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[Pharmacology](https://durgical.com/en/pharmacology/) · Class

# Fibrates

PPAR-alpha agonists that mainly lower triglycerides. Used for very high triglycerides, especially to reduce the risk of pancreatitis.

Updated 2026-11-01

## What they are

Fibric acid derivatives (fenofibrate, gemfibrozil, bezafibrate, ciprofibrate) that act on the nuclear receptor PPARα. Their main use is severe hypertriglyceridemia.

## Mechanism of action

Fibrates activate PPARα in the liver, muscle and other tissues. This increases fatty acid oxidation, raises lipoprotein lipase activity and lowers apolipoprotein C-III (an inhibitor of the lipase), so triglyceride-rich particles are cleared faster and the liver makes less VLDL. PPARα also raises apo A-I and A-II, which modestly increases HDL.

Target: PPARα (peroxisome proliferator-activated receptor alpha), a nuclear receptor

## Key points

- Best drugs for lowering triglycerides; used to prevent pancreatitis in severe hypertriglyceridemia.
- Gemfibrozil plus a statin markedly raises myopathy risk (it blocks statin uptake by OATP1B1 and statin glucuronidation); fenofibrate is the fibrate combined with statins.
- They make bile more lithogenic: gallstones are a classic adverse effect.
- They potentiate warfarin; the INR is checked.
- Fenofibrate has not been shown to reduce coronary events in type 2 diabetes when added to a statin.

## Drugs in this class

- [**Fenofibrate** A fibrate that lowers triglycerides by activating PPAR-alpha. The fibrate usually chosen when one is needed together… PPARα (nuclear receptor)](https://durgical.com/en/pharmacology/fenofibrate/)
- [**Gemfibrozil** A fibrate that lowers triglycerides. Famous for interactions: it raises statin and repaglinide levels and must not be… PPARα (nuclear receptor)](https://durgical.com/en/pharmacology/gemfibrozil/)

## Others in the class

- bezafibrate
- ciprofibrate
- pemafibrate (selective PPARα modulator)

## Test yourself

Think of the answer, then tap the question to see it.

## Through which receptor do fibrates lower triglycerides?

PPARα, a nuclear receptor that switches on fatty acid oxidation and lipoprotein lipase activity and lowers apo C-III.

## Which fibrate must not be combined with simvastatin, and why?

Gemfibrozil: it blocks hepatic uptake (OATP1B1) and glucuronidation of statins, raising statin levels and the risk of rhabdomyolysis.

## Which gallbladder adverse effect is shared by fibrates?

Gallstones: they increase cholesterol excretion into the bile.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - FENOFIBRATE tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=35ba17d9-0dd7-4f15-8f74-be5fd15f1917) (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 37 (McGraw Hill, 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=C10AB) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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