TRILIPIXTM ( fenofibric acid ) - New Cholesterol Drug
Now that more recent pharmaceutical studies have all but proven the irrelevance of cholesterol in atherosclerosis, a new drug makes its reappearance - TriLipix. The last time I used this class of drugs was thirty years ago ( when I was in family practice ) and when the statins came out I promised myself no more fibrates.
In those days we had Atromid-S and Lopid. More recently there is TriCor, so Phoenix might be a far more appropriate name since this is an old drug with a new lease on life. I did not like fibrates then because of the frequency of disagreeable side effects and there is no reason to believe TriLipix is any different in that respect.
These side effects include severe stomach pain, nausea, vomiting, unusual weakness, joint pain, bloating, indigestion, gas, fever and a rash. Nothing serious like what we are seeing with statins but enough so those experiencing them are far from happy with the new cross to carry that was just prescribed to them.
And the effect on cholesterol, if any, was no more than 10%, about what you get from margarine laced with stanol esters that came on the market a few years ago. The only time I felt really comfortable prescribing this drug ( back when I was in practice ) was in familial hypercholesterolemics where the fatty ( triglyceride ) deposits were coming out in the skin.
I cannot imagine any experienced physician wanting to go back to this class of drug when most of the major pharmaceutical companies are now focusing on inflammation as the problem and anti-inflammatories as the need.
They call TriLipix the first fibrate to be specifically approved for use along with a statin but this is not saying much because many physicians have been using this off label combination ( statins plus fibrates ) for years. So bottom line is that nothing has changed except the FDA has approved TriLipix along with diet to lower LDL cholesterol, raise HDL and lower triglycerides.
Since the FDA approved the marketing of statins with no awareness of the tendency for glial cell inhibition of cholesterol synthesis or complete blockade of the mevalonate pathway, wiping out our CoQ10 and dolichols stores; or even that its mode of action in reduction of CV risk was by nuclear factor kappa B inhibition not cholesterol lowering, I do not consider this a step forward.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor