There are three main classes of drugs used to lower triacylglycerol (TAG): omega-3 fatty acids, niacin, and fibric acid. Certain statins (atorvastatin, rosuvastatin, and simvastatin) also lower triglycerides by about 50 percent.
● Niacin. Niacin has many adverse effects, including chemical hepatitis. Flushing and itching are expected side effects; however, they occur less in long-acting preparations.
● Fibric acid derivatives. Popular fibric acid derivatives used as triglyceride-lowering agents include gemfibrozil, fenofibrate, and fenofibric acid. Gemfibrozil is not as safe as fenofibrate when used together with statins. But fenofibrates, when used together with statins, may increase the risk for muscle breakdown.
● Gemfibrozil is safer for patients with impaired renal function—it is not excreted through the kidneys. If fenofibrate is to be given in renal impairment, lower doses are recommended. If creatinine clearance is lower than 30, however, fibrates are contraindicated.
● Fenofibrates have been added to statins in patients with diabetes, low HDL, and elevated triglycerides. But the U.S. Food and Drug Administration recommends additional research to justify the addition of fenofibrates to statins, especially after the Action to Control Cardiovascular Risk in Diabetes (ACCORD)-Lipid trial revealed no benefit.
Given the unique drug profiles, treatment should always be individualized, with the risks and benefits carefully considered before any drug regimen is prescribed.