Topic overview

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Fibrates—including gemfibrozil, fenofibrate, bezafibrate, and ciprofibrate—activate PPAR-α. This increases lipoprotein lipase activity, reduces apoC-III, and promotes fatty-acid β-oxidation. The resulting lipid changes include lower triglycerides and higher HDL, while LDL reduction is variable and limited. Their main clinical role is severe hypertriglyceridemia, including types III, IV, and V, and mixed dyslipidemia; reducing pancreatitis risk is a key outcome. Important risks include myopathy, cholestatic hepatotoxicity, and gallstones. Muscle toxicity is more concerning with statin combinations, particularly gemfibrozil, while fenofibrate is preferred when a fibrate is used with a statin. The lesson also covers interactions, renal dose considerations, contraindications, and monitoring of liver enzymes, CK, renal function, and lipids.