Fibrates

Fibrates are most effective at lowering elevated triglycerides, but they also tend to lower LDL cholesterol and raise HDL cholesterol. Fibrates include clofibrate, bezafibrate (Bezalip / Bezalip Mono), ciprofibrate (Modalim), fenofibrate (Lipantil / Supralip 160), ispaghula and gemfibrozil.

These drugs should not be used in people with kidney, gall stone or liver problems, and should not be taken by pregnant women. Side-effects include nausea, stomach pain, rash, impotence, dizziness, fatigue and muscle pain.

The fibrates are less likely than statins to interact with protease inhibitors because they are not primarily metabolised by the P450 CYP3A4 pathway. The clinical effects of taking fibrates with antiretroviral therapy are not currently well understood.

Studies in people on HAART have confirmed that fibrates are more effective than statins at reducing triglyceride levels, and modestly elevating HDL levels. ^{1 2 3} However, people with antiretroviral therapy-related metabolic disorders tend not to have high triglycerides without also having elevated LDL cholesterol. Sometimes, however, LDL can just be on the wrong side of the upper limit of normal and under these circumstances - when triglyceride levels are above 5.65mmol/L - then fibrate therapy can be used. The two recommended drugs are gemfibrozil (600mg twice daily 30 minutes before meals) or micronised fenofibrate (54 to 160 mg daily).

The combination of gemfibrozil with atorvastatin has been moderately effective at reducing cholesterol and triglyceride levels among people on protease inhibitors. ^{4 5}