Medicine & USMLE


Cardio Drugs - Lipid Lowering
  1. Fibrates
  2. Statins
  3. Ezetimibe
  4. Nicotinic Acid (Niacin)
  5. Bile Acid Sequestrants


Fibrates, also called fibric acid derivatives, are a drug class that includes the drugs gemfibrozil and fenofibrate. Fibrates are used clinically as lipid lowering drugs and are used to treat hyperlipidemia.

Fibrates work in the body by raising HDL and lowering triglyceride levels.

Side effects of fibrates include myopathy, and the risk of myopathy is increased with the concurrent use of statins. Fibrates may cause gastrointestinal side effects including nausea and vomiting, abdominal pain, and diarrhea. Other side effects include liver damage and cholesterol gallstones. Fibrates also increase the effect of warfarin, meaning that a patient taking both a fibrate and warfarin is at an increased risk of bleeding.

Key Points

  • Fibrates (Fibric Acid Derivatives)
    • Drug Names
      • Gemfibrozil
      • Fenofibrate
    • Clinical Use
      • Lipid-Lowering drug
        • Also referred to as an “Antilipemic”
    • Mechanism
      • Lowers triglyceride levels
        • A type of fat that circulates in the bloodstream
      • Raises HDL levels
        • HDL stands for high density lipoprotein
        • Often referred to as “good” cholesterol
        • Memory trick - think of H for Healthy!
    • Side Effects
      • Gastrointestinal effects
        • Nausea/vomiting
        • Diarrhea
        • Abdominal Pain
      • Myopathy
        • Generalized muscle pain/weakness
        • Monitor CK levels while on treatment
        • Patient should report muscle pain/aches to provider immediately
        • Statins increase risk of myopathy
          • Fibrates and statins should not be taken together
      • Cholesterol Gallstones
        • Also called cholelithiasis
        • Hardened deposits that form inside the gallbladder
      • Liver damage (hepatotoxicity)
        • Monitor for increased liver enzymes (AST, ALT)
      • Increases Warfarin’s Effect
        • Fibrates increase the effect of warfarin and can lead to warfarin toxicity. This puts the patient at risk of bleeding.
        • Fibrates and warfarin should not be taken together.