Fenofibrate

CLINICAL USE

Treatment of hyperlipidaemias types IIa, IIb, III, IV and V

DOSE IN NORMAL RENAL FUNCTION

Depends on preparation

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :360.8

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :99

%Excreted unchanged in urine &nbsp &nbsp : 0

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :0.89

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :20/140–360

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20–60 134 mg daily

10 to 20 &nbsp &nbsp : 67 mg daily

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : Avoid

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unlikely to be dialysed. Avoid

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Avoid

HDF/high flux &nbsp :Unlikely to be dialysed. Avoid

CAV/VVHD &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Antibacterials: increased risk of myopathy with daptomycin – try to avoid concomitant use

Anticoagulants: enhances effect of coumarins and phenindione; dose of anticoagulant should be reduced by up to 50% and readjusted by monitoring INRAntidiabetics: may improve glucose tolerance and have an additive effect with insulin or sulphonylureas

Ciclosporin: ciclosporin levels appear to be unaffected; however, it is recommended that concomitant therapy should be avoided because of the possibility of elevated serum creatinine levelsLipid-regulating drugs: increased risk of myopathy in combination with statins and ezetimibe; increased risk of cholelithiasis and gall bladder disease with ezetimibe – avoid with ezetimibe

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

A few studies have noted that use of second-generation fibrates in transplant recipients is hampered by frequent rises in serum creatinineAvoid use in patients with GFR< 10 mL/min due to increased risk of rhabdomyolysis

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