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Warning over fibrates to treat cholesterol

The UK drug regulator has warned GPs against use of fibrates to treat high cholesterol, except in rare circumstances.

A review by the Medicines and Healthcare Products Regulatory Agency concluded use of the drugs as first line treatment was no longer justified.

Fibrates should be reserved only for patients with isolated severe hypertriglyceridaemia or patients with mixed hyperlipidaemia who could not tolerate statins, it said.

The new guidelines, published in the MHRA's Drug Safety Update, add that gemfibrozil can be considered in patients with primary hyper-cholesterolaemia but only if a statin cannot be used.

And combination therapy with a statin and a fibrate should be used with caution.

Dr Brian Crichton, a GP in Solihull, Birmingham and an honorary lecturer in therapeutics and pharmacology at the University of Warwick, said the MHRA conclusions were highly reasonable. ‘The evidence is for fibrates is much smaller when you compare it with the evidence for statins.'

He said the drugs should be reserved for rare cases such as patients with hypertriglyceridaemia but that he tended to refer such patients to specialist lipid clinics for advice.

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