Names and pronunciation
Fibricor, Trilipix
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Drug reference
Fibricor, Trilipix
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Func. class.: Antilipemic
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Chem. class.: Fibric acid derivative
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Do not confuse: Tricor/Tracleer
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ACTION: Increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase, resulting in changes in triglycer- ide size and composition of LDL, leading to rapid breakdown of LDL; mobilizes triglycerides from tissue; increases excretion of neutral sterols
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USES: Hypercholesterolemia; types IV, V hyperlipidemia that do not respond to other treatment and that increase risk for pancreatitis; Fredrickson type IV, V hypertriglyceridemia
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CONTRAINDICATIONS: Hyper- sensitivity, severe renal/hepatic disease, primary biliary cirrhosis, preexisting gallbladder disease, breastfeeding Precautions: Pregnancy, geriatric patients, peptic ulcer, pancreatitis, renal/ hepatic disease, diabetes mellitus
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SIDE EFFECTS CNS: Fatigue, dizziness, headache, par- esthesia, insomnia, depression CV: Hypertension, angina, DVT, PE GI: Nausea, vomiting, dyspepsia, flatu- lence, pancreatitis, cholelithiasis, diarrhea, constipation GU: Polyuria INTEG: Rash, pruritus MS: Myalgias, arthralgias, myopathy, rhabdomyolysis RESP: Bronchitis, cough
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INTERACTIONS Increase: myopathy, rhabdomyolysis— colchicine • Avoid use with HMG-CoA reductase in- hibitors; rhabdomyolysis may occur Increase: anticoagulant effects—oral anticoagulants Decrease: absorption of fenofibrate— bile acid sequestrants; give 1 hr prior to or ≥4 hr after bile acid sequestrant Drug/Food Increase: absorption Drug/Lab Test Increase: ALT, AST, BUN, CK, creatinine Decrease: WBC, uric acid, HB, paradoxi- cal effect in HDL
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DOSAGE AND ROUTES Hypertriglyceridemia • Adult: PO (Antara) 30-90 mg/day; (Fenoglide) 40-120 mg/day; (Tricor) 48-145 mg/day; (Lipofen) 50 mg/day Primary hypercholesterolemia/ mixed hyperlipidemia • Adult: PO (Antara) 90 mg/day; (Fenoglide) 120 mg/day; (Tricor) 145 mg/day Renal dose (geriatric) • Adult: PO (Tricor) CCr 30-80 mL/min, 48 mg/day; CCr <30 mL/min, contraindicated; Adult: PO CCr 30-80 mL/min, 50 mg/day (Triglide, Lipofen), 30 mg/day (Antara), CCr <30 mL/min, contraindicated (Antara, Lipofen)
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Available forms: Cap: Antara 30, 90 mg; Lipofen 50, 150 mg; Tab: 43, 50, 67, 130, 134, 150, 200 mg; TriCor 48, 145 mg; Fenoglide 40, 120 mg; feno- fibrate choline: del rel caps 45, 135 mg; fenofibric acid: tabs 35, 105 mg
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Administer: • Product with meals (Lipofen); Antara without regard to food; may increase q4- 8wk; discontinue if there is not adequate response after 2 mo • Caps must be swallowed whole • Brands are not interchangeable • Protect Lipofen, Triglide from light, moisture
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Assess: • Hypercholesterolemia/hyperlipidemia diet history: obtain a dietary history in- cluding fat content; lipid levels (triglyc- erides, LDL, HDL, cholesterol); may cause a paradoxical decrease in HDL; LFTs at baseline, periodically during treatment, if >3 × ULN, discontinue; CPK if muscle pain occurs; CBC, Hct, HB, PT with anticoagulant therapy; serum biliru- bin (total and direct) • Pancreatitis, cholelithiasis, renal failure, rhabdomyolysis (when com- bined with HMG Co-A reductase inhibi- tors), myositis; product should be discon- tinued; assess often for muscle pain, weakness, fever • Severe skin reactions: angioedema, anaphylaxis, monitor throughout treat- ment • Pregnancy/breastfeeding: identify whether pregnancy is planned or sus- pected; do not breastfeed
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Evaluate: • Therapeutic response: decreased tri- glycerides, cholesterol levels
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That compliance is needed; not to consume chipped or broken tabs (Tri- glide) • That risk factors should be decreased: high-fat diet, smoking, alcohol consump- tion, absence of exercise • To notify prescriber if pregnancy is suspected or planned; not to breastfeed during or for ≥5 days of last dose • To notify prescriber of muscle pain, weakness, fever, fatigue, epigastric pain • To report signs/symptoms of DVT (swollen, warm extremity) or PE (short- ness of breath, chest pain) to provider immediately HIGH ALERT
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PHARMACOKINETICS Peak 2 wk, protein binding 99%, con- verted to fenofibric acid, metabolized in liver to fenofibric acid, excreted in urine (60%), feces (25%), half-life 20 hr
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• Adult: PO (Antara) 30-90 mg/day; (Fenoglide) 40-120 mg/day; (Tricor) 48-145 mg/day; (Lipofen) 50 mg/day Primary hypercholesterolemia/ mixed hyperlipidemia
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• Adult: PO (Antara) 90 mg/day; (Fenoglide) 120 mg/day; (Tricor) 145 mg/day Renal dose (geriatric)
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• Adult: PO (Tricor) CCr 30-80 mL/min, 48 mg/day; CCr <30 mL/min, contraindicated; Adult: PO CCr 30-80 mL/min, 50 mg/day (Triglide, Lipofen), 30 mg/day (Antara), CCr <30 mL/min, contraindicated (Antara, Lipofen)
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