Ciprofibrate

Fibrate medicines play an important role in lipid management, particularly for patients with elevated triglycerides or mixed lipid disorders where a statin alone may not address all aspects of the lipid profile. Ciprofibrate tablets are a prescription-only fibrate used in adults for the treatment of hyperlipidaemia, including raised triglycerides, raised LDL cholesterol, and mixed dyslipidaemia. As a once-daily tablet, ciprofibrate offers a convenient approach to triglyceride reduction and cholesterol management as part of cardiovascular therapy. A prescription can only be issued following a clinical consultation.

Ciprofibrate tablets are an oral prescription medicine containing ciprofibrate as the active ingredient. Ciprofibrate belongs to the fibrate class of lipid-lowering medicines, the same class as bezafibrate, fenofibrate, and gemfibrozil. Fibrates are used primarily when triglyceride management is required, or in mixed dyslipidaemia where both elevated triglycerides and lipid control more broadly are treatment priorities.

Ciprofibrate is licensed in the UK for the treatment of hyperlipidaemia in adults, including primary hypercholesterolaemia, mixed hyperlipidaemia, hypertriglyceridaemia, and familial hypercholesterolaemia as an adjunct to dietary measures. Ciprofibrate is available in a single strength of 100 mg and is taken once daily. Unlike bezafibrate, which is typically taken in the evening with food, ciprofibrate can be taken once daily at a consistent time that suits the patient's routine.

Ciprofibrate is less commonly prescribed than fenofibrate or bezafibrate in current UK clinical practice but remains a licensed and clinically appropriate fibrate option for certain patients. It is available as a generic medicine. As with all fibrate medicines, the interaction with statins and the risk of muscle problems when these classes are combined require careful prescriber assessment.

Ciprofibrate lowers blood lipid levels through its action as a PPAR alpha agonist, the same fundamental mechanism shared by other fibrates.

PPAR Alpha Activation. Ciprofibrate activates peroxisome proliferator-activated receptor alpha (PPAR alpha) receptors inside cells, particularly in the liver and muscle tissue. PPAR alpha is a nuclear receptor that regulates the transcription of genes involved in lipid metabolism and lipoprotein clearance. Activation of these receptors by ciprofibrate produces several coordinated effects on the lipid profile.

Effects on Blood Lipids. Activation of PPAR alpha by ciprofibrate significantly reduces plasma triglyceride levels. It achieves this by increasing the activity of lipoprotein lipase, the enzyme responsible for clearing triglyceride-rich particles from the circulation, and by reducing VLDL production in the liver. These two effects together produce a substantial fall in triglycerides.

Ciprofibrate also raises HDL cholesterol by increasing the production of apolipoproteins A-I and A-II, the structural proteins of HDL particles. In patients with mixed dyslipidaemia, ciprofibrate can also reduce LDL cholesterol, though the LDL-lowering effect of fibrates is generally less pronounced than that achieved with statins. The overall lipid profile effect — lower triglycerides, higher HDL, and modest LDL reduction — makes ciprofibrate useful in patients where these parameters need addressing as part of a broader lipid control strategy.

Always take ciprofibrate exactly as your prescriber instructs. Read the Patient Information Leaflet supplied with your medicine before starting treatment.

• Take one 100 mg ciprofibrate tablet once daily. The SmPC does not mandate a specific time of day, so take it consistently at the same time each day.
• Ciprofibrate can be taken with or without food.
• Swallow the tablet whole with a glass of water.

If you miss a dose, take it as soon as you remember on the same day. If you only remember the following day, skip the missed dose and continue as normal. Do not take two doses on the same day. Do not stop taking ciprofibrate without speaking to your prescriber first.

Your prescriber will arrange blood tests to check your lipid levels before and after starting treatment. Liver and kidney function may also be monitored, particularly as ciprofibrate is renally excreted. If you develop unexplained muscle pain, tenderness, or weakness, contact your prescriber promptly.

