Fibraten

Fibraten, more commonly called fibrates or fibric acid derivatives, are a class of prescription medications used to modify blood lipids. They act as agonists of peroxisome proliferator-activated receptor alpha (PPAR-α). Activation of PPAR-α increases hepatic fatty acid oxidation, upregulates lipoprotein lipase activity, and decreases hepatic production of very-low-density lipoprotein (VLDL). The net effect is a reduction in triglycerides, a modest rise in high-density lipoprotein (HDL), and variable effects on low-density lipoprotein (LDL).

Clinical use for fibraten includes treatment of hypertriglyceridemia and mixed dyslipidemia, particularly when triglycerides are markedly elevated or HDL is low. They are generally not first-line for LDL lowering and are sometimes added to statin therapy if triglyceride reduction remains insufficient. When combined with statins, there is an increased risk of myopathy and liver injury; gemfibrozil carries a higher interaction risk, and some combinations are avoided. Fenofibrate is often preferred in combination therapy due to a relatively lower risk of myopathy.

Common agents include fenofibrate and gemfibrozil, with bezafibrate used in some regions. Dosing depends on the specific drug and on renal function, as some fibrates require dose adjustment in kidney impairment. Monitoring typically includes liver enzymes, kidney function, lipid panels, and assessment for symptoms of myopathy.

Safety and contraindications include active liver disease, biliary tract disease, and, for some agents, significant renal impairment. Adverse effects can involve gastrointestinal symptoms, liver enzyme elevations, cholelithiasis, and, less commonly, myopathy or rhabdomyolysis, especially with concomitant statin use. Pregnancy considerations generally favor avoidance.