Fenofibrate is primarily used to treat hypertriglyceridemia (high triglycerides) and mixed dyslipidemia as an adjunct to a heart‑healthy diet and lifestyle changes. It typically lowers triglycerides by 30–50%, modestly increases HDL cholesterol, and can reduce non‑HDL cholesterol and VLDL particles. In people with very high triglycerides (often ≥500 mg/dL), lowering triglycerides is crucial to reduce the risk of acute pancreatitis, a dangerous inflammatory condition of the pancreas.
In mixed dyslipidemia, fenofibrate can be paired with statins in select patients, especially those with high triglycerides and low HDL. While statins remain the cornerstone for reducing LDL cholesterol and cardiovascular risk, fenofibrate is sometimes added when triglycerides remain high despite statin therapy and lifestyle measures. Clinical data suggest that patients with atherogenic dyslipidemia (high triglycerides and low HDL) may derive additional benefit from a fibrate under clinician supervision.
Fenofibrate is not a substitute for nutrition, weight management, smoking cessation, limiting alcohol, and increased physical activity. These measures amplify the lipid improvements and cardiovascular protection you gain from medication.
Fenofibrate activates peroxisome proliferator‑activated receptor alpha (PPAR‑α), a nuclear receptor that regulates genes involved in lipid metabolism. Activation of PPAR‑α reduces hepatic VLDL synthesis, enhances lipoprotein lipase activity to clear triglyceride‑rich particles, and increases fatty acid oxidation. The net effect is lower circulating triglycerides, fewer remnant particles, and often a rise in HDL cholesterol.
These changes are particularly helpful in metabolic syndrome and type 2 diabetes, where elevated triglycerides, low HDL, and small dense LDL particles are common. By improving this profile, fenofibrate can lessen pancreatitis risk in severe hypertriglyceridemia and may improve cardiovascular risk markers when used appropriately.
Fenofibrate is available in several formulations and strengths. Common once‑daily tablet strengths include 48–54 mg (lower dose) and 145–160 mg (standard dose), depending on the brand or generic product. Your prescriber will select a formulation and dose based on your kidney function, baseline lipid values, other medications, and treatment goals.
General adult dosing often starts at 145 mg once daily for severe hypertriglyceridemia in patients with normal renal function. A lower starting dose (e.g., 48–54 mg once daily) is recommended if you have mild to moderate kidney impairment, with careful monitoring and possible adjustment. Some fenofibrate brands historically required taking them with meals for optimal absorption, while newer formulations can be taken without regard to food—follow the specific instructions on your prescription label.
Take fenofibrate at the same time each day. If you also use bile acid sequestrants (e.g., cholestyramine, colesevelam, colestipol), separate dosing to avoid binding interactions: take fenofibrate at least 1 hour before or 4–6 hours after the bile resin. Your clinician will check fasting lipids 4–8 weeks after starting or adjusting the dose to assess response and decide whether to titrate.
Do not change your dose or stop fenofibrate without consulting your healthcare professional. If you experience unexplained muscle pain, weakness, dark urine, abdominal pain, or unusual fatigue, stop the medication and seek medical advice promptly.
Kidney function: Fenofibrate and its active metabolite are renally excreted. Measure baseline kidney function (e.g., eGFR) and monitor periodically. Dose reductions are needed in mild to moderate renal impairment; avoid use if eGFR is severely reduced (see Contraindications). Notify your clinician if you have dehydration, acute illness, or are starting other nephrotoxic medications.
Liver health: Obtain baseline liver enzymes and monitor during therapy. Fenofibrate can raise transaminases; persistent elevations or signs of hepatitis warrant discontinuation. Patients with active liver disease or cirrhosis should not use fenofibrate.
Muscle safety: The risk of myopathy and rhabdomyolysis increases when fenofibrate is combined with statins, particularly in older adults, those with renal impairment, or with hypothyroidism. Report muscle pain, tenderness, or weakness—especially if accompanied by malaise or fever. Your clinician may check creatine kinase (CK) if symptoms occur.
Gallbladder: Fibrates can increase cholesterol excretion into bile and may promote gallstone formation. Use caution if you have a history of gallbladder disease, and avoid fenofibrate in active gallbladder disease.
