Issues for surgery
Potential increase in serum triglycerides if omitted.
Risk of myopathy and rhabdomyolysis if continued (see Further information).
Advice in the perioperative period
Elective and emergency surgery
Continue – including the following combination product:
- Cholib® (fenofibrate + simvastatin) – see also Simvastatin
Surgery for gallbladder disease
Fenofibrate is contraindicated in gallbladder disease. Consider asking patient’s General Practitioner (GP) or surgeon to review fenofibrate if patient is awaiting surgery for gallbladder disease – see product literature for further information.
Post-operative advice
Restart post-operatively as soon as next dose is due.
Monitor liver and renal function – treatment interruption or dose reduction may be necessary if liver or renal function is impaired (see Further information).
Interactions with common anaesthetic agents
None.
For combination product containing simvastatin see Simvastatin.
Interactions with other common medicines used in the perioperative period
None.
For combination product containing simvastatin see Simvastatin.
Further information
Renal function and skeletal muscle effects
A concern with perioperative fibrate therapy is the risk of fibrate-induced myopathy and rhabdomyolysis. Perioperatively, factors increasing the risk of fibrate-induced myopathy include impairment of renal function after major surgery. Monitor renal function and adjust fibrate dose or interrupt treatment according to recommendations in product literature. Monitor the patient for signs and symptoms of skeletal muscle effects such as muscle pain, cramps or weakness. If symptoms occur, measure creatinine kinase (CK) level and if found to be more than 5 times the upper limit of normal (ULN), the fibrate should be stopped.
Liver effects
Patients who develop increased serum transaminase levels (alanine aminotransferase, ALT and aspartate aminotransferase, AST) should be monitored until the abnormality(ies) resolve. If serum transaminases of more than 3 times ULN persist, withdrawal of fenofibrate is recommended.
References
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 4th January 2024]
Fenofibrate. In: Brayfield A (Ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://www.medicinescomplete.com [Accessed 4th January 2024]
Summary of Product Characteristics – Lipantil® (fenofibrate) Micro 200 mg Capsules. Mylan. Accessed via www.medicines.org.uk 04/01/2024 [date of revision of the text September 2020]
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 4th January 2024]