Drug Comparisons

The fibric acid derivatives, also known as "fibrates," are a class of medications used for the treatment of high cholesterol. These drugs were first introduced to the market in 1967, but because studies showed no affect on decreasing the risk of death, they are used mostly in combination with other cholesterol-lowering agents. How fibrates work in the body to lower cholesterol is largely unknown, but it is believed that through a variety of mechanisms, they reduce production of cholesterol, increase the breakdown of triglycerides, and promote elimination of certain types of cholesterol from the body.

Drugs in this Class
Fenofibrate Micronized Capsules (Antara Capsules, Lofibra Micronized Capsules)
Gemfibrozil Tablets (Lopid Tablets)
Fenofibrate Tablets (Fenoglide Tablets, Lofibra Tablets, Tricor Tablets, Triglide Tablets)

Summarizing the Evidence

• Fibrates are mainly used to lower high triglyceride levels. They are not as effective as "statins" in lowering total cholesterol and LDL cholesterol (LDL-C or "bad cholesterol") levels, but are sometimes used in combination with statins to lower very high cholesterol levels. Fibrates are also sometimes added to statins to raise HDL cholesterol (HDL-C or "good cholesterol") levels.

• Few studies have compared the fibrates to each other. Further definitive trials are needed before firm comparisons of effectiveness between these medications can be made. Thus far, studies have shown gemfibrozil (Lopid) to be slightly more effective than clofibrate (Atromid-S)--now unavailable in the U.S.-- and similarly effective as fenofibrate (Tricor) in reducing triglyceride levels.

• A very small study of 21 patients compared micronized fenofibrate (Lofibra) to gemfibrozil. Lofibra further reduced triglycerides and provided a further beneficial increase in HDL-C (or "good cholesterol") over gemfibrozil. There were no significant differences between Lofibra and gemfibrozil in reducing total cholesterol or LDL-C ("bad cholesterol"). Larger studies are required to substantiate the results of this small trial.

• For treating high triglyceride levels, the choice of which fibrate to use will typically be based upon your doctor's preference and/or your prescription benefits formulary. Gemfibrozil (Lopid) is prescribed more commonly because of its effectiveness, its generic availability, and it has been on the market longer.

• If fibrates are used instead of "statins" for lowering total cholesterol and LDL cholesterol, initial studies have shown that fenofibrate (Tricor, Lofibra) may be the most effective medication in this class for this purpose. However, further study is needed to verify this.

Dosing and Administration

• Gemfibrozil (Lopid) is typically taken twice daily. Fenofibrate (Tricor) and micronized fenofibrate (Lofibra) are typically taken once daily.

Generic Availability

• Gemfibrozil (brand name: Lopid), fenofibrate (brand name: Tricor), and micronized fenofibrate (brand name: Lofibra) are available generically.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

References

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4. Tricor [package insert]. N Chicago, IL: Abbott Laboratories; Nov 2004.
5. Lopid [package insert]. Morris Plains, NJ: Park-Davis; July 2001.
6. Lofibra [package insert]. Sellersville, PA: Gate Pharmaceuticals; July 2003.
7. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001; 285:2486-2497.
8. Insua A, Massari F, Rodriguez-Moncalvo JJ, Ruben-Zanchetta J, et al. Fenofibrate or gemfibrozil for treatment of types Iia and Iib primary hyperlipoproteinemia: a randomized, double-blind, crossover study. Endocr Pract 2002; 8(2): 96-101.
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15. Rabkin SW, Hayden M, and Frohlich J. Comparison of gemfibrozil and clofibrate on serum lipids in familial combined hyperlipidemia. A randomized placebo-controlled, double-blind, crossover clinical trial. Atherosclerosis. 1988;73(2-3):233-40.
16. Nye EE, Sutherland WH & Temple WA: The treatment of hyperlipoproteinaemia with gemfibrozil compared with placebo and clofibrate. N Z Med J 1980; 92:345-349.
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18. Atromid-S [package insert]. Philadelphia, PA: Wyeth-Ayerst; May 2000.

Last Updated: December 2007
This content was created by members of the DrugDigest team of experts and is solely under DrugDigest's editorial control.

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It should not be construed to indicate that the use of the product is safe, appropriate, or effective for you. Consult your healthcare professional before taking any medication.