Ciprofibrate 100 mg is the only strength available through this service. The standard dose is 100 mg once daily. This once-daily dosing schedule is a practical advantage over some other fibrates, such as bezafibrate standard-release tablets, which require three times daily dosing.

The current UK SmPC does not specify a different dose for older patients, but kidney function is relevant to ciprofibrate use since it is substantially eliminated by the kidneys. Your prescriber will assess your kidney function before prescribing and will consider whether the standard dose is appropriate for your individual circumstances. Do not change your dose without medical advice.

Like all medicines, ciprofibrate can cause side effects.

Common Side Effects (may affect up to 1 in 10 people):

• Gastrointestinal effects including nausea, abdominal discomfort, and diarrhoea — often mild.
• Muscle aches or weakness (myalgia). Contact your prescriber if you experience unexplained muscle pain, tenderness, or weakness, particularly if severe.

Uncommon Side Effects (may affect up to 1 in 100 people):

• Raised liver enzymes, monitored during treatment.
• Headache.
• Dizziness.
• Skin rash or itching.

Serious Side Effects — Seek Urgent Medical Attention: Go to your nearest accident and emergency department or call 999 immediately if you experience severe muscle pain, weakness, or cramps, particularly with dark, tea coloured urine (rhabdomyolysis risk, significantly higher when combined with a statin); signs of significant liver problems such as yellowing of the skin or eyes, severe abdominal pain, or very dark urine; or signs of a severe allergic reaction such as sudden widespread rash, difficulty breathing, or swelling of the face, lips, tongue, or throat.

Ciprofibrate tablets may be suitable if you:

• Are an adult with hyperlipidaemia, hypertriglyceridaemia, or mixed dyslipidaemia that has not responded adequately to dietary measures.
• Have raised triglycerides as a primary treatment target or as part of a mixed lipid disorder.
• Require lipid control and your prescriber has assessed that ciprofibrate is appropriate, either alone or alongside other lipid-lowering treatment.
• Are already prescribed ciprofibrate and require a repeat prescription through an online prescribing service.

Ciprofibrate tablets are not suitable if you:

• Have significant kidney impairment, as ciprofibrate is substantially excreted by the kidneys and reduced function increases the risk of muscle problems.
• Have significant liver disease or persistently abnormal liver function tests.
• Have a history of photoallergy or phototoxicity related to fibrate medicines.
• Have gallbladder disease, as fibrates can increase the cholesterol content of bile and raise the risk of gallstones.
• Are pregnant or planning to become pregnant.
• Are breastfeeding.
• Are under 18 years of age.
• Have a known allergy or hypersensitivity to ciprofibrate or any excipient listed in the SmPC.

Important Drug Interactions: Statins (atorvastatin, simvastatin, rosuvastatin) combined with ciprofibrate significantly increase the risk of myopathy and rhabdomyolysis and require careful prescriber assessment and close monitoring. Warfarin and anticoagulants may have their effect enhanced — closer INR monitoring is needed. Antidiabetic medicines may have their blood glucose lowering effect enhanced, increasing hypoglycaemia risk. Ciclosporin may increase the risk of kidney impairment when combined with ciprofibrate.

Ciprofibrate is a Prescription Only Medicine. The clinical consultation is the essential first step. A prescription will only be issued if a registered prescriber concludes, based on their individual assessment of your circumstances, that ciprofibrate is clinically appropriate for you.

During your online consultation with Pharmacy Planet, a registered prescriber will review your lipid profile, kidney and liver function where available, current medicines, and other relevant medical history. The prescriber will assess whether ciprofibrate is the right choice for your lipid management and cholesterol management needs, and whether online prescribing is appropriate for your individual situation.

Not all consultations will result in a prescription. The prescriber may recommend a statin or a different fibrate, request recent blood test results, or advise that a more detailed review by your GP is needed before prescribing proceeds.