Mosby's 2014 Nursing Drug Reference (172 page)

Read Mosby's 2014 Nursing Drug Reference Online

Authors: Linda Skidmore-Roth

Canada only Side effects:
italics
= common;
bold
= life-threatening
Nurse Alert

fenofibrate (Rx)

(fen-oh-fee′brate)

Antara, Apo-Feno-Micro
, Fenoglide, Lipidil Micro
, Lipidil Supra Cap, Lipofen, Lofibra, Tricor, Triglide

Func. class.:
Antilipemic

Chem. class.:
Fibric acid derivative

ACTION:

Increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase, thereby resulting in changes in triglyceride size and composition of LDL, leading to rapid breakdown of LDL; mobilizes triglycerides from tissue; increases excretion of neutral sterols

USES:

Hypercholesterolemia; types IV, V hyperlipidemia that do not respond to other treatment and that increase risk for pancreatitis; Fredrickson type IV, V hypertriglyceridemia

CONTRAINDICATIONS:

Hypertensivity, severe renal/hepatic disease, primary biliary cirrhosis, preexisting gallbladder disease

Precautions:
Pregnancy (C), breastfeeding, geriatric patients, peptic ulcer, pancreatitis, renal/hepatic disease

DOSAGE AND ROUTES
Calculator

Hypertriglyceridemia

• Adult:
PO
(Antara) 43-130 mg/day; (Lofibra) 67-200 mg/day; (Tricor) 48-145 mg/day; (Triglide) 50-160 mg/day

Primary hypercholesterolemia/mixed hyperlipidemia

• Adult:
PO
(Antara) 130 mg/day; (Lofibra) 200 mg/day; (Tricor) 145 mg/day; (Triglide) 160 mg/day

Renal dose (geriatric)

• Adult:
PO
(Tricor) CCr 30-80 ml/min, 48 mg/day; CCr <30 ml/min, contraindicated

• Adult:
PO
CCr 30-48 ml/min, 50 mg/day (Triglide, Liprofen), 43 mg/day (Antara), 67 mg/day (Lofibra caps), 54 mg/day (Lofibra tabs); CCr <10 ml/min, contraindicated (Antara, Lipofen, Lofibra, Triglide); 40 mg/day (Fenoglide)

Available forms:
Tabs (Triglide) 50, 160 mg; (Tricor) 48, 145 mg; micronized cap (Antara) 43, 130 mg; (Lofibra) 67, 134, 200 mg; cap (Lipofen) 50, 100, 150 mg; tabs (Fenoglide) 40, 120 mg

Administer:

•
Product with meals (Lipofen, Lofibra); Triglide without regard to food; may increase q4-8wk; brands are not interchangeable; therapy should be discontinued if there is not adequate response after 2 mo

SIDE EFFECTS

CNS:
Fatigue, weakness
, drowsiness, dizziness, insomnia, depression, vertigo

CV:
Angina, hypertension

GI:
Nausea
, vomiting, dyspepsia, increased liver enzymes, flatulence, hepatomegaly, gastritis,
pancreatitis, cholelithiasis

GU:
Dysuria, urinary frequency

HEMA:
Anemia, leukopenia,
thrombosis/pulmonary embolism

INTEG:
Rash
, urticaria, pruritus, photosensitivity

MISC:
Polyphagia, weight gain, infection, flulike syndrome

MS:
Myalgias, arthralgias
,
myopathy, rhabdomyolysis

RESP:
Pharyngitis, bronchitis, cough

PHARMACOKINETICS

Peak 6-8 hr, protein binding 99%, converted to fenofibric acid, metabolized in liver, excreted in urine (60%), feces (25%), half-life 20 hr

INTERACTIONS

Increase:
myopathy—colchicine

Increase:
nephrotoxicity—cycloSPORINE

•
Avoid use with HMG-CoA reductase inhibitors; rhabdomyolysis may occur

Increase:
anticoagulant effects—oral anticoagulants

Increase:
effects of—antidiabetics

Decrease:
absorption of fenofibrate—bile acid sequestrants

Drug/Herb

Increase:
effect—red yeast rice

Drug/Food

Increase:
absorption

Drug/Lab Test

Increase:
ALT, AST, BUN, CK, creatinine

Decrease:
WBC, uric acid, Hgb, paradoxical effect in HDL

NURSING CONSIDERATIONS

Assess:

•
Diet history:
fat content; lipid levels (triglycerides, LDL, HDL, cholesterol), may cause a paradoxical decrease in HDL, LFTs at baseline, periodically during treatment, CPK if muscle pain occurs, CBC, Hct, Hgb; PT with anticoagulant therapy

•
Pancreatitis, cholelithiasis renal failure, rhabdomyolysis
(when combined with HMG Co-A reductase inhibitors), myositis; product should be discontinued

Evaluate:

•
Therapeutic response: decreased triglycerides, cholesterol levels

Teach patient/family:

•
That compliance is needed

•
That risk factors should be decreased: high-fat diet, smoking, alcohol consumption, absence of exercise

•
To notify prescriber if pregnancy is suspected or planned

•
To report GU symptoms: decreased libido, impotence, dysuria, proteinuria, oliguria, hematuria

•
To notify prescriber of muscle pain, weakness, fever, fatigue, epigastric pain

Canada only Side effects:
italics
= common;
bold
= life-threatening
Nurse Alert