Fenofibrate

Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026

Fenofibrate is an oral fibrate lipid-lowering agent used primarily to treat severe hypertriglyceridemia and mixed dyslipidemia. It substantially lowers triglycerides and modestly raises HDL cholesterol, and is often used as an adjunct to diet and, in selected patients, to statin therapy. Fenofibrate is a prodrug that is hydrolyzed to its active metabolite, fenofibric acid.

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Publication status

Exploratory record, not a reviewed medical publication.

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This generated database record has not completed a claim-level review by a qualified human medical reviewer. Bibliography links and evidence labels are not approval. The page remains available for reference and is excluded from search indexing.

In short

What the research says.

A quick, data-only summary. The full evidence, dosing, and sources are below.

Fenofibrate is an oral fibrate lipid-lowering agent used primarily to treat severe hypertriglyceridemia and mixed dyslipidemia. NutriStack rates the supporting evidence as strong. Common adult dosing is Fenofibrate 48 to 145 mg once daily (formulation-dependent; micronized and nanocrystallized products differ); fenofibric acid 35 to 135 mg once daily. Dose is reduced in renal impairment and the highest doses are avoided when eGFR is low., though a prescriber sets the actual dose. With long-term use it can deplete coenzyme q10, vitamin e. This profile indexes 4 sources.

What it's good for

Treatment of severe hypertriglyceridemia to reduce pancreatitis risk²
Management of primary hypercholesterolemia and mixed dyslipidemia²
Modest increase in HDL cholesterol^4,3

What to watch for

Elevated liver enzymes (transaminases)
Increased serum creatinine (usually reversible)
Myalgia and muscle pain
Severe renal impairment, including patients on dialysis³
Active liver disease, including primary biliary cholangitis and unexplained persistent liver function abnormalities

The bottom line

Evidence rating strong. Most-documented uses: treatment of severe hypertriglyceridemia to reduce pancreatitis risk, management of primary hypercholesterolemia and mixed dyslipidemia, modest increase in hdl cholesterol. 4 sources indexed (2001–2019), with 0 interaction records on file.

The science

How it works, mechanistically.

Core mechanism

Fenofibrate is converted in vivo to fenofibric acid, which activates peroxisome proliferator-activated receptor alpha (PPAR-alpha). PPAR-alpha activation increases lipolysis and clearance of triglyceride-rich particles by inducing lipoprotein lipase and reducing apolipoprotein C-III, which normally inhibits lipoprotein lipase. It also stimulates hepatic fatty acid oxidation and increases synthesis of apolipoproteins A-I and A-II, contributing to higher HDL cholesterol. The net effect is a marked reduction in plasma triglycerides and VLDL, with smaller effects on LDL and HDL.^4,1

Class

Fibrate (PPAR-alpha agonist)

Absorption

Water-soluble; take with food

Dosing

Dosing & protocol.

Common range

Fenofibrate 48 to 145 mg once daily (formulation-dependent; micronized and nanocrystallized products differ); fenofibric acid 35 to 135 mg once daily. Dose is reduced in renal impairment and the highest doses are avoided when eGFR is low.

Recommended form

Oral tablet or capsule once daily; bioavailability varies by formulation, so older non-micronized products are best taken with food while many newer micronized or nanocrystallized products may be taken without regard to meals.

Absorption is formulation-dependent. Older micronized and non-coated formulations are better absorbed with food, whereas certain nanocrystallized or coated products are designed to be taken without regard to meals. Follow the specific product labeling.

Depletions

What it depletes.

Nutrients this medication can lower over time, and what to replace.

Coenzyme Q10

Mild

Fibrates inhibit HMG-CoA reductase activity indirectly and reduce mevalonate pathway flux similar to (though more weakly than) statins, lowering endogenous synthesis of ubiquinone (CoQ10), which shares this biosynthetic pathway. This effect is amplified when fenofibrate is combined with a statin, a common clinical scenario that also increases myopathy risk.

