Dawaa Reference

Clinical reference

Hypertriglyceridemia (Severe)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

Lopid (gemfibrozil) 600 mg tablets SmPC sections 4.2-4.5 (eMC product 2261) · Supralip ® 160 mg, film-coated tablet SmPC section 4.2 Posology and method of administration (eMC product 2198)

Verified against3 documents
  • Lopid (gemfibrozil) 600 mg tablets SmPC sections 4.2-4.5 (eMC product 2261)
  • Supralip ® 160 mg, film-coated tablet SmPC section 4.2 Posology and method of administration (eMC product 2198)
  • Hypertriglyceridemia - disease-level clinical article (hypertriglyceridemia-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Signs — what you find (2)

  • Familial dysbetalipoproteinemia shows characteristic orange-yellow deposits along the palm creases, plus raised bumps over the elbows, buttocks, and knees
  • Chylomicronemia syndrome combines epigastric pain, eruptive skin bumps on the buttocks and arms, an enlarged liver and spleen, pancreatitis, brief memory lapses, and lipemia retinalis [abdominal pain · epigastric pain · hepatomegaly]

Tests (7)

  • Hypertriglyceridemia is diagnosed with a fasting lipid panel
  • By NCEP ATP III cutoffs, triglycerides of 150-199 mg/dL are mild, 200-499 mg/dL are high, and over 500 mg/dL are very high
  • Above a triglyceride level of 400 mg/dL, LDL-C is calculated using the Friedewald equation
  • Because this calculation can underestimate LDL-C, non-HDL-C or a direct LDL-C measurement is an alternative
  • LDL particle size or density testing does not add value for managing cardiovascular risk in this condition
  • Apo B and Lp(a) levels can help assess cardiovascular risk in this setting
  • Fatty liver is usually suspected from raised liver enzymes and confirmed with a liver ultrasound

If not this — what else fits (3)

  • Familial combined hyperlipidemia raises VLDL and/or LDL with a high Apo B level, which separates it from familial hypertriglyceridemia
  • Familial hypertriglyceridemia is usually not linked to early cardiovascular disease unless triglycerides run very high, though it can still cause pancreatitis
  • Familial dysbetalipoproteinemia comes from defective Apo E, with roughly equal elevation of both cholesterol and triglycerides pointing to the diagnosis

SourceStatPearls "Hypertriglyceridemia" - disease-level clinical article

Presentation findings are traced to the source above.

1

FENOFIBRATE

1st line

Strength160 mg

Formoral.solid

Adult dose and duration

160 mg once daily with food

Paediatric dose

Specialist pediatric lipidologist referral

Dose source

Supralip ® 160 mg, film-coated tablet SmPC section 4.2 Posology and method of administration (eMC product 2198)

Why

Fibrate that activates PPAR-alpha to lower triglycerides by increasing lipoprotein lipase activity; used in severe hypertriglyceridaemia specifically to reduce the risk of acute pancreatitis.

Cautions
  • Monitor renal function and transaminases; use caution and monitor muscle symptoms if combined with a statin.
  • CONTRAINDICATED in hepatic insufficiency, severe renal insufficiency (eGFR <30 mL/min), and known gallbladder disease.
  • If eGFR is between 30 and 59 mL/min per 1.73 m2, the dose of fenofibrate should not exceed 100 mg standard or 67 mg micronized once daily.
Egyptian brands
Egyptian brandManufacturerIndicative price
LIPANTHYL SUPRA 160MG 30 F.C. TABS.MINA PHARM > ABBOTT LABORATORIES141.00 EGP (4.70/unit)
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Hypertriglyceridemia - disease-level clinical article (hypertriglyceridemia-full.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Pancreatitis risk rises sharply at the triglyceride levels this condition entry covers (severe HTG).
3

GEMFIBROZIL

2nd line

Strength600 mg

Formoral.solid

Adult dose and duration

600 mg twice daily taken 30 minutes before breakfast and dinner

Paediatric dose

Specialist use only

Choice

Gemfibrozil is the first choice here; omega-3 fatty acids are a further option.

Dose source

Lopid (gemfibrozil) 600 mg tablets SmPC sections 4.2-4.5 (eMC product 2261)

Why

Fibrate with the same triglyceride-lowering mechanism as fenofibrate, offered as a second option; avoided in combination with any statin because of a severe interaction risk that does not apply to fenofibrate.

Cautions
  • CONTRAINDICATED in hepatic impairment, severe renal impairment (eGFR <30 mL/min), and preexisting gallbladder disease.
  • Never with simvastatin, and never with rosuvastatin 40 mg - both are contraindicated, not cautioned. The combination causes severe myositis and rhabdomyolysis. Check what statin the patient is already on before writing this.
  • Also contraindicated with repaglinide - it drives exposure up and causes severe hypoglycaemia.
  • Not in gallstones or any biliary tract disease, past or present, and not in severe renal or in hepatic impairment.
  • Periodic blood count determinations are recommended during the first 12 months of gemfibrozil administration.
Egyptian brands
Egyptian brandManufacturerIndicative price
FIBROPID 600 MG 30 F.C. TABS.BIOPHARM EGYPT36.00 EGP (1.20/unit)
CHOLENORM 600MG 10 F.C.TAB.MEPACO13.20 EGP (1.32/unit)
LOPID 600MG 30 F.C. TAB.PFIZER54.00 EGP (1.80/unit)
4

OMEGA-3 FATTY ACIDS

2nd line

Formoral.solid

Adult dose and duration

3 g to 4 g/day

Paediatric dose

No paediatric dose is stated in the sources held for this drug.

Dose source

Hypertriglyceridemia (Severe) - disease-level clinical article (hypertriglyceridemia-full.txt)

Why

FDA-approved prescription therapy for severe hypertriglyceridemia (>1000 mg/dL) to lower triglyceride levels and reduce acute pancreatitis risk.

Cautions
  • May increase levels of low-density lipoprotein cholesterol (LDL-C) due to increased conversion of VLDL to LDL (an effect not observed with EPA-only prescription products).
  • Gastrointestinal discomfort and fish-like taste are common dose-limiting factors with high doses.
  • Because nonprescription products contain variable amounts of EPA and DHA, attention must be paid to the specific constituents when selecting an omega-3 formulation.
Egyptian brands
Egyptian brandManufacturerIndicative price
TOTAL FORTE 30 CAPS.HOCHSTER PHARMACEUTICAL INDUSTRIES237.00 EGP (7.90/unit)
OMEGATONEX 500/250 20 CAPSGRANTY FOOD INDUSTRY FACTORY > INTEGRA PHARMACEUTICALS360.00 EGP (18.00/unit)
SHIRE 25 GUMMIESMEDCARE > MEDICINA MEDICAL LTD.110.00 EGP
SHIRE 50 GUMMIESMEDCARE > MEDICINA MEDICAL LTD.180.00 EGP
OMEGA-3 ENRICHED 40 SOFTGELS (ADRIEN GAGNON)ADRIEN GAGNON > EGYPHARMA650.00 EGP
FISH OIL 100 SOFTGELSOPTIMUM NUTRITION > RAMCO800.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.