TriCor


Also found in: Dictionary.

fenofibrate

Antara, Apo-Fenofibrate (CA), Fenogal (UK), Lipantil (UK), Lipofen, Lofibra, Nu-Fenofibrate (CA), Tricor, Triglide, Supralip (UK)

Pharmacologic class: Fibric acid derivative

Therapeutic class: Antihyperlipidemic

Pregnancy risk category C

Action

Inhibits triglyceride synthesis in liver, reducing levels of low- and very-low-density lipoproteins. Also increases uric acid secretion.

Availability

Capsules: 50 mg, 150 mg

Capsules (micronized): 43 mg, 67 mg, 130 mg, 134 mg, 200 mg

Tablets: 48 mg, 50 mg, 54 mg, 145 mg, 160 mg

Indications and dosages

Adjunct to dietary therapy to reduce elevated low-density lipoproteins (LDL)-C, total cholesterol, triglycerides, and apolipoprotein B; to increase high-density lipoprotein-C level in adult patients with primary hypercholesterolemia or mixed dyslipidemia (Fredrickson Types IIa and IIb)

Adults: 1 tablet (145 or 160 mg), 1 capsule (150 mg), or 1 micronized capsule (130 or 200 mg) P.O. daily

Hypertriglyceridemia

Adults: Initially, 50 to 150 mg P.O. daily (capsule); 43 to 200 mg P.O. daily (micronized capsule); 48 to 160 mg P.O. daily (tablet)

Dosage adjustment

• Renal impairment
• Elderly patients

Off-label uses

• Polymetabolic syndrome X

Contraindications

• Hypersensitivity to drug
• Hepatic disease or unexplained, persistent liver function test abnormalities
• Severe renal impairment
• Gallbladder disease
• Breastfeeding

Precautions

Use cautiously in:
• pancreatitis, cholelithiasis
• patients receiving warfarin concurrently
• pregnant patients
• children.

Administration

Before giving, be aware of potentially serious interactions, such as with nephrotoxic drugs.
• Administer with meals.
• Give bile acid sequestrants at least 1 hour before or 4 to 6 hours after fenofibrate.

Adverse reactions

CNS: drowsiness, dizziness, fatigue, headache, migraine, insomnia, depression, vertigo, nervousness, anxiety, paresthesia, hypotonia, neuralgia

CV: tachycardia, varicose veins, phlebitis, angina, hypertension, hypotension, peripheral vascular disease, vasodilation, ECG abnormalities, coronary artery disease, arrhythmias, ventricular extrasystoles, myocardial infarction, atrial fibrillation

EENT: conjunctivitis, abnormal vision, cataracts, refraction disorder, otitis media, rhinitis, sinusitis, pharyngitis, laryngitis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, flatulence, dyspepsia, gastritis, gastroenteritis, esophagitis, duodenal or peptic ulcer, colitis, cholelithiasis, cholecystitis, rectal disorder, rectal hemorrhage

GU: urinary frequency, dysuria, cystitis, urolithiasis, prostatic disorder, gynecomastia, vaginal candidiasis, decreased libido, renal dysfunction

Hematologic: eosinophilia, anemia, lymphadenopathy, thrombocytopenia, leukopenia

Hepatic: fatty liver deposits

Metabolic: hyperuricemia, gout, hypoglycemia

Musculoskeletal: back, muscle, or joint pain; myositis; arthritis; tenosynovitis; arthrosis; bursitis

Respiratory: respiratory disorders, bronchitis, increased cough, dyspnea, pneumonia, asthma

Skin: rash, pruritus, urticaria, bruising, acne, eczema, diaphoresis, dermatitis, herpes simplex, herpes zoster, alopecia, nail disorder

Other: weight loss or gain, edema, fever, flulike symptoms, hypersensitivity reactions

Interactions

Drug-drug.Bile acid sequestrants (resins): decreased absorption and efficacy of fenofibrate

Immunosuppressants, other nephrotoxic drugs: increased risk of renal toxicity

Oral anticoagulants: increased risk of bleeding

Statins (such as simvastatin): rhabdomyolysis, acute renal failure

Drug-diagnostic tests.Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, blood urea nitrogen, creatinine, gamma-glutamyltransferase, uric acid: increased values

Granulocytes, hemoglobin, neutrophils, platelets, white blood cells (WBCs): decreased values

Liver function tests: abnormal results

Drug-food.Any food: increased drug absorption

Drug-behaviors.Alcohol use: elevated triglyceride level

Patient monitoring

• Assess creatine kinase and lipid levels and liver function test results.
• Monitor CBC and WBC count. Expect these to decrease at start of therapy, then stabilize.

