Fenofibrate

Popular Brand Names:

Tricor Antara Fenoglide Lipofen Lofibra Triglide

Fenofibrate is a well-established drug which lowers cholesterol and triglyceride levels. It belongs to a group of drugs known as fibrates and was first approved for use in 1993. In some countries, bezafibrate (approved in 1977) clofibrate (approved in 1963), ciprofibrate (approved in 2009) and gemfibrozil (approved in 1981) are more widely available, and these drugs are considered interchangeable.

The potential benefit of using fenofibrate and bezafibrate to treat COVID-19 was first published in the medical literature in JMIR on April 7th, 2020, by Rogosnitzky, Berkowitz, and Jadad. They proposed the drugs’ broad antiviral activity, coupled with their cardio and kidney protective properties and their ability to reduce excessive blood clotting and inflammation made them good candidates for treating COVID-19.

In July 2020, a team of researchers from the Hebrew University of Jerusalem led by Professor Yakov Nahmias, in collaboration with researchers at Mount Sinai in New York, and The Broad Institute of Harvard and MIT revealed fenofibrate and bezafibrate can block viral replication in cells infected with SARS-CoV-2.

These findings spurred widespread interest in the medical community and prompted a number of clinical trials using fenofibrate, the first of which took place in Israel in 2021, which reported remarkable benefits of giving this drug to hospitalized patients who had severe COVID-19.

Fenofibrate and other fibrate drugs including bezafibrate, gemfibrozil, and ciprofibrate, are pleiotropic drugs, which means they have multiple, unrelated effects on the body. Fibrates have off-label uses in numerous conditions.

Key Facts for Fenofibrate

Description: Anti-lipid, fibrate
Year Approved: 1993
Approved Uses:

High cholesterol (US, UK)
High triglycerides (US, UK)

Typical Dose Range: 30 to 160mg / daily
Maximum Reported Safe Dose in Adults: 400mg / daily
Populations of Use: Pediatric, Adult, Geriatric
Typical Duration of Use: Long Term
Further Drug Information: medicine.com
IMPORTANT NOTE: Fenofibrate is considered interchangeable with other fibrates such as bezafibrate, ciprofibrate, and gemfibrozil, although the dosage for each one is different.

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Fenofibrate's Anti-COVID Properties

  • Activates PPARα fatty acid oxidation, which impedes SARS-CoV-2 replication by reducing the availability of needed cholesterol and other lipids
  • Induces ACE2 dimerization, which prevents the virus from binding to ACE2 and infecting cells
  • Alters the spike protein to block binding to ACE2 and prevents infection
  • Decreases IL17 which is involved in neuroinflammation
  • Decreases CCL2 to reduce acute respiratory distress
  • Decreases CCL20 which is part of the COVID-19 “cytokine storm” causing severe inflammation
  • Inhibits nuclear factor-κB to reduce inflammation
  • Activates adenosine monophosphate (AMP)-activated protein kinase to reduce viral infection and replication
  • Destabilizes the receptor-binding domain of the SARS-CoV-2 spike protein to prevent infection
  • Inhibits cell deterioration and destruction by the SARS-CoV-2 virus
  • Anti-inflammatory
  • Anti-oxidant
  • Renoprotective – protects kidney function
  • Cardioprotective
  • Reverses excessive blood clotting activity
  • Inhibits TNF-α to reduce inflammation
  • Inhibits IL6 to reduce inflammation and inhibit acute protein synthesis needed for viral replication
  • Inhibits vascular adhesion molecule-1 to reduce excessive blood clotting
  • Inhibits cyclooxygenase-2 to reduce inflammation
  • Inhibits matrix metalloproteinases to reduce neurological problems associated with COVID-19
  • Inhibits VEGF-1 to reduce the development of new blood vessels during inflammation
  • Inhibits phospholipid accumulation – required for viral replication
  • Reverses increased glycolysis – the breakdown of glucose which provides extra energy needed for viral replication.
  • Blocks CXCL10 activity to reduce inflammation
  • Increases sulfatide production – thought to be beneficial against COVID-19

Published Medical Literature About Fenofibrate’s Role in COVID

Access all Research

September 28, 2021 | Peer Reviewed: Yes | Publication Type: Original , Theoretical

Identifying existing drugs with anti-COVID effects

Drug repurposing for COVID-19 based on an integrative meta-analysis of SARS-CoV-2 induced gene signature in human airway epithelium
August 