Diabetes and thyroid: Dyslipidemia secondary to uncontrolled diabetes or hypothyroidism should be managed by addressing the underlying condition alongside lipid therapy. Optimizing glucose and thyroid levels can significantly improve triglycerides.
Pregnancy and breastfeeding: Safety data in pregnancy are limited; fenofibrate should be used only if potential benefits justify potential risks, and generally avoided if safer alternatives exist. Do not use during breastfeeding, as the drug may pass into human milk; consider an alternative feeding plan or a different medication.
Alcohol and diet: Heavy alcohol use can markedly raise triglycerides and counteract fenofibrate’s benefits. Limit alcohol and emphasize dietary patterns rich in vegetables, fruits, whole grains, lean proteins, and omega‑3 fats while minimizing refined carbs and added sugars.
Do not use fenofibrate if you have active liver disease, severe renal impairment (e.g., eGFR <30 mL/min/1.73 m²), preexisting gallbladder disease, or known hypersensitivity to fenofibrate or fenofibric acid. Avoid use during breastfeeding.
Fenofibrate is also contraindicated in patients with unexplained persistent liver enzyme elevations, and generally should not be used in active pancreatitis unless the pancreatitis is secondary to severe hypertriglyceridemia, in which case a clinician may consider fibrate therapy in a monitored setting.
Common side effects: Indigestion or abdominal discomfort, nausea, headache, dizziness, back pain, and mild increases in liver enzymes can occur. Many people tolerate fenofibrate well, and mild symptoms may improve as your body adjusts.
Serious adverse effects: Contact a clinician promptly if you experience severe muscle pain or weakness (possible myopathy/rhabdomyolysis), dark urine, jaundice, severe abdominal pain (possible gallstones or pancreatitis), unusual bleeding or bruising, or signs of allergic reaction such as rash, swelling, or difficulty breathing.
Lab changes: Fenofibrate can affect liver transaminases, creatinine, and occasionally blood counts. Routine labs are important for safe, ongoing use. Your prescriber will set a schedule for monitoring based on your risk factors and concomitant therapies.
Anticoagulants (e.g., warfarin): Fenofibrate may potentiate the effect of coumarin anticoagulants, increasing bleeding risk. If used together, clinicians often reduce the anticoagulant dose initially and monitor INR closely until stable.
Statins: Combining fenofibrate with statins can increase the risk of muscle toxicity, though fenofibrate is generally safer with statins than gemfibrozil. The combination may be considered in high triglycerides/low HDL when benefits outweigh risks, with close symptom and CK monitoring. Avoid concurrent use with gemfibrozil due to heightened myopathy risk.
Bile acid sequestrants: These resins can bind fenofibrate in the gut and reduce absorption. Separate dosing by taking fenofibrate at least 1 hour before or 4–6 hours after the resin.
Cyclosporine and tacrolimus: Co‑administration can elevate the risk of kidney dysfunction and alter fenofibrate exposure. If necessary, monitor renal function and consider alternative lipid‑lowering strategies.
Ezetimibe: Combined use may increase cholelithiasis risk; weigh risks and benefits and monitor for gallbladder symptoms.
Other interactions: Tell your clinician about all prescription drugs, OTC medicines, and supplements. Notable considerations include other lipid agents (omega‑3s are generally safe), diabetes medications, and agents that can stress the liver or kidneys. Avoid significant grapefruit intake only if directed for other medications, as fenofibrate itself is not significantly affected by CYP3A4.
If you miss a dose of fenofibrate, take it as soon as you remember unless it is near the time of your next dose. If it’s close to the next dose, skip the missed one and resume your regular schedule. Do not double the dose to catch up. Consistency helps maintain steady lipid control.
Symptoms of fenofibrate overdose are often nonspecific and may include severe nausea, dizziness, or unusual weakness. If an overdose is suspected, seek medical attention immediately. In the U.S., contact Poison Control at 1‑800‑222‑1222 or use poisonhelp.org for real‑time guidance. Supportive care is the mainstay; bring the medication bottle to the emergency department if possible.
Store fenofibrate at room temperature, away from excess heat, moisture, and direct light. Keep in the original container with the lid tightly closed and out of reach of children and pets. Do not use past the expiration date, and consult your pharmacist for proper disposal of unused tablets.
