Table 3.
Fibrates' drug-drug interactions with medications used for COVID-19 or assessed in clinical trials and recommendations.
| Fibrates |
||||
|---|---|---|---|---|
| Fenofibrate | Bezafibrate | Gemfibrozil | Clofibrate | |
| Remdesivir [127] | Not directly studied but likely safe Recommend: Continue |
Not directly studied but likely safe Recommend: Continue |
Not directly studied but likely safe Recommend: Continue |
Not directly studied but likely safe Recommend: Continue |
| Hydroxychloroquine [140] | NSI Recommend: Continue |
NSI Recommend: Continue |
NSI Recommend: Continue |
NSI Recommend: Continue |
| Lopinavir | NSI Recommend: Continue [141,142] |
Not studied directly but likely safe Recommend: Continue with monitoring [141,142] |
NSI - recommend to continue, however, efficacy of Gemfibrozil may be reduced [143] Recommend: Continue |
Not studied – but likely safe Recommend: Continue with monitoring |
| Ritonovir | NSI Recommend: Continue [141,142,144] |
Not studied directly but likely safe Recommend: Continue with monitoring [141,142] |
NSI - recommend to continue, however, efficacy of Gemfibrozil may be reduced [143] Recommend: Continue |
Not studied – but likely safe Recommend: Continue with monitoring |
| Ribavirin | Not studied directly but likely safe Recommend: Continue with monitoring |
NSI Recommend: Continue |
Not studied directly but likely safe Recommend: Continue with monitoring |
Not studied directly but likely Safe- Recommend: Continue with monitoring |
| Inteferon-Beta 1 -Alpha | Increased risk of hepatoxicity Recommend: Stop |
Increased risk of hepatoxicity Recommend: Stop |
Increased risk of hepatoxicity Recommend: Stop |
Increased risk of hepatoxicity Recommend: Stop |
| Melatonin | Not directly studied but likely safe Recommend: Continue with LFT monitoring |
Not directly studied but likely safe Recommend: Continue with LFT monitoring |
Not directly studied but likely safe Recommend: Continue with LFT monitoring |
Not directly studied but likely safe Recommend: Continue with LFT monitoring |
|
Dexamethasone [145] |
Not directly studied but likely safe Recommend: Continue |
Not directly studied but likely safe Recommend: Continue |
Not directly studied but likely safe Recommend: Continue |
Not directly studied but likely safe Recommend: Continue |
| Azithromycin [146] | Not directly studied but likely safe Recommend: Continue with LFT monitoring |
Not directly studied but likely safe Recommend: Continue with LFT monitoring |
Not directly studied but likely safe Recommend: Continue with LFT monitoring |
Not directly studied but likely safe Recommend: Continue with LFT monitoring |
| Tocilizumab | Caution- interaction with metabolising enzymes [138] Recommend: Stop |
Caution- interaction with metabolising enzymes Recommend: Stop |
Caution- interaction with metabolising enzymes [138] Recommend: Stop |
Caution- interaction with metabolising enzymes [138] Recommend: Stop |
| Ivermectin | Not directly studied but likely safe Recommend: Continue with LFT monitoring |
Not directly studied but likely safe Recommend: Continue with LFT monitoring |
Not directly studied but likely safe Recommend: Continue with LFT monitoring |
Not directly studied but likely safe Recommend: Continue with LFT monitoring |
Fibrates are contraindicated as GFR declines. To reassess if there is a decline in renal function and consider stopping (please refer to recommendation 4).
Fibrates can interact with anticoagulants. This should be taken in consideration if oral anticoagulants used.
Refer to individual drugs SmPC and the University of Liverpool's Drug interaction site (www.COVID-19-druginteractions.org).
NSI: no significant interactions.