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Bezafibrate
โ ๏ธ Key risk: Myotoxicity (rhabdomyolysis) if dose not reduced in renal failure. Always adjust by eGFR.
๐ About Bezafibrate
- Always check the BNF entry for up-to-date prescribing advice.
- Fibrate used for hyperlipidaemia, especially when statins are contraindicated or not tolerated.
- Particularly effective for hypertriglyceridaemia.
โ๏ธ Mode of Action
- PPAR-ฮฑ agonist โ increases lipoprotein lipase activity.
- โ Triglycerides, โ HDL cholesterol, modest โ in LDL cholesterol.
- Reduces VLDL production in the liver.
๐ฏ Indications & Doses
- Hyperlipidaemia (statin-intolerant): 200 mg PO every 8 h (TDS).
- Modified release: 400 mg PO once daily (OD).
- Severe hypertriglyceridaemia: as above.
๐ Dose Summary
| Preparation | Dose | Frequency | Route |
|---|---|---|---|
| Bezafibrate | 200 mg | TDS | PO |
| Bezafibrate (MR) | 400 mg | OD | PO |
โ ๏ธ Dose Adjustments in Renal Impairment
- eGFR 40โ60 โ max 400 mg daily.
- eGFR 15โ40 โ 200 mg every 1โ2 days.
- Contraindicated if eGFR < 15 mL/min/1.73mยฒ.
๐ซ Contraindications
- Hypoalbuminaemia.
- Primary biliary cirrhosis or gall bladder disease.
- Nephrotic syndrome.
- Pregnancy & breastfeeding.
๐ฅ Side Effects
- Common: GI disturbance, anorexia.
- Liver: cholestasis, raised LFTs.
- Muscle: myopathy, rhabdomyolysis (โ risk with renal impairment or statins).
๐ Interactions
- โ Risk of myopathy if combined with statins โ monitor CK closely.
- Monitor LFTs and renal function during therapy.
๐ References
- BNF โ Bezafibrate
- NICE Lipid Modification Guidelines
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