Fenofibrate Patient Tips

Medically reviewed by Carmen Pope, BPharm. Last updated on July 28, 2025.

1. How it works

• Fenofibrate is used to reduce triglyceride levels in adults with severe hypertriglyceridemia or to reduce low-density lipoprotein cholesterol (LDL-C) in adults with primary hyperlipidemia.
• Fenofibrate lowers triglycerides (blood fats) by activating lipoprotein lipase, an enzyme that breaks down fat particles in the blood. It also reduces apoprotein C-III production, which normally blocks this enzyme. This dual action increases fat breakdown and removal from the bloodstream, lowering triglyceride levels. Its effects on LDL-C are not as robust. Fenofibrate enhances hepatic fatty acid oxidation pathways. By accelerating β-oxidation processes, it decreases the fatty acid pool available for very-low density lipoprotein (VLDL) production and release from liver cells.
• Fenofibrate belongs to the drug class called fibrates.

2. Upsides

• Used in addition to diet to reduce triglyceride (TG) levels in adults with severe hypertriglyceridemia (TG greater than or equal to 500 mg/dL). • Also used to reduce elevated low-density lipoprotein cholesterol (LDL-C) in adults with primary hyperlipidemia when use of recommended LDL-C lowering therapy (such as statins) is not possible. Can be a good alternative for people who can't tolerate statins.
• Reduces triglycerides by 30-50% (most significant effect) and increases HDL cholesterol by 10-25%.
• Fenofibrate is more effective than statins at increasing HDL cholesterol levels, similar to atorvastatin and rosuvastatin at reducing triglyceride levels, but less effective than statins at lowering LDL cholesterol levels.
• Available as oral tablets in several strengths depending on the manufacturer.
• Generic fenofibrate is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Abdominal pain, headache, backache, nausea, constipation, nasal congestion, or a runny nose are the most common side effects reported.
• Fenofibrate has been associated with myopathy (dysfunction of muscle fibers) and rhabdomyolysis (muscle cell destruction). The risk is increased in seniors and people with diabetes, kidney disease, hypothyroidism, and also in those taking statins or colchicine. Tablets may need to be discontinued if serious muscle problems occur.
• Fenofibrate is generally not the preferred choice for treating elevated LDL cholesterol. Statins are the first-line therapy because they more effectively reduce LDL levels (typically 25-55% reduction). fenofibrate has a variable effect on LDL cholesterol and may modestly decrease levels by 5-15%, or levels may remain unchanged, or sometimes increase slightly.
• Markedly elevated levels of serum TG (ie, those >2,000 mg/dL) may increase the risk of developing pancreatitis. The effect of fenofibrate therapy on reducing this risk has not been determined. • Fenofibrate did not reduce coronary heart disease morbidity and mortality in two large, randomized controlled trials of patients with type 2 diabetes mellitus.
• Dosage may need to be reduced in people with mild-to-moderate kidney disease (the recommended initial dose is 54 mg/day). Not recommended for people with severe kidney disease.
• May cause an increase in liver enzymes. Liver enzymes need to be periodically monitored and fenofibrate should be discontinued if liver enzymes reach three times the upper limit of normal.
• In some people, fenofibrate may severely depress HDL cholesterol levels. HDL levels should be checked within the first few weeks of fenofibrate therapy and the drug discontinued if HDL cholesterol levels have dropped significantly.
• May not be suitable for some people including those with gallbladder disease, liver disease, severe kidney disease, and in women who are pregnant or breastfeeding.
• May interact with some drugs including warfarin (which may prolong bleeding times), sulfonylureas, statins, colchicine, bile acid-binding resins, and immunosuppressants.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

• Fenofibrate is used in addition to diet to reduce triglyceride (TG) levels in adults with severe hypertriglyceridemia or to reduce elevated low-density lipoprotein cholesterol (LDL-C) in adults with primary hyperlipidemia when use of recommended LDL-C lowering therapy (such as statins) is not possible. Fenofibrate is generally not the preferred choice for lowering LDL-C. Abdominal pain, headache, backache, nausea, constipation, nasal congestion, or a runny nose are the most common side effects reported. May not be suitable for some people including those with gallbladder disease, liver disease, severe kidney disease, and in women who are pregnant or breastfeeding.

5. Tips

• Can be given with or without food.
• Use in addition to an appropriate lipid-lowering diet and regular exercise. Reducing body weight and alcohol consumption will also help lower cholesterol and triglyceride levels.
• Report promptly any unexplained muscle tenderness, weakness, or pain, especially if other symptoms (such as fever or feeling unwell) are also present.
• Seek urgent medical attention if you develop symptoms of an allergic reaction (such as difficulty breathing, swelling, or a rash) or yellowing of the skin or eyes while taking fenofibrate.
• Diseases such as hypothyroidism (low thyroid levels) and diabetes contribute to dyslipidemia, so these must be treated as well. In addition, some medications (for example, estrogen, bendroflumethiazide, and atenolol) may increase triglyceride levels.
• Monitoring cholesterol/triglyceride levels every four to eight weeks is important to establish the effectiveness of fenofibrate therapy. Your doctor should consider discontinuing therapy if you have not had an adequate response after two months of treatment.
• Tell your doctor if you are pregnant or intend to become pregnant because it is not known if fenofibrate has any effects on the developing baby. Do not breastfeed if you are being treated with fenofibrate.

6. Response and effectiveness

• Fenofibrate is quickly absorbed and converted into its active ingredient, fenofibric acid, once inside the body. Takes about a week for levels to stabilize. May take several weeks before the effects on cholesterol and triglyceride levels are apparent.
• Fenofibrate lowers total cholesterol by 9 to 13%, VLDL cholesterol by 44 to 49%, triglycerides by 46 to 54%, and apolipoprotein B (Apo B). Fenofibrate also increases HDL cholesterol by 19-22%.
• Cholesterol and triglyceride levels should be monitored every four to eight weeks.
• Dosage should be individualized according to the response.
• People with markedly elevated levels of serum triglycerides (> 2000 mg/dL) have a higher risk of developing pancreatitis. It is not known if fenofibrate treatment reduces this risk.

7. Interactions

Medicines that interact with fenofibrate may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with fenofibrate. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with fenofibrate include:

• acyclovir
• aminoglycosides, such as gentamicin or neomycin
• beta-blockers, such as atenolol or sotalol
• black cohosh
• colchicine
• cancer medications, such as cisplatin or pemetrexed
• cholestyramine
• cyclosporine
• diabetes medications, such as insulin, glimepiride, glipizide, or glyburide
• diuretics, such as HCTZ or chlorthalidone
• ezetimibe
• leflunomide
• other lipid-lowering drugs such as atorvastatin or simvastatin
• raltegravir
• red yeast rice
• ursodiol
• warfarin.

Alcohol may make fenofibrate treatment less effective.

Note that this list is not all-inclusive and includes only common medications that may interact with fenofibrate. You should refer to the prescribing information for fenofibrate for a complete list of interactions.

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Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use fenofibrate only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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