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Paradoxical severe decrease in high-density lipoprotein cholesterol due to rosiglitazone-fenofibrate interaction.

William Schwing¹, Leighanne Hustak, Harris C Taylor

¹Division of Clinical and Molecular Endocrinology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

|January 12, 2010

Summary

This summary is machine-generated.

Combination therapy with fibrates and thiazolidinediones can cause a significant decrease in high-density lipoprotein cholesterol (HDL-C). This study suggests this adverse effect is likely due to a drug interaction between the two agents.

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Area of Science:

Pharmacology
Cardiovascular Medicine

Background:

Combination therapy with fibrates and thiazolidinediones is used to manage dyslipidemia.
A notable decrease in high-density lipoprotein cholesterol (HDL-C) has been observed with this combination therapy.

Purpose of the Study:

To investigate whether the reduction in HDL-C is caused by a drug interaction between fibrates and thiazolidinediones or solely by fibrate administration.
To clarify the mechanism behind HDL-C reduction in patients receiving both drug classes.

Main Methods:

Prospective follow-up of two patients on fenofibrate and rosiglitazone.
Literature review of PubMed for cases of HDL-C reduction associated with fibrates, alone or with rosiglitazone/statins.

Main Results:

Both patients exhibited a high probability of drug interaction (Drug Interaction Probability Score = 9).
Review of existing literature did not provide conclusive evidence that the HDL-C decrease was solely due to either drug administered alone.
The study found that the concurrent administration of fenofibrate and rosiglitazone was associated with significant HDL-C reduction.

Conclusions:

In some patients, the marked decrease in HDL-C during combination therapy with fenofibrate and rosiglitazone is a result of a drug interaction.
This severe adverse effect is not observed when either fenofibrate or rosiglitazone is administered singly.