy." Am J Cardiol 83 (1999): 1146
  2. Iliadis EA, Rosenson RS "Long-term safety of pravastatin-gemfibrozil therapy in mixed hyperlipidemia." Clin Cardiol 22 (1999): 25-8
  3. Gorriz JL, Sancho A, Lopezmartin JM, Alcoy E, Catalan C, Pallardo LM "Rhabdomyolysis and acute renal failure associated with gemfibrozil therapy." Nephron 74 (1996): 437-8
View all 21 references
Moderate

Fibric Acid Derivatives (Includes Fenofibrate) ↔ Hematological Changes

Moderate Potential Hazard, Moderate plausibility

Applies to: Anemia

Mild to moderate hemoglobin, hematocrit and white blood cell decreases have been observed in patients following initiation of fibric acid derivatives therapy. However, these levels stabilize during long-term administration. Thrombocytopenia and agranulocytosis have been reported in individuals treated with these agents. Caution is recommended when treating patients predisposed to hematologic changes. Periodic monitoring of red and white blood cell counts is recommended during the first 12 months of therapy.

fenofibrate drug Interactions

There are 87 drug interactions with fenofibrate

fenofibrate alcohol/food Interactions

There is 1 alcohol/food interaction with fenofibrate

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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