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Are fasting triglycerides below 250 mg/dl?

Fibrates are indicated primarily when triglycerides are elevated.

If triglycerides are below 250 mg/dl, re-evaluate whether fibrates are really needed.

Is LDL cholesterol also elevated above goal levels?

Great triglyceride lowering drugs, fibrates will probably NOT also reduce the LDL cholesterol.

Be prepared to add an additional lipid lowering drug if LDL remains elevated.

Is patient already taking a statin?

If so, be sure to keep the statin dose low and instruct patient to stop both drugs if myalgias and/or muscle weakness develops.

Does the patient have renal disease?

Fibrates are catabolized primarily by kidney; toxicity is much more likely if creatinine clearance is less than 50 cc/hr.