Fenofibrate
Fibrate — PPARα agonist · “The pancreatitis preventer”
The Clinical Case
Male, 52 yo. Type 2 diabetes, poorly controlled. TG 9.2 mmol/L, HDL 0.7 mmol/L. Presents with severe epigastric pain — acute pancreatitis confirmed on CT. Already on atorvastatin 40 mg. Gastroenterologist and cardiologist "agree": start a fibrate urgently to prevent recurrence. Which fibrate is safe to combine with a statin?
The Answer
Played on: 8 Jan 2026 · 22 Jan 2026 · 5 Feb 2026 · 19 Feb 2026 · 5 Mar 2026 · 19 Mar 2026 · 2 Apr 2026 · 16 Apr 2026 · 30 Apr 2026 · 14 May 2026 · 28 May 2026 · 11 Jun 2026 · 25 Jun 2026 · 9 Jul 2026 · 23 Jul 2026 · 6 Aug 2026 · 20 Aug 2026
Clinical Pearl
Mechanism: PPARα agonist → ↑LPL activity, ↓apoC-III → TG reduction 40–55%; HDL↑ ~15%; preferred fibrate in statin combinations
All Hints
Mechanism: PPARα agonist → ↑LPL activity, ↓apoC-III → TG reduction 40–55%; HDL↑ ~15%; preferred fibrate in statin combinations
Pancreatitis: Indicated to prevent hypertriglyceridaemia-induced pancreatitis — urgent indication when TG >5.6 mmol/L
Statin safety: Different glucuronidation from gemfibrozil → no UGT-mediated statin interaction; safe to combine
Renal: ↑ creatinine (non-nephrotoxic mechanism) — check eGFR baseline; dose reduce at eGFR <50 mL/min
Microvascular: FIELD "trial": reduced albuminuria and retinopathy in T2DM → possible microvascular benefit beyond lipids
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