Replace Coenzyme Q10 (ubiquinone)Monitor Plasma/serum CoQ10 (rarely measured clinically); monitor for myalgia and serum creatine kinase if myopathy suspectedOnset Weeks to a few months of continuous therapy

Vitamin E

Mild

Fenofibrate lowers circulating lipoproteins (VLDL and LDL) that transport fat-soluble vitamin E (tocopherols) in plasma. Because measured serum vitamin E is largely lipoprotein-bound, the marked triglyceride and lipoprotein reduction can lower total circulating vitamin E levels; true tissue depletion is less well established and the lipid-standardized vitamin E ratio may be unchanged.

Replace Vitamin E (mixed tocopherols) only if a documented deficiency is confirmedMonitor Serum alpha-tocopherol, ideally interpreted relative to serum lipids (tocopherol-to-cholesterol ratio)Onset Weeks to months, paralleling the lipid-lowering response

Full Fenofibrate depletion and interaction guide →

Safety

Full safety detail.

Side effects

Elevated liver enzymes (transaminases)
Increased serum creatinine (usually reversible)
Myalgia and muscle pain
Rare rhabdomyolysis, particularly with concurrent statin use
Cholelithiasis (gallstones)
Nausea, abdominal pain, and other gastrointestinal upset
Headache
Increased risk of venous thromboembolism

Contraindications

Severe renal impairment, including patients on dialysis³
Active liver disease, including primary biliary cholangitis and unexplained persistent liver function abnormalities
Preexisting gallbladder disease
Known hypersensitivity to fenofibrate or fenofibric acid^4,1
Breastfeeding
Caution and dose adjustment with concurrent statin therapy due to increased myopathy and rhabdomyolysis risk

Sources

Sources, by evidence tier.

Numbered references. Citations throughout the page link here.

Randomized controlled trials

1Effects of combination lipid therapy in type 2 diabetes mellitus (ACCORD Lipid)PMIDGinsberg HN, Elam MB, Lovato LC, et al. · New England Journal of Medicine · 2010
Adding fenofibrate to simvastatin did not reduce cardiovascular events overall, though a possible benefit was seen in patients with high triglycerides and low HDL.
2Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study)PMIDKeech A, Simes RJ, Barter P, et al. · Lancet · 2005
Fenofibrate lowered triglycerides and reduced nonfatal myocardial infarction, though it did not significantly reduce the primary coronary endpoint in the overall diabetic population.

Reviews & position papers

3Fenofibrate, homocysteine and renal functionWestphal S, Dierkes J, Luley C · Cardiovascular Drugs and Therapy · 2001
Fenofibrate raises plasma homocysteine in some analyses while it has been associated with reversible elevations in serum creatinine, complicating interpretation of renal effects.

Reference material

4TriCor (fenofibrate) tablets prescribing informationAbbVie Inc. · US FDA Prescribing Information · 2019
Fenofibric acid activates PPAR-alpha, increasing lipolysis and clearance of triglyceride-rich particles and modestly raising HDL.

FAQ

Common questions.

Quick answers about Fenofibrate, drawn from the data on this page.

What is Fenofibrate?

What is Fenofibrate used for?

Commonly cited benefits of Fenofibrate include: Treatment of severe hypertriglyceridemia to reduce pancreatitis risk; Management of primary hypercholesterolemia and mixed dyslipidemia; Modest increase in HDL cholesterol. NutriStack rates the overall evidence as strong.

What is a typical dose of Fenofibrate?

A typical adult dose of Fenofibrate is Fenofibrate 48 to 145 mg once daily (formulation-dependent; micronized and nanocrystallized products differ); fenofibric acid 35 to 135 mg once daily. Dose is reduced in renal impairment and the highest doses are avoided when eGFR is low.. The commonly recommended form is Oral tablet or capsule once daily; bioavailability varies by formulation, so older non-micronized products are best taken with food while many newer micronized or nanocrystallized products may be taken without regard to meals.. These are general ranges, not personalized advice; confirm the right dose with a clinician.

What are the side effects of Fenofibrate?

Reported side effects include elevated liver enzymes (transaminases), increased serum creatinine (usually reversible), myalgia and muscle pain, rare rhabdomyolysis, particularly with concurrent statin use, cholelithiasis (gallstones), nausea, abdominal pain, and other gastrointestinal upset. This is educational information; check with a healthcare professional before use.

How strong is the evidence for Fenofibrate?

NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.

Use this with your stack

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