Name of the Fibrates drugs:
- Fenofibrate
- Bezafibrate
- Gemfibrozil
Mechanism of Action:
- Once absorbed into the bloodstream, fibrates work by activating an intranuclear receptor called PPARα, or peroxisome proliferator-activated receptor alpha, a major regulator of lipid metabolism.
- When activated by fibrates, PPARα causes adipose tissue cells to produce more lipoprotein lipase, increasing lipolysis and lowering triglyceride levels.
- Fibrates also increase the synthesis of HDL, which is sometimes referred to as “good” cholesterol; however, they aren’t very effective at decreasing the levels of low-density lipoproteins or LDL, which is sometimes referred to as “bad” cholesterol.
Indications:
- Hypertriglyceridemia
- Hypercholesterolemia
- Mixed dyslipidemia
| Gemfibrozil |
| Availability : Tablets: 600 mg |
| Administration and handling: PO • Give 30 min before morning and evening meals |
| Hyperlipidemia/Hypertriglyceridemia PO: ADULTS, ELDERLY: 600 mg twice daily 30 min before breakfast and dinner |
| Fenofibrate |
| Availability: Capsules: 30 mg, 43 mg, 50 mg, 67 mg, 90 mg, 130 mg, 134 mg, 150 mg, 200 mg. Capsules, Delayed-Release: 45 mg, 135 mg. Tablets: 35 mg, 40 mg, 48 mg, 54 mg, 105 mg, 120 mg,145 mg, 160 mg. |
| Administration and handling: PO • Give with or without regard to meals. Swallow whole; do not open (capsules), crush, dissolve, or cut. |
| Hypertriglyceridemia PO:(Fenofibrate): Adults, elderly: 43–130 mg/day. |
| Hypercholesterolemia, Mixed Hyperlipidemia PO:(Fenofibrate): Adults, elderly: 130 mg/day. |
| Bezafibrate |
| Availability: tablet: 200mg, 400mg |
| Primary hyperlipidemia: Adult: PO- 200 mg 3 times/day. Maintenance: 200 mg twice daily. Extended release 400 mg/day. |
| Adults: The standard dosage for Bezalip 200 mg tablets is 1 tablet (200 mg) 3 times daily. In cases of good therapeutic response, especially in hypertriglyceridemia, the dosage can be reduced to 1 tablet twice daily. For patients with a history of gastric sensitivity, the dosage may be gradually increased to the maintenance level. The standard dosage for Bezalip Retard 400 mg tablets is 1 tablet once daily. |
Cautions and Contraindications:
- Severe hepatic or renal impairment (resulting in low albumin e.g., nephrotic syndrome)
- Primary biliary cirrhosis
- Gallbladder disease
- Pregnancy and breastfeeding
- Fenofibrate: elderly clients, pancreatitis, diabetes mellitus
Side –Effects:
- Myositis – like syndrome (uncommon)
- Cholestasis and increased risk of cholelithiasis
- GI: dyspepsia, abdominal pain, nausea, vomiting, diarrhoea, pancreatitis
- Skin: rash, urticaria, pruritus
- CNS: fatigue, dizziness, headache
- Muscular: rhabdomyolysis (increased risk when combined with colchicine and statins)
- Gemfibrozil: pancytopenia, eosinophilia
Metabolism and Half- life:
Variable- e.g., fenofibrate (t ½ 20 h) is excreted largely unchanged in the urine; gemfibrozil (t ½ 1 ½ h) is eliminated mainly by metabolism.
Drug Interactions:
- Increased risk of rhabdomyolysis with statins (especially gemfibrozil)
- The enhanced anticoagulant effect of warfarin.
- Increased risk of hypoglycaemia with oral antidiabetic agents.
NURSING CONSIDERATIONS
Baseline assessment
- Obtain diet history, esp. fat/alcohol consumption. Obtain serum glucose, triglyceride, cholesterol, LFT.
- Question history of hepatic/renal impairment, cholecystectomy.
- Receive full medication history and screen for contraindications.
Intervention/evaluation
- Monitor LDL, VLDL, serum triglycerides, cholesterol lab results for therapeutic response.
- Monitor daily pattern of bowel activity, stool consistency.
- Assess for rash, pruritus.
- Question for headache, dizziness.
- Monitor LFT, haematology tests.
- Assess for abdominal pain, esp. right upper quadrant or epigastric pain suggestive of adverse gallbladder effects.
- Monitor serum glucose in pts receiving insulin, oral antihyperglycemics.
Patient/family teaching
- Follow special diet (important part of treatment).
- Take before meals.
- Periodic lab tests are essential part of therapy.
- Report pronounced dizziness, blurred vision, abdominal pain, diarrhea, nausea, vomiting.
Important Points:
Fibrates may be required in combination with statins in diabetic patients to achieve target lipid- lowering
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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