Fibrates

If you have high total blood cholesterol levels, then you may have heard about a class of medications called fibrates which are used by doctors to treat elevated cholesterol levels. Fibrates have been in use by physicians for many years, and are generally considered to be a safe class of medications. There are a variety of fibrates which include Gemfibrozil (brand name Lopid), Ciprofibrate (brand name Modalim), Bezafibrate (brand name Bezalip), and Fenofibrate (brand name TriCor, Lipidil).

Fibrates are often used in combination with statins, which are a very popular class of medications also used to lower cholesterol. This combination therapy is successful for many patients because fibrates work differently to lower cholesterol than statins, but mostly because fibrates are very good at raising your good cholesterol level, the HDL or High Density Lipoprotein level, and fibrates are also very good at lowering your triglyceride level.

While statins work by inhibiting your body's synthesis of cholesterol and thus lower the bad cholesterol or LDL, fibrates act by activating a receptor in your body called the PPAR-alpha receptor. The effects of activation of this receptor are to increase HDL, decrease triglyceride secretion by your liver, and very modestly decrease the level of bad cholesterol, LDL, in your body. Because fibrates are very effective in lowering triglyceride levels, much more so than statins, fibrates are often prescribed to patients who have very high triglyceride levels, a condition called hypertriglyceridemia. Fibrates have also been found to decrease insulin resistance which is found in patients with diabetes and metabolic syndrome. Also, fibrates are much more efffective in increasing the good cholesterol level, the HDL level, in your body than statins. However, compared with statins, fibrates are much less effective in lowering the level of bad cholesterol, or LDL, in your blood.

Studies have shown that patients who have low good cholesterol or HDL, and high triglycerides, can be treated with fibrates which then decreases a person's risk of a heart attack. Because fibrates have such beneficial effects for patients with high total cholesterol, they are often prescribed in combination with statins. Physicians will usually consider prescribing fibrates for a patient who is at high risk of a heart attack, due to either obesity or diabetes, and who also has either low HDL or high triglyerides on a blood test. If you are worried about your risk of a heart attack, you could ask your physician to perform a fasting lipid panel which will measure LDL, HDL, and triglycerides and then discuss with your physician if you are a candidate for being placed on a statin, a fibrate, or both. Patients with very high triglyeride levels may be at risk for developing pancreatitis, and thus treatment with a fibrate may help a person to avoid this potentially dangerous medical condition.

However, when combined with statins, fibrates can have the rare, but potentially dangerous side effect of muscle breakdown, called rhabdomyolysis by physicians. For this reason, patients taking either statins or fibrates, whether or not in combination, should alert their doctor if they experience any side effects, especially muscle pains or cramps as this could indicate a serious side effect. The fibrate most likely to cause muscle breakdown when combined with a statin is Gemfibrozil, and for this reason physicians will most often prescribe a fibrate other than Gemfibrozil when a person is also taking a statin.

Most patients can tolerate taking a fibrate without experiencing any side effect. Fibrates have been noted to increase the risk of gallstone formation, and stomach discomfort is the most common adverse reaction, with occasional nausea and diarrhea also being possible adverse reactions.

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