In the United States, fenofibrate is an FDA‑regulated, prescription‑only medication. It is not legally available over the counter, and offers to “buy fenofibrate without prescription” are unsafe and unlawful. For your protection, obtain fenofibrate through licensed clinicians and state‑licensed pharmacies. This ensures proper evaluation, dosing, monitoring, and manufacturer quality controls.
You can access fenofibrate legally in several ways: schedule a visit with your primary care clinician or cardiologist; use accredited telehealth services that include a medical evaluation by a licensed prescriber; or work with a local clinic for same‑day care. After assessment, a clinician can send your prescription to a legitimate U.S. pharmacy for dispensing. Many pharmacies also offer mail‑order delivery once a valid prescription is on file.
Hospitals and reputable health systems operate within strict legal frameworks. For example, large regional facilities (such as HealthSouth MountainView and comparable organizations) can provide structured clinical pathways—often including telehealth—to evaluate your lipid profile and, if appropriate, issue a prescription to be filled at a licensed pharmacy. These services do not dispense fenofibrate without a prescription; rather, they streamline the process of obtaining a legitimate prescription after proper medical review.
Safety checklist for U.S. consumers: avoid websites that sell fenofibrate without requiring a prescription; look for Verified Internet Pharmacy Practice Sites (VIPPS) or NABP accreditation; confirm the pharmacy lists a U.S. physical address and phone number; and be cautious of prices that seem too good to be true. Legitimate channels protect you from counterfeit products and ensure access to clinician support if side effects or interactions arise.
Insurance often covers generic fenofibrate for approved indications; if you’re paying cash, ask your pharmacist about discount programs, manufacturer coupons (when applicable), or price‑matching tools. Above all, align your lipid‑lowering plan with your clinician to maximize benefits and minimize risks.
Fenofibrate is a fibrate lipid-lowering medication that activates the PPAR‑alpha receptor. This boosts lipoprotein lipase activity, reduces hepatic VLDL production, speeds clearance of triglyceride-rich particles, lowers triglycerides, and modestly raises HDL (“good”) cholesterol. LDL changes are variable.
It is prescribed for severe hypertriglyceridemia (to reduce pancreatitis risk) and for mixed dyslipidemia when triglycerides are elevated and HDL is low. It is not a first-line drug for LDL lowering.
Most patients see triglycerides fall by about 30–50% (sometimes more when baseline levels are very high) and HDL rise by roughly 5–20%. LDL may fall modestly, remain unchanged, or increase when triglycerides are extremely elevated.
Cardiovascular outcome data are mixed. Large trials (e.g., FIELD, ACCORD-Lipid) did not show overall event reduction, but patients with high triglycerides and low HDL appeared to benefit. Fenofibrate is most clearly useful for lowering very high triglycerides and addressing atherogenic dyslipidemia patterns.
In patients with very high triglycerides, lowering levels with fenofibrate reduces the risk of triglyceride-induced pancreatitis. Direct randomized evidence is limited, but the risk generally tracks with triglyceride level.
Lipid improvements begin within 1–2 weeks, with near-maximal effect by 4–8 weeks. Clinicians usually recheck a fasting lipid panel about 4–12 weeks after starting or adjusting therapy.
Take it once daily at the same time each day. Some formulations must be taken with food, while others can be taken without regard to meals—follow the specific product label your pharmacy dispenses.
Possible effects include stomach upset, headache, increased liver enzymes, reversible increases in creatinine, and rash. Most people tolerate the medication well.
Seek care for unexplained muscle pain or weakness (especially with dark urine), severe abdominal pain (possible gallstones or pancreatitis), yellowing of skin or eyes (liver issues), or unusual bruising or bleeding.
Do not use it with active liver disease, severe kidney impairment, preexisting gallbladder disease, or known hypersensitivity to fibrates. It is not recommended during breastfeeding and is generally avoided in pregnancy.
The combination is sometimes used for mixed dyslipidemia, especially with high triglycerides and low HDL. Fenofibrate is the preferred fibrate if a statin is needed due to a lower myopathy interaction risk than gemfibrozil. Muscle and liver safety monitoring is important.
