19
Table 7. Nonstatin Safety Recommendations (continued)
Recommendations
ACC/AHA
COR
ACC/AHA
LOE
Safety of Fibrates
1. Gemfibrozil should not be initiated in patients on statin
therapy because of an increased risk for muscle symptoms
and rhabdomyolysis.
III: Harm B
2. Fenofibrate may be considered concomitantly with a
low- or moderate-intensity statin only if the benefits from
ASCVD risk reduction or triglyceride lowering when
triglycerides are ≥500 mg/dL are judged to outweigh the
potential risk for adverse effects.
IIb C
3. Renal status should be evaluated before fenofibrate
initiation, within 3 months aer initiation, and every 6
months thereaer. Assess renal safety with both a serum
creatinine level and an eGFR based on creatinine.
• Fenofibrate should not be used if moderate or severe
renal impairment, defined as eGFR <30 mL/min per
1.73 m
2
, is present.
• If eGFR is between 30 and 59 mL/min per 1.73 m
2
, the
dose of fenofibrate should not exceed 54 mg/day
a
.
• If, during follow-up, the eGFR decreases persistently
to ≤30 mL/min per 1.73 m
2
, fenofibrate should be
discontinued.
I B
III: Harm B
Safety of Omega-3 Fatty Acids
1. If EPA and/or DHA are used for the management
of severe hypertriglyceridemia, defined as triglycerides
≥500 mg/dL, it is reasonable to evaluate the patient for
gastrointestinal disturbances, skin changes, and bleeding.
IIa B
a
Consult the manufacturer's prescribing information as there are several forms of fenofibrate available.
