The drugs fenofibrate and gemfibrozil are considered fibric acid derivatives. They can reduce serum triglycerides by as much as 50% in some studies. The mechanism of action is complex. Fibrates activate peroxisome proliferator-activated receptor alpha which in turn activates lipoprotein lipase. This increases lipolysis and the elimination of triglycerides from the plasma. Despite the triglyceride reduction, there is little data to support a mortality benefit from fibrates.
Fibrates must be used with caution in patients on HMG-CoA reductase inhibitors due to potential myalgias and rhabdomyolysis. Pravastatin or fluvastatin are the safest to use in combination with fibrates due to their elimination via the CYP3A4 system. While rosuvastatin also uses this system, doses should not exceed 10 mg daily while taking fibrates concomitantly.