Fenofibrate/Lipantil

When triglycerides are elevated or a mixed lipid profile needs addressing alongside or instead of statin therapy, a fibrate can provide targeted lipid control through a mechanism distinct from statins. Fenofibrate tablets and capsules, available under the brand name Lipantil and as generic formulations, are a prescription-only fibrate used in adults for the treatment of severe hypertriglyceridaemia and mixed dyslipidaemia. Available in three strengths (160 mg, 200 mg, and 267 mg) across different formulations, Fenofibrate provides once-daily triglyceride reduction and HDL improvement as part of cardiovascular therapy. A prescription can only be issued following a clinical consultation.

Fenofibrate is an oral prescription medicine belonging to the fibrate class of lipid-lowering medicines. Lipantil is a well-known brand name for Fenofibrate in the UK. Fenofibrate is available in several formulations and strengths: 160 mg tablets, 200 mg capsules, and 267 mg capsules are the strengths listed for this product. Generic Fenofibrate at equivalent strengths is also available.

An important note about Fenofibrate formulations: different Fenofibrate products have different bioavailability and must not be assumed to be interchangeable. The 200 mg and 267 mg capsule strengths typically refer to micronised Fenofibrate formulations, while 160 mg may refer to a tablet or alternative capsule formulation. Always check which specific formulation has been prescribed for you, and always take the formulation and strength specified on your prescription.

Fenofibrate is licensed in the UK as adjunctive therapy to diet and other non-pharmacological treatments (exercise and weight reduction) for severe hypertriglyceridaemia with or without low HDL cholesterol, and for mixed dyslipidaemia when a statin is contraindicated or not tolerated. Fenofibrate is also used alongside statins in some patients with mixed dyslipidaemia where triglycerides and HDL remain outside target despite statin therapy, under careful prescriber assessment.

Fenofibrate lowers blood lipids through its action as a PPAR alpha agonist — the same mechanism shared by bezafibrate and ciprofibrate.

Conversion to Fenofibric Acid. Fenofibrate is a prodrug. After absorption it is rapidly hydrolysed in the body to fenofibric acid, the pharmacologically active form. Fenofibric acid is responsible for all the lipid lowering effects of Fenofibrate. The rate and extent of conversion and absorption varies between formulations, which is why different Fenofibrate products are not interchangeable.

PPAR Alpha Activation and Lipid Effects. Fenofibric acid activates peroxisome proliferator-activated receptor alpha (PPAR alpha) receptors in cells, particularly in the liver. These nuclear receptors regulate genes involved in fatty acid metabolism and lipoprotein handling. PPAR alpha activation by fenofibric acid increases the activity of lipoprotein lipase, the enzyme that clears triglyceride rich particles from the blood, producing a significant fall in plasma triglycerides. It also reduces hepatic VLDL production, further lowering triglycerides. Fenofibric acid raises HDL cholesterol by increasing production of apolipoproteins A-I and A-II, the main structural proteins of HDL particles.

In patients with mixed dyslipidaemia, Fenofibrate can also produce a modest reduction in LDL cholesterol, though the magnitude of LDL lowering varies between patients and is generally less consistent than its triglyceride lowering effect. The overall lipid profile improvement with Fenofibrate makes it particularly useful where triglyceride management is the primary treatment priority as part of a broader cardiovascular therapy plan.

Always take Fenofibrate exactly as your prescriber instructs. Instructions vary between formulations. Read the Patient Information Leaflet for your specific product before starting treatment.

• Take Fenofibrate once daily. All strengths listed (160 mg, 200 mg, and 267 mg) are taken as a single daily dose.
• Take with food. Fenofibrate absorption, particularly for non-micronised formulations, is significantly improved when taken with a meal.
• Swallow the capsule or tablet whole with a glass of water. Do not crush or open the capsule.

If you miss a dose, take it as soon as you remember with your next meal. If you only remember the following day, skip the missed dose and continue as normal. Do not take two doses on the same day. Do not stop taking Fenofibrate without speaking to your prescriber first.

Your prescriber will arrange blood tests to check your lipid levels before and during treatment, typically at three to six months. Liver and kidney function may also be monitored.

Fenofibrate is available in three strengths through this service. The appropriate strength depends on the specific formulation prescribed and your individual clinical needs. Do not switch between strengths or formulations without first consulting your prescriber or pharmacist.

