Fenofibrate !

A fibrate that lowers triglycerides by activating PPAR-alpha. The fibrate usually chosen when one is needed together with a statin.

Updated 2026-11-01

Class: Fibrates
Receptor: PPARα (nuclear receptor)
ATC code: C10AB05

PPARα (nuclear receptor)Fenofibrate

The figure shows fenofibric acid, the active form of fenofibrate, in the ligand-binding domain of human PPARα.

Target in 3D: PPARα (nuclear receptor). PDB structure 6LX4 (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Fenofibrate is a prodrug rapidly converted to fenofibric acid, which activates PPARα. The receptor switches on genes for fatty acid oxidation and lipoprotein lipase and lowers apolipoprotein C-III, so triglyceride-rich lipoproteins are cleared faster and VLDL output falls. HDL rises modestly through more apo A-I and A-II.

Prodrug becomes fenofibric acid
Fenofibric acid activates the nuclear receptor PPARα
More lipoprotein lipase activity, less apo C-III
Triglycerides fall; HDL rises modestly

Pharmacokinetics

Absorption: Oral; absorption increases when taken with food (depends on the formulation).
Metabolism: Hydrolyzed to fenofibric acid, then conjugated with glucuronic acid.
Elimination: Mainly in urine; it accumulates in kidney impairment.
Half-life: Fenofibric acid: about 20 hours.

Indications

Severe hypertriglyceridemia, to lower triglycerides (as an adjunct to diet) Familial hypertriglyceridaemia →
Primary hypercholesterolemia or mixed dyslipidemia, as an adjunct to diet Atherosclerosis and dyslipidaemia →
Mixed hyperlipidemia Familial combined hyperlipidaemia →

Adverse effects

Common

Abdominal pain, nausea, constipation
Raised liver transaminases
Reversible rise in serum creatinine
Muscle aches

Contraindications

Severe kidney impairment, including dialysis
Active liver disease, including primary biliary cholangitis
Pre-existing gallbladder disease
Breastfeeding; hypersensitivity to fenofibrate

Key interactions

Warfarin and other coumarins: Potentiate the anticoagulant effect; the INR is checked and the warfarin dose often reduced.
Statins: Add to myopathy risk; the combination is used only when the benefit is judged greater.
Bile acid resins: Bind fenofibrate; it is given at least 1 hour before or 4–6 hours after the resin.
Cyclosporine, tacrolimus: Nephrotoxicity can reduce fenofibrate clearance; kidney function is watched.

What is monitored

Lipid panel, especially triglycerides
Liver tests (ALT, AST, bilirubin) at baseline and periodically
Kidney function
Blood count and INR if on warfarin

Administration and safety

Oral, once daily; many formulations are taken with meals for better absorption.
Formulations are not interchangeable milligram for milligram: the product name and strength are checked.
Separated in time from bile acid resins.

Nursing care

Before: lipid panel, liver and kidney function, gallbladder history, anticoagulants.
Teach the warning signs of gallstones or pancreatitis (upper abdominal pain) and of liver injury (jaundice, dark urine).
Ask about muscle pain, more so if a statin is also taken.
Check the INR more often after starting it in a patient on warfarin.

Pregnancy and breastfeeding

Few human data; generally used in pregnancy only for very severe hypertriglyceridemia with pancreatitis risk. Breastfeeding is avoided during treatment.

Test yourself

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

What is the active form of fenofibrate?

Fenofibric acid, formed by rapid hydrolysis of the prodrug.

Which anticoagulant interaction is classic for fenofibrate?

It potentiates warfarin and other coumarins, raising the INR and bleeding risk.

Which kidney laboratory change is common and usually reversible on fenofibrate?

A rise in serum creatinine, which tends to return to baseline after stopping.

Add to my cards (3)

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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: Fenofibrate: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); DailyMed - FENOFIBRATE tablet (DailyMed (U.S. National Library of Medicine), 2026); X-ray structure of human PPARalpha ligand binding domain-fenofibric acid co-crystals obtained by delipidation and co-crystallization (RCSB Protein Data Bank, 2020); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.