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Lipired 200 mgLipired 200 mg is indicated for hyperlipidemias of type lla, llb, III, IV & V in patients who have not responded adequately to diet & other appropriate measures.Theropeutic ClassFibratesPharmacologyLipired 200 mg is a fibric acid derivative, a prodrug comprising fenofibric acid linked to an isopropyl ester. Lipired 200 mg is rapidly hydrolyzed after oral ingestion to its pharmacologically active form, fenofibric acid. The effects of fenofibric acid seen in clinical practice have been explained in vivo in transgenic mice and in vitro in human hepatocyte cultures by the activation of peroxisome proliferator activated receptor ? (PPAR?)It lowers lipid levels by activating peroxisome proliferator-activated receptor alpha (PPAR?). PPAR? activates lipoprotein lipase and reduces apoprotein CIII (an inhibitor of lipoprotein lipase activity), which increases lipolysis and elimination of triglyceride-rich particles from plasma. The resulting fall in triglycerides produces an alteration in the size and composition of LDL from small, dense particles (which are thought to be atherogenic due to their susceptibility to oxidation), to large buoyant particles. These larger particles have a greater affinity for cholesterol receptors and are catabolized rapidlyPPAR? also increases apoproteins AI and AII, reduces VLDL- and LDL-containing apoprotein B, and increases HDL-containing apoprotein AI and AII. Lipired 200 mg also reduces serum uric acid levels in hyperuricemic and normal individuals by increasing the urinary excretion of uric acid.Dosage & Administration of Lipired 200 mgThe dose is one 200 mg capsule per day. Dosage should be individualized according to patient response, and should be increased sequentially if necessary following repeat serum triglyceride estimations at 4 to 8 week intervals. Patients should be placed on an appropriate triglyceride-lowering diet before receiving Lipired 200 mg, and should continue this diet during treatment with Lipired 200 mg. Lipired 200 mg should be given with meals, thereby optimizing the bioavailability of the medication.Dosage of Lipired 200 mg For the treatment of adult patients with hypercholesterolemia or mixed hyperlipidemia, the initial dose of Lipired 200 mg is 200 mg per day. For adult patients with hypertriglyceridemia, the initial dose is 67 to 200 mg per day. Dose should be individualized according to patient response. Lipired 200 mg should be given with meal there by, optimizing the bioavailability of the medication. Or, as directed by the registered physician. Interaction of Lipired 200 mgLipired 200 mg has been reported to potentiate the anticoagulant effects of warfarin. When administered with antidiabetic drug it may improve glucose tolerance and have additive effect. Lipired 200 mg may also increase the nephrotoxicity of cyclosporine. Due to a potential increase in the risk of rhabdomyolysis, cautions should be taken against the use of Lipired 200 mg with HMG-CoA reductase inhibitors. However, the use of low-dose statins with Lipired 200 mg appears to be well tolerated.ContraindicationsLipired 200 mg is contraindicated in patients with hypersensitivity to Lipired 200 mg, severe renal or hepatic impairment, existing gall bladder disease, breast feeding mothers, photosensitivity to ketoprofen.Side Effects of Lipired 200 mgGastro-intestinal (e.g. nausea, anorexia, gastric pain), pruritus, urticaria, impotence, also headache, dizziness, vertigo, fatigue, hair loss; myotoxicity.Pregnancy & LactationPregnancy Category C. Lipired 200 mg should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.Nursing mothers: Lipired 200 mg should not be used in nursing mothers. Because of the potential for tumorigenicity seen in animal studies, a decision should be made whether to discontinue nursing or to discontinue the drug.Precautions & WarningsSpecial care needed in patients with renal disease, as progressive increases in serum creatinine concentration or failure to follow dosage guidelines may result in myotoxicity; discontinue if myotoxicity suspected or creatinine kinase concentration increases significantly. Liver function tests recommended every 3 months for first year.Overdose Effects of Lipired 200 mgThere is no specific treatment for overdose with Lipired 200 mg. General supportive care of the patients is indicated, including monitoring of vital signs and observation of clinical status, should an overdose occur. Because Lipired 200 mg is highly bound to plasma proteins, hemodialysis should not be considered.Storage ConditionsDo not store above 30?C. Keep away from light and out of the reach of children.Use In Special PopulationsGeriatrics: This indicates that a similar dosage regimen can be used in the elderly, without increasing accumulation of the drug or metabolites.Pediatrics: No data are available. Lipired 200 mg is not indicated for use in the pediatric population.Gender: No pharmacokinetic difference between male and female has been observed for Lipired 200 mg.Renal insufficiency: The dosage of Lipired 200 mg should be minimized in patients who have severe renal impairment, while no modification of dosage is required in patients having moderate renal impairment.Hepatic insufficiency: No pharmacokinetic study has been conducted in patients having hepatic insufficiency.Drug ClassesFibratesMode Of ActionLipired 200 mg is a fibric acid derivative. Lipired 200 mg is rapidly hydrolyzed after oral ingestion to its pharmacologically active form, fenofibric acid. Fenofibric acid produces reductions in total cholesterol, LDL cholesterol, Apo-lipoprotein B, Total triglycerides and VLDL. In addition, treatment with Lipired 200 mg results in increases in HDL and apo-proteins apoAI apoAII. Lipired 200 mg also reduces serum uric acid levels in hyperuricemic and normal individuals by increasing the urinary excretion of uric acid. The micronised form of Nofiate (Lipired 200 mg) has enhanced absorption over the non-micronised formulation.PregnancyLipired 200 mg is not recommended for pregnant women.