Lipantyl,Fournier,France,1975
Antilipemic. It is a lipid regulating drug. Increases high density lipoprotein levels by reducing cholesteryl ester transfer protein expresion.
Fenofibrate has been used:
- to study its effect on plasma lipids, liver phenotype and gene expression
- to study its impact on endothelium-dependent vasodilatation of thoracic aorta
- to administer to NASH knock-in mice along with a high fat diet (HFD) to study its effect
ChEBI: A chlorobenzophenone that is (4-chlorophenyl)(phenyl)methanone substituted by a [2-methyl-1-oxo-1-(propan-2-yloxy)propan-2-yl]oxy group at position 1 on the phenyl ring.
(a) Preparation of p-(4-chlorobenzoyl)-phenoxyisobutyric acid: 1 mol of 4-
hydroxy-4'-chlorobenzophenone is dissolved in anhydrous acetone and then 5
mols of powdered sodium hydroxide is added. The corresponding sodium
phenoxide precipitates. Refluxing is effected, and then, 1.5 mols of CHCl3
diluted with anhydrous acetone is added and the resulting mixture is refluxed
for 10 hours. After cooling, water is added, the acetone is evaporated, the
aqueous phase is washed with ether and acidified and the organic phase is
redissolved in ether and extracted into a solution of bicarbonate. The
bicarbonate solution is than acidified to obtain the desired acid, having a
melting point of 185°C, with a yield of 75%.
(b) Preparation of fenofibrate: 1 mol of the acid obtained is converted into its
acid chloride using thionyl chloride (2.5 mols). 1 mol of the acid chloride is
then condensed with 1.05 mol of isopropyl alcohol in the presence of 0.98 mol
of pyridine in an inert solvent such as benzene.
Since traces of SO2 (which has a bad smell) may be obtained from the thionyl
chloride, it is preferable to avoid this disadvantage by carrying out the
esterification directly.
Fenofibrate, 2-[4-(4-chlorobenzoyl)phenoxy]-2-methylpropanoic acid 1-methylethyl ester (Tricor),has structural features represented in clofibrate. The primarydifference involves the second aromatic ring. This imparts agreater lipophilic character than exists in clofibrate, resultingin a much more potent hypocholesterolemic and triglycerideloweringagent. Also, this structural modification results in alower dose requirement than with clofibrate or gemfibrozil.
Fenofibrate increases high density lipoprotein levels by reducing cholesteryl ester transfer protein expression. It is used in treating the condition of increased cholesterol levels in the blood, abnormal lipid levels in the body and also hypertriglyceridaemia. Fenofibrate is a lipid regulating drug and proliferator-activated receptor-α (PPARα) mediates its action. It decreases the plasma levels of fibrinogen and C-reactive protein. By this fenofibrate allows better flow-mediated dilatation and reduces the risk of atherosclerosis. Fenofibrate is also known to reduce uric acid levels.
Potentially hazardous interactions with other drugs
Antibacterials: increased risk of myopathy with
daptomycin - try to avoid concomitant use.
Anticoagulants: enhances effect of coumarins and
phenindione; dose of anticoagulant should be
reduced by up to 50% and readjusted by monitoring
INR.
Antidiabetics: may improve glucose tolerance
and have an additive effect with insulin or
sulphonylureas.
Ciclosporin: ciclosporin levels appear to be
unaffected; however, it is recommended that
concomitant therapy should be avoided because of
the possibility of elevated serum creatinine levels.
Colchicine: possible increased risk of myopathy.
Lipid-regulating drugs: increased risk of myopathy
in combination with statins and ezetimibe
(maximum 20 mg of rosuvastatin); increased risk of
cholelithiasis and gallbladder disease with ezetimibe
- avoid with ezetimibe.
After oral administration, fenofibrate is rapidly
hydrolysed by esterases to the active metabolite fenofibric
acid.No unchanged fenofibrate can be detected in the plasma.
Fenofibric acid is excreted mainly in the urine, mainly as
the glucuronide conjugate, but also as a reduced form of
fenofibric acid and its glucuronide; practically all the drug
is eliminated from the body within 6 days
