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Lipid modification - primary and secondary CVD prevention - Management
Which fibrates are recommended?
- Four fibrates are licensed in the UK: bezafibrate, ciprofibrate, fenofibrate, and gemfibrozil (see Table 1).
- Although all four fibrates may be considered, bezafibrate and fenofibrate are preferred.
Clarification / Additional information
- The licensed indications for fibrates available in the UK are shown in Table 1.
Table 1. Licensed indications for fibrates available in the UK.
Bezafibrate | Ciprofibrate | Fenofibrate | Gemfibrozil |
|---|
Hyperlipidaemias of Type IIa, IIb, III, IV, and V in people who are inadequately controlled by dietary means or by other changes in lifestyle, such as physical exercise and weight reduction. | Hyperlipidaemias of Types IIa, IIb, III and IV in people who are refractory to appropriate dietary treatment. | Hyperlipidaemias of Types IIa, IIb, III, IV, and V in people who are refractory to appropriate dietary and other non-drug therapeutic measures (e.g. exercise) (Supralip®) or just dietary measures (Lipantil®). | Mixed dyslipidaemia characterized by hypertriglyceridaemia and/or low HDL cholesterol. |
Primary hypercholesterolaemia, particularly when a statin is considered inappropriate or is not tolerated. |
Primary prevention: Reduction of cardiovascular morbidity in males with increased non-HDL cholesterol and at high risk for a first cardiovascular event, particularly when a statin is considered inappropriate or is not tolerated. |
HDL = high-density lipoprotein. |
Basis for recommendation
- The National Institute for Health and Clinical Excellence does not recommend any particular fibrate for use in the primary or secondary prevention of cardiovascular disease (CVD) for people who can not tolerate a statin [National Collaborating Centre for Primary Care, 2008a; NICE, 2008a].
- CKS could find no randomized controlled trials comparing different fibrates for primary and secondary prevention of CVD.
- CKS does not recommended a particular fibrate based on the very limited evidence for fibrates for primary and secondary prevention of CVD.
- However, of the four fibrates, bezafibrate and fenofibrate are preferred:
- There is a greater risk of drug interactions with gemfibrozil, and it is considerably more expensive than other fibrates.
- Dose titration is less flexible for ciprofibrate as it is only available in one dose (100 mg daily).
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