Warfarin effects can be enhanced; INR should be monitored closely and the warfarin dose may need adjustment. Combining with statins increases myopathy risk. Cyclosporine or tacrolimus can raise kidney and muscle toxicity risk. Take fenofibrate at a different time than bile acid sequestrants to avoid absorption interference.
Kidney function (creatinine/eGFR) and liver enzymes are checked at baseline and periodically thereafter. Dose adjustments are needed with reduced eGFR, and the drug is usually avoided if eGFR is below 30 mL/min/1.73 m².
Yes. It is frequently used in diabetes to manage high triglycerides and low HDL. It does not typically raise blood glucose and has shown some microvascular benefits in studies, though it is not a substitute for statins in LDL-driven risk.
Fenofibrate can lower serum uric acid and may reduce gout flares over time. It is not an FDA-approved gout treatment but can be a helpful bonus in patients with hyperuricemia.
Heavy alcohol intake can raise triglycerides and counteract treatment, so limiting alcohol is advisable. Grapefruit has no meaningful interaction with fenofibrate, unlike with some statins.
If you miss a dose, take it when remembered unless it is close to the next dose—don’t double up. Stopping the medication can lead to a rebound in triglycerides; talk with your clinician before discontinuing.
Common brands/formulations include Tricor, Triglide, Fenoglide, Lipofen, and Antara; fenofibric acid is marketed as Trilipix. Formulations differ in bioavailability and food requirements, so follow the specific product instructions.
Weight change is not typical. If you notice significant weight changes, discuss them with your healthcare professional to look for other causes.
Both lower triglycerides effectively. Fenofibrate often delivers similar or slightly greater reductions at typical doses and may better improve non-HDL cholesterol, while gemfibrozil may raise HDL slightly more in some patients.
Yes. Gemfibrozil strongly inhibits statin metabolism and raises myopathy risk. Fenofibrate has a lower interaction risk and is generally preferred if combination therapy with a statin is needed.
Fenofibrate usually produces a modest LDL reduction, while gemfibrozil’s effect on LDL is more neutral. In very high triglyceride states, either drug can lead to a temporary rise in calculated LDL as triglycerides fall.
Gemfibrozil is typically taken twice daily before meals. Fenofibrate is once daily; some formulations must be taken with food while others do not—check your specific product. This flexibility often favors fenofibrate.
Both can cause dyspepsia, elevated liver enzymes, gallstones, and muscle problems. Myopathy risk, especially with statins, is higher with gemfibrozil. Both require periodic lab monitoring.
Bezafibrate (not available in the United States) is a pan‑PPAR agonist with triglyceride-lowering and HDL-raising effects comparable to fenofibrate. Choice often depends on regional availability, clinician experience, and patient factors such as renal function and concomitant medications.
Both increase HDL, with differences being small and patient-specific. Lifestyle measures and statins remain central for ASCVD risk reduction even when using a fibrate for HDL/TG optimization.
Fenofibric acid is the active metabolite of fenofibrate. Lipid effects are essentially equivalent at comparable exposures. Some fenofibric acid products were designed and labeled for coadministration with statins, offering dosing and compatibility advantages.
They deliver similar lipid effects when taken as directed, but bioavailability and food requirements vary. Some must be taken with meals, others can be taken without food. Do not switch products without confirming the correct dose and instructions.
Ciprofibrate (available in some regions outside the US) is another fibrate with potent triglyceride lowering. Comparative outcome data are limited; selection usually reflects local availability, regulatory approvals, and individual tolerance.
Clofibrate fell out of favor due to safety concerns, including increased non-cardiovascular mortality in older studies. Newer fibrates like fenofibrate have a better overall safety and efficacy balance.
Pemafibrate is a selective PPAR‑alpha modulator available in limited markets. It lowers triglycerides robustly but did not reduce cardiovascular events on top of statins in a recent large trial. Fenofibrate remains the commonly used agent where approved.
All fibrates require caution with reduced eGFR. Fenofibrate needs dose reduction in moderate impairment and is typically avoided in severe impairment; gemfibrozil is also not recommended in severe renal dysfunction. The choice hinges on kidney function, drug interactions, and monitoring feasibility.
Fenofibrate and gemfibrozil are widely available as generics; gemfibrozil is often the least expensive. Fenofibric acid and certain branded formulations can cost more. Insurance formularies frequently drive selection when multiple options are clinically suitable.
