Treat secondary causes of hypercholesterolemia (eg, uncontrolled type 2 DM, hypothyroidism, nephrotic syndrome, dysproteinemia, obstructive liver disease or alcoholism) before fenofibrate therapy is considered. Reports of increased transaminase levels; pancreatitis; muscle toxicity, including rare cases of rhabdomyolysis, w/ or w/o renal failure; reversible elevations in serum creatinine. Monitor transaminase levels every 3 mth during the 1st 12 mth of treatment & regularly thereafter. Discontinue treatment if AST & ALT levels increase to >3x ULN, & in case of confirmed hepatitis. Increased risk of developing rhabdomyolysis in patients w/ predisposing factors for myopathy &/or rhabdomyolysis, including age >70 yr, personal or family history of hereditary muscular disorders, renal impairment, hypothyroidism & high alcohol intake. Stop treatment in patients presenting diffuse myalgia, myositis, muscular cramps & weakness &/or marked increases in creatine phosphokinase levels (>5x ULN). Reserve combination w/ HMG-CoA reductase inhibitor or another fibrate to patients w/ severe combined hyperlipidemia & high CV risk w/o any history of muscle disease & those w/ close monitoring of potential muscle toxicity. Measure creatinine during the 1st 3 mth after treatment initiation & periodically thereafter. Interrupt treatment when creatinine level is 50% above ULN. Should not be taken by patients w/ rare hereditary problems of galactose or fructose intolerance, lactase deficiency, glucose-galactose malabsorption or sucrase-isomaltase insufficiency. Caution in patients w/ mild to moderate renal insufficiency. Discontinue use if eGFR decreases persistently to <30 mL/min/1.73 m
2 during follow-up. Not recommended for patients w/ hepatic impairment. Should only be used during pregnancy after careful benefit/risk assessment. Do not use during breast-feeding. Not recommended in childn & adolescents <18 yr.