19
Dosing Frequency Comments
†
Once daily • Oral agents
• CVOTs show no reduction in cardiovascular events when
fenofibrate is added to statin therapy in primary prevention
patients with diabetes; CVOT evidence demonstrating
reductions in cardiovascular events in primary and secondary
prevention patients with gemfibrozil monotherapy
• First-line option for severe hypertriglyceridemia
(≥500 mg/dL, especially when ≥1000 mg/dL)
• Expected TG reduction: 30%–50%
‡
• Many different formulations of fenofibrate and fenofibric acid
are available with varied dosages
• Dose may need to be reduced in decreased kidney function;
avoid in severe kidney dysfunction
• Blunted to no TG reduction in patients with familial
chylomicronemia syndrome due to reduced lipoprotein
lipase activity
• Gemfibrozil should not be combined with statin therapy
because of serious potential drug interaction
Once daily
Twice daily
Twice daily with
food
• Oral agents
• First-line option for severe (≥500 mg/dL) hypertriglyceridemia
• CVOT evidence demonstrating reductions in cardiovascular
events with icosapent ethyl in individuals being treated for
primary prevention of ASCVD patients with type 2 diabetes
or secondary prevention if TG between 150–499 mg/dL and
LDL-C is 41–100 mg/dL despite statin therapy
• Expected TG reduction: 15%–61%
‡
• Icosapent ethyl contains EPA only
• Omega-3 acid ethyl esters contain DHA and EPA, which can
modestly raise LDL-C (but not apoB)
• Nonprescription fish oil supplements are not equivalent to, or
considered prescription medications, and have variable fatty
acid content
• Give with a fat-containing meal to ensure absorption (pancreatic
lipase stimulation breaks ethyl bonds to facilitate absorption)
Once or twice daily
with food