Fenofibrate 160 mg: Typically available as a tablet formulation (for example Supralip 160 mg). Provides the standard maintenance dose for most adults, taken once daily with food. Not interchangeable with the 200 mg micronised capsule on a milligram for milligram basis.

Fenofibrate 200 mg: Typically available as a micronised capsule formulation (for example Lipantil Micro 200 mg). Micronised Fenofibrate has improved bioavailability compared to non-micronised formulations and is one of the most commonly prescribed strengths in the UK.

Fenofibrate 267 mg: Available as a micronised capsule (for example Lipantil Micro 267 mg). Provides greater Fenofibrate exposure than the 200 mg capsule and may be used when more intensive triglyceride lowering is required. Do not change your strength or formulation without medical advice.

Like all medicines, Fenofibrate can cause side effects.

Common Side Effects (may affect up to 1 in 10 people):

• Gastrointestinal effects including abdominal pain, nausea, diarrhoea, and flatulence. Taking Fenofibrate with food helps reduce gastrointestinal discomfort.
• Muscle aches or weakness (myalgia). Contact your prescriber if you experience unexplained muscle pain, tenderness, or weakness.

Uncommon Side Effects (may affect up to 1 in 100 people):

• Raised liver enzymes, monitored during treatment.
• Headache.
• Skin rash or itching.
• Raised creatinine levels on blood tests, usually without symptoms.

Serious Side Effects — Seek Urgent Medical Attention: Go to your nearest accident and emergency department or call 999 immediately if you experience severe muscle pain, weakness, or cramps, particularly with dark, tea coloured urine (rhabdomyolysis risk, higher when combined with a statin); signs of significant liver problems such as yellowing of the skin or eyes, severe abdominal pain, or very dark urine; pancreatitis (severe upper abdominal pain radiating to the back); or signs of a severe allergic reaction such as sudden widespread rash, difficulty breathing, or swelling of the face, lips, tongue, or throat.

Fenofibrate may be suitable if you:

• Are an adult with severe hypertriglyceridaemia or mixed dyslipidaemia that has not responded adequately to dietary measures and non-pharmacological treatment.
• Cannot tolerate a statin and require an alternative for lipid management, and your prescriber has assessed Fenofibrate as appropriate.
• Are taking a statin and have residual elevated triglycerides or low HDL that your prescriber has determined require additional treatment with Fenofibrate.
• Are already prescribed Fenofibrate and require a repeat prescription through an online prescribing service.

Fenofibrate is not suitable if you:

• Have severe kidney impairment, as Fenofibrate is substantially eliminated by the kidneys.
• Have significant liver disease or persistently abnormal liver function tests.
• Have a history of photoallergy or phototoxicity from fibrate medicines.
• Have gallbladder disease — Fenofibrate is contraindicated in gallbladder disease.
• Are pregnant or planning to become pregnant.
• Are breastfeeding.
• Are under 18 years of age.
• Have a known allergy or hypersensitivity to Fenofibrate or any excipient listed in the SmPC for your specific product.

Important Drug Interactions: Statins combined with Fenofibrate increase the risk of myopathy and rhabdomyolysis — requires careful prescriber assessment. Warfarin and anticoagulants may have their effect enhanced — INR monitoring and possible dose reduction needed. Ciclosporin may increase the risk of kidney problems when combined. Antidiabetic medicines may have their blood glucose lowering effect enhanced. Bile acid sequestrants such as colestyramine may reduce Fenofibrate absorption — take at least one hour before or four to six hours after.

Fenofibrate is a Prescription Only Medicine. The clinical consultation is the essential first step. A prescription will only be issued if a registered prescriber concludes, based on their individual assessment of your circumstances, that Fenofibrate is clinically appropriate for you.

During your online consultation with Pharmacy Planet, a registered prescriber will review your lipid profile, triglyceride and HDL levels, kidney function where available, current medicines, and relevant medical history. The prescriber will determine the appropriate formulation and strength, whether Fenofibrate is suitable as monotherapy or alongside a statin, and whether online prescribing is appropriate for your situation.

Not all consultations will result in a prescription. The prescriber may request blood test results, recommend a different approach to lipid management, or advise that a GP review is needed before prescribing proceeds.