ADDENDUM к сообщению N.6
К сожалению, это не первое наблюдение и является характерным для всего класса фибратов, недавние рекомендации:
Small retrospective studies have suggested that fenofibrate, bezafibrate, and ciprofibrate are more likely than gemfibrozil to increase creatinine and homocysteine levels. Gemfibrozil was previously thought not to cause increased serum creatinine, but case reports and data from VA-HIT suggest that gemfibrozil is not entirely exempt.
Fibrates should be used with caution and at lower doses in patients with renal dysfunction. Fenofibrate should not be used in patients receiving renal dialysis. All fibrates are renally metabolized, and all are eliminated primarily via the renal route. The excretion of all fibrates is impaired in renal dysfunction to some extent. In a study in patients with moderate-to-severe renal impairment (creatinine clearance <50 mL/min), the rate of clearance of fenofibric acid was greatly reduced, and the compound was shown to accumulate during chronic dosage. In patients with moderate renal impairment (creatinine clearance 50–90 mL/min), the clearance after oral dosing and volume of distribution of fenofibric acid were increased compared with healthy adults (2.1 L/hr and 95 L vs 1.1 L/hr and 30 L, respectively). The National Kidney Foundation (NKF) recommends gradually restricting the dose of fenofibrate, beginning with a GFR of 60–90 mL/min and avoiding it altogether when the GFR is <15 mL/min, with which the National Lipid Association (NLA) Safety Task Force concurs.
Из Am J Cardiol. 2007 Mar 19;99(6A):S3-S18.
Safety considerations with fibrate therapy.
Davidson MH, Armani A, McKenney JM, Jacobson TA.
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