# Hypertriglyceridemia (Severe) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Fenofibrate — 160 mg — oral.solid - Referral & safety-netting (no drug therapy) - Gemfibrozil — 600 mg — oral.solid - Omega-3 fatty acids — oral.solid ## Complete treatment card ```text HYPERTRIGLYCERIDEMIA (SEVERE) 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) Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Hypertriglyceridemia" - disease-level clinical article Status traced to the source above 1. FENOFIBRATE [1st line] Adult 160 mg once daily with food Peds Specialist pediatric lipidologist referral 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. Caution 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. Egypt LIPANTHYL SUPRA 160MG 30 F.C. TABS. MINA PHARM > ABBOTT LABO... 141.00 EGP (4.70/unit) 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution RED FLAG - Pancreatitis risk rises sharply at the triglyceride levels this condition entry covers (severe HTG). 3. GEMFIBROZIL [2nd line] Adult 600 mg twice daily taken 30 minutes before breakfast and dinner Peds Specialist use only Choice Gemfibrozil is the first choice here; omega-3 fatty acids are a further option. 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. Caution 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. Egypt FIBROPID 600 MG 30 F.C. TABS. BIOPHARM EGYPT 36.00 EGP (1.20/unit) CHOLENORM 600MG 10 F.C.TAB. MEPACO 13.20 EGP (1.32/unit) LOPID 600MG 30 F.C. TAB. PFIZER 54.00 EGP (1.80/unit) 4. OMEGA-3 FATTY ACIDS [2nd line] Adult 3 g to 4 g/day Peds No paediatric dose is stated in the sources held for this drug. 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. Caution 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. Egypt TOTAL FORTE 30 CAPS. HOCHSTER PHAR... 237.00 EGP (7.90/unit) OMEGATONEX 500/250 20 CAPS GRANTY FOOD I... 360.00 EGP (18.00/unit) SHIRE 25 GUMMIES MEDCARE > MED... 110.00 EGP SHIRE 50 GUMMIES MEDCARE > MED... 180.00 EGP OMEGA-3 ENRICHED 40 SOFTGELS (ADRIEN GAGNON) ADRIEN GAGNON > EGYPHARMA 650.00 EGP FISH OIL 100 SOFTGELS OPTIMUM NUTRI... 800.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)