Patient teaching

• Instruct patient to take with meals for best effect.
• Remind patient that he still needs to follow a triglyceride-lowering diet.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient to minimize GI upset by eating frequent, small servings of food and drinking plenty of fluids.
• Tell patient that drug may take up to 2 months to alter lipid values.
• Inform breastfeeding patient that she must choose between taking fenofibrate and breastfeeding.
• Tell female patient to inform prescriber if she is pregnant.
• Inform patient that he'll undergo regular blood testing.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and behaviors mentioned above.

fenofibrate

(fen-o-fi-brate) ,

Antara

(trade name),

Fenoglide

(trade name),

Fenomax

(trade name),

Lipidil EZ

(trade name),

Lipidil Micro

(trade name),

Lipidil Supra

(trade name),

Lipofen

(trade name),

Lofibra

(trade name),

Tricor

(trade name),

Triglide

(trade name)

Classification

Therapeutic: lipid lowering agents
Pharmacologic: fibric acid derivatives
Pregnancy Category: C

Indications

With dietary therapy to decrease LDL cholesterol, total cholesterol, triglycerides, and apolipoprotein B in adult patients with hypercholesterolemia or mixed dyslipidemia.With dietary management in the treatment of hypertriglyceridemia (types IV and V hyperlipidemia) in patients who are at risk for pancreatitis and do not respond to nondrug therapy.

Action

Fenofibric acid primarily inhibits triglyceride synthesis.

Therapeutic effects

Lowering of cholesterol and triglycerides with subsequent decreased risk of pancreatitis.

Pharmacokinetics

Absorption: Well absorbed (60%) after oral administration; absorption ↑ by food.
Distribution: Unknown.
Protein Binding: 99%.
Metabolism and Excretion: Rapidly converted to fenofibric acid, which is the active metabolite; fenofibric acid is metabolized by the liver. Fenofibric acid and its metabolites are primarily excreted in urine (60%).
Half-life: 20 hr.

Time/action profile (lowering of triglycerides)

ROUTEONSET PEAKDURATION
POunknown 2 wkunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Hepatic impairment (including primary biliary cirrhosis);Pre-existing gallbladder disease;Severe renal impairment;Concurrent use of HMG-CoA reductase inhibitors; Lactation: Potential for tumorigenicity noted in animal studies; discontinue breast feeding.
Use Cautiously in: Concurrent warfarin or HMG-CoA reductase inhibitor therapy; Obstetric: Embryocidal and teratogenic in animal studies; use only if potential benefits outweigh risks to the fetus; Pediatric: Safety not established; Geriatric: Age-related ↓ in renal function may make older patients more susceptible to adverse reactions.

Adverse Reactions/Side Effects

Central nervous system

  • fatigue/weakness (most frequent)
  • headache

Cardiovascular

  • pulmonary embolism (life-threatening)
  • arrhythmias
  • deep vein thrombosis

Gastrointestinal

  • cholelithiasis
  • pancreatitis

Dermatologic

  • rash (most frequent)
  • urticaria

Metabolic

  • ↓ HDL levels

Musculoskeletal

  • rhabdomyolysis

Miscellaneous

  • hypersensitivity reactions

Interactions

Drug-Drug interaction

↑ anticoagulant effects of warfarin.HMG-CoA reductase inhibitors ↑ risk of rhabdomyolysis (concurrent use should be avoided).Absorption is ↓ by bile acid sequestrants (fenofibrate should be given 1 hr before or 4–6 hr after).↑ risk of nephrotoxicity with cyclosporine.Concurrent use with colchicine may ↑ risk of rhabdomyolysis

Route/Dosage

Primary hypercholesterolemia/mixed dyslipidemia

Oral (Adults) Antara—90 mg/day initially; Fenoglide—120 mg/day; Lofibra—200 mg/day initially; Tricor—145 mg/day initially; Triglide—160 mg/day initially; Lipofen—50 mg daily.

Hypertriglyceridemia

Oral (Adults) Antara—30–90 mg/day ; Fenoglide—40–120 mg/day; Lofibra—67–200 mg/day initially; Tricor—48–145 mg/day initially; Triglide—50–160 mg/day initially; Lipofen—50 mg daily.

Renal impairment/Geriatric patients

Oral (Adults) Antara—30 mg/day; Fenoglide—start at 40 mg/day; Lofibra—67 mg/day; Tricor—48mg/day.

Availability (generic available)

Tablets (Tricor): 48 mg, 145 mg Cost: Generic — 48 mg $171.86 / 90, 145 mg $515.58 / 90
Tablets (Fenoglide): 40 mg, 120 mg Cost: 40 mg $289.44 / 90, 120 mg $869.40 / 90
Tablets (Triglide): 50 mg, 160 mg Cost: Generic — 160 mg $176.40 / 100
Micronized tablets (Lofibra): 54 mg, 100 mg, 160 mg Cost: Generic — 54 mg $71.29 / 90, 160 mg $213.88 / 90
Micronized capsules (Antara): 30 mg, 90 mg
Capsules (Lipofen): 50 mg, 150 mg Cost: 50 mg $213.58 / 90, 150 mg $468.24 / 90
Micronized capsules (Lofibra): 67 mg, 134 mg, 200 mg Cost: Generic — 67 mg $74.95 / 100, 134 mg $199.62 / 100, 200 mg $266.45 / 100

Nursing implications

Nursing assessment

  • Obtain a diet history, especially with regard to fat consumption. Every attempt should be made to obtain normal serum triglyceride levels with diet, exercise, and weight loss in obese patients before fenofibrate therapy is instituted.
  • Assess patient for cholelithiasis. If symptoms occur, gallbladder studies are indicated. Discontinue therapy if gallstones are found.
  • Lab Test Considerations: Monitor serum lipids before therapy to determine consistent elevations, then monitor periodically during therapy.
    • Monitor serum AST and ALT periodically during therapy. May cause ↑ levels. Therapy should be discontinued if levels rise >3 times the normal limit.
    • If patient develops muscle tenderness during therapy, monitor CPK levels. If CPK levels are markedly ↑ or myopathy occurs, discontinue therapy.
    • May cause mild to moderate ↓ in hemoglobin, hematocrit, and WBCs. Monitor periodically during first 12 mo of therapy. Levels usually stabilize during long-term therapy.
    • Monitor prothrombin levels frequently until levels stabilize in patients taking anticoagulants concurrently.

Potential Nursing Diagnoses

Noncompliance (Patient/Family Teaching)

Implementation

  • Do not confuse Tricor with Tracleer (bosentan).
  • Place patients on a triglyceride-lowering diet before therapy and remain on this diet throughout therapy.
    • Dose may be increased after repeated serum triglyceride levels every 4–8 wk.
    • Brands are not interchangeable.
  • Oral: Administer Antara, Fenoglide, Lipofen, Lipidil Micro, Lipidil Supra, Lofibra, and Tricor products with meals. Triglide formulation may be taken without regard to meals.

Patient/Family Teaching

  • Instruct patient to take medication as directed, not to skip doses or double up on missed doses. Medication helps control but does not cure elevated serum triglyceride levels.
  • Advise patient that this medication should be used in conjunction with diet restrictions (fat, cholesterol, carbohydrates, alcohol), exercise, and cessation of smoking.
  • Instruct patient to notify health care professional if unexplained muscle pain, tenderness, or weakness occurs, especially if accompanied by fever or malaise.
  • Advise patient to notify health care professional of medication regimen before treatment or surgery.
  • Instruct female patients to notify health care professional promptly if pregnancy is planned or suspected.
  • Emphasize the importance of follow-up exams to determine effectiveness and to monitor for side effects.

Evaluation/Desired Outcomes

  • Decrease in serum triglycerides and cholesterol to normal levels. Therapy should be discontinued in patients who do not have an adequate response in 2 mo of therapy.

TriCor®

Fenofibrate Cardiology An adjunct to diet for managing stratospheric serum TG levels in Pts unresponsive to diet or at risk of pancreatitis

Patient discussion about TriCor

Q. Improving High Triglycerides I take Tricor for high triglyceride levels; I have a healthy level of total cholesterol, with low LDL, very good HDL. I am now being treated for hypothyroidism, but my doctor says that it's also genetic (I had almost the exact same level number as my brother). How can I work to get my triglycerides under control?

A. High level of triglycerides are generally both genetic and diet related. If you are consuming a high fat containing diet then your level of triglycerides will be increased. On the other hand, regardless of your good cholesterol levels, if you start lowering the amount of fat in your food (less oil, less sweets, less red meat) and combine it with physical activity you can lower your triglycerides level, especially if you are already on medications.

More discussions about TriCor
References in periodicals archive ?
Fenofibrate, including AbbVie's TriCor, has also failed to show benefit in two separate studies, Krumholz said.
Litre Meter is now able to supply the full Tricor range of coriolis instruments to its UK customers.
Ms Wong has provided outsourced company secretarial services to many private companies and has been actively involved, as a manager of Tricor, in servicing a number of public companies listed on the Stock Exchange.
Tricor Group, a member of The Bank of East Asia Group, is expanding into Dubai and the Middle East through a new Joint Venture with Praesidium.
One group also received TriCor, an Abbott Laboratories medicine to lower the blood fat triglycerides and raise good HDL cholesterol that belongs to a class of drugs called fibrates.
The multistate lawsuit alleged that Abbott and a unit of Belgium drugmaker Solvay Pharmaceuticals SA made minor changes to the formulation of TriCor to prevent cheaper generic versions from launching.
ordinary shares under the name of Tricor Plc (AIM: TRIC) will commence on 6
Specialists in underground irrigation systems, Tricor, is offering a free design planning service to landscapers and groundsmen, in conjunction with its innovative Mona Plant System (MPS) irrigation range.
MPS, an underground watering system, was manufactured by Marske-based Tricor International and the Corporation joins a growing client list which includes the Tivoli Gardens in Copenhagen, Disneyland-Tokyo, Helsinki Airport and even a royal garden in Saudi Arabia.
NEL made the investment in Teesside-based garden features company Tricor.
The combination of Pravachol and Tricor (fenofibrate), a drug used to treat high triglyceride levels, was also investigated in another study (abstract 723).
My doctor's orders demanded a low-fat diet and daily doses of Zocor, followed months later by the metabolic diet and Lipitor, followed months later by yet another diet and Tricor.