Can Increased Liver Enzymes Be Caused By Fenofibrate?

Fenofibrate is a medication that can cause mild, transient serum aminotransferase elevations in up to 20 patients, but values above 3 times normal in only 3 to 5 patients. These abnormalities are usually asymptomatic and transient, resolving even with the continuation of fenofibrate. However, they occasionally may require drug discontinuation. Fenofibrate is related to mild aminotransferase elevations and in some cases, severe chronic injury such as fibrosis or cirrhosis, resulting in liver damage.

The addition of fenofibrate and Ursodiol significantly reduces serum liver enzyme abnormalities and normalizes ALP levels in 90 of patients with PBC and 78 of patients. Elevated liver enzymes eventually decline to normal within 2 to 12 months after the treatment. Liver injury after fenofibrate exposure occurs with variable latency, enzyme elevation, and histology. Common causes of elevated liver enzymes include nonprescription pain medicines, such as acetaminophen (Tylenol), and certain prescription medicines.

Some potentially serious adverse effects that may require dose adjustment or discontinuation may include elevated liver enzymes, elevated creatine phosphokinase (CPK), cholelithiasis development, arrhythmia, and an increase in liver enzymes. Liver enzymes need to be periodically monitored and fenofibrate should be discontinued if liver enzymes reach three times the upper limit of normal. In some people, fenofibrate may severely depress HDL cholesterol levels.

Fenofibrate can affect liver function, which is why healthcare professionals should be aware of its potential side effects. Elevated liver enzymes may indicate liver damage or inflammation. Clinicians should discontinue treatment in patients with jaundice and highly elevated liver enzymes during fenofibrate therapy.

Is fenofibrate bad for the kidneys?

Conclusion. Fenofibrate treatment resulted in increased serum creatinine levels and reduced estimated glomerular filtration rates in a primary care setting. Therefore, regular renal function monitoring should be considered essential during fibrate administration.

Keywords: Fibric Acids, Hypertriglyceridemia, Creatinine, Glomerular Filtration Rate, Propensity Score.

INTRODUCTION. Metabolic syndrome, diabetes, and obesity are highly correlated with hypertriglyceridemia, high low-density lipoprotein (LDL) cholesterol, and low high-density lipoprotein (HDL) cholesterol. 1) Conventionally, statins have been widely used to treat hyperlipidemia; these 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors have a significant role in reducing the risk of cardiovascular diseases and stroke. 2) It has recently emerged that high serum triglyceride (TG) levels are a significant risk factor for arteriosclerosis. 3)

What to avoid when taking fenofibrate?

Carefully follow your doctor’s order about any special diet. If you have excess body weight, your doctor may tell you to exercise to lose this weight before using this medicine. Also avoid drinking alcohol before and during treatment with fenofibrate. This medicine is usually taken once a day.

It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly to lower your cholesterol and triglyceride (fat) levels and to decide if you should continue to take it. Blood and urine tests may be needed to check for unwanted effects.

Call your doctor right away if you have a headache, stomach pain, vomiting, dark urine, loss of appetite, weight loss, general feeling of tiredness or weakness, light-colored stools, upper right stomach pain, or yellow eyes or skin. These could be symptoms of serious liver problems.

Check with your doctor right away if you have unexplained muscle pain, tenderness, or weakness, especially if you also have unusual tiredness or fever. These could be symptoms of a serious muscle problem called myopathy.

Do fibrates cause elevated liver enzymes?

Three fibrates have been used in the United States: Gemfibrozil (Lopid: 1981), Fenofibrate (Lofibra, Tricor, Antara, Lipofen, Triglide: 1993), and Clofibrate (Abitrate, Atromid-S). Clofibrate has been withdrawn from use, largely because of concerns regarding increased risk of cancer and studies showing that, despite its cholesterol lowering activity, clofibrate therapy is not associated with a decrease in cardiovascular mortality. All three of the fibrates are associated with mild-to-moderate serum aminotransferase elevations during therapy that are typically transient, asymptomatic and may resolve even without discontinuation. All three agents have also been linked to cases of clinically apparent acute liver injury, fenofibrate most frequently and convincingly. The frequency and pattern of hepatic injury varies with the different fibrates and they do not appear to share a common pathway or class effect in causing liver injury. For these reasons each fibrate is discussed separately. The acute liver injury from the fibrates can be severe and prolonged and, unlike most forms of drug induced liver injury, can lead to chronic liver disease and cirrhosis.

Drugs in the Subclass, Fibrates: Clofibrate, Fenofibrate, Gemfibrozil.

Can cholesterol cause high liver enzymes?

High Cholesterol Is Harmful To Your Liver. It is a fact that high cholesterol is harmful to your heart, but little does everyone knows that it is even worse for your liver. Yes, high cholesterol can be bad for your liver. Besides increasing your risk for developing fatty liver disease, too much cholesterol in the body can turn the existing underlying condition into a fatal one. An uncontrollable rise in cholesterol levels can make steatosis into nonalcoholic steatohepatitis (NASH). Therefore, it is essential to control high cholesterol levels. If not managed and nonalcoholic steatohepatitis (NASH) has occurred, it can lead to:

• Scarring
• Liver cancer
• Liver Failure
• Chronic liver inflammation

Familial Hypercholesterolemia And High Cholesterol. High cholesterol in the family is called Familial Hypercholesterolemia. It is a genetic disorder that elevates bad cholesterol, which as a result can increase one’s risk of developing coronary heart disease or having a heart attack at a very young age. Familial Hypercholesterolemia affects an individual’s liver’s ability to recycle bad cholesterol. The condition can increase cholesterol levels in the body and lead to liver problems and other health conditions.

