Fenofibrate

INTRODUCTION

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.

Adverse Reactions/Side Effects

CNS: fatigue/weakness, headache. CV: arrhythmias. GI: cholelithiasis, pancreatitis. Derm: rash, urticaria. MS: rhabdomyolysis. Misc: hypersensitivity reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess any muscle pain, tenderness, or weakness, especially if accompanied by fever, malaise, and dark-colored urine. Advise patient that these symptoms may represent drug-induced myopathy, and that myopathy can progress to severe muscle damage (rhabdomyolysis). Report any unexplained musculoskeletal symptoms to the physician immediately.

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Report signs of gallstones (cholelithiasis), including sudden intense pain in the abdomen or right side, jaundice, chills, and fever.

Interventions

• In patients with drug-induced myopathy, implement gradual strengthening and other therapeutic exercises to facilitate recovery from muscle pain and weakness. Use caution during early stages to avoid fatigue of affected muscles, and implement assistive devices (walker, cane, crutches) as needed to prevent falls and assist mobility. Increase exercise intensity as tolerated; recovery from myopathy typically takes 4–6 wk, but can be longer in older patients or people with comorbidities.

• Design and implement aerobic exercise and endurance training programs to improve cardiovascular function and help reduce the risk of coronary heart disease.

• Because of the risk of arrhythmias, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

• Remind patients to take medication as directed to control hyperlipidemia even though they are asymptomatic.

• Counsel patients about additional interventions to help control lipid disorders and improve cardiovascular health, including dietary modification, regular exercise, moderation of alcohol consumption, and smoking cessation.

• Advise patient to report signs of pancreatitis, including upper abdominal pain (especially after eating), indigestion, ...