What organ is affected by high triglycerides?

Why do high triglycerides matter?. High triglycerides may contribute to hardening of the arteries or thickening of the artery walls (arteriosclerosis) — which increases the risk of stroke, heart attack and heart disease. Extremely high triglycerides can also cause acute inflammation of the pancreas (pancreatitis).

High triglycerides are often a sign of other conditions that increase the risk of heart disease and stroke, including obesity and metabolic syndrome — a cluster of conditions that includes too much fat around the waist, high blood pressure, high triglycerides, high blood sugar and abnormal cholesterol levels.

• Type 2 diabetes or prediabetes
• Metabolic syndrome — a condition when high blood pressure, obesity and high blood sugar occur together, increasing your risk of heart disease
• Low levels of thyroid hormones (hypothyroidism)
• Certain rare genetic conditions that affect how your body converts fat to energy

What happens if I suddenly stop taking fenofibrate?

Fenofibrate oral tablet is used for long-term treatment. It comes with risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: Your cholesterol levels may not be controlled. This raises your risk of serious health problems such as heart disease, heart attack, or stroke.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

Can triglycerides affect liver enzymes?

High triglyceride levels can be a clue that you have fatty liver disease. Poor eating habits lead not only to high levels of fat in the bloodstream (triglycerides) but increased storage of fat throughout the body, including in the liver. Elevations in liver function tests (like ALT and AST) can indicate that fatty liver is present. Fatty liver usually does not cause symptoms, but unless reversed, fatty liver can lead to permanent liver damage and cirrhosis.

If your triglyceride levels are “very high” above 500 mg/dL you are more likely to get inflammation in your pancreas.

Inflammation of the pancreas (a condition that doctors call pancreatitis ) can cause permanent tissue damage. Symptoms can include abdominal pain, which may be severe.

When should fenofibrate be stopped?

Your doctor will probably start you on an average dose of fenofibrate and may increase or decrease your dose depending on the results of laboratory tests that you will take to measure the amount of fatty substances in your blood. Your doctor may tell you to stop taking fenofibrate if your test results do not show improvement after 2 months.

Swallow the delayed-release tablets whole; do not split, chew, or crush them.

If you are taking Triglide tablets, do not use any tablets that are chipped or broken.

What are the most common side effects of fenofibrate?

Common fenofibrate side effects include abdominal pain, back pain, and headaches. Nasal congestion, nausea, and constipation are also possible. More serious fenofibrate side effects to watch out for include liver damage, muscle pain, gallstones, and pancreatitis.

Is fenofibrate safe for the liver?

Chronic liver injury and fibrosis have been reported with fenofibrate use, often in patients who continued therapy despite evidence of liver injury. In most cases, serum aminotransferase levels fall to normal within 2 to 12 months after stopping fenofibrate use. Recurrence is usually followed by a recurrence of liver injury, and should be avoided. Chronic injury with vanishing bile duct syndrome may underlie many cases of chronic liver disease due to fenofibrate. In some cases, features of autoimmune hepatitis may be present. Corticosteroids have been used with apparent effect on serum enzyme levels, but their efficacy in altering the outcome of injury is less clear. If corticosteroids are used, the dose and duration of therapy should be kept to a minimum. There may be some degree of cross reactivity to hepatic injury among the different fibrates.

In a case of acute hepatitis due to fenofibrate therapy, a 74-year-old woman developed jaundice after being on oral therapy with fenofibrate for two years. Laboratory findings included elevated serum aminotransferase levels and bilirubin levels. Tests for hepatitis A and B were negative, and autoantibodies were not found. After stopping fenofibrate, the woman began to improve, with rapid regression of jaundice and being discharged after 25 days in the hospital.

Does fenofibrate increase SGPT?

Liver Function. Fenofibrate at doses equivalent to 100 mg to 150 mgfenofibrate per day has been associated with increases in serum transaminases(AST (SGOT) or ALT (SGPT)). In a pooled analysis of 10 placebocontrolled trialsof fenofibrate, increases to 3 times the upper limit of normal of ALToccurred in 5. 3% of patients taking fenofibrate versus 1. 1% of patients treatedwith placebo. The incidence of increases in transaminases observed withfenofibrate therapy may be dose related. When transaminase determinations werefollowed either after discontinuation of treatment or during continuedtreatment, a return to normal limits was usually observed.

Chronic active hepatocellular and cholestatic hepatitisassociated with fenofibrate therapy have been reported after exposures of weeksto several years. In extremely rare cases, cirrhosis has been reported inassociation with chronic active hepatitis.

Baseline and regular monitoring of liver tests, includingALT should be performed for the duration of therapy with fenofibrate, andtherapy discontinued if enzyme levels persist above three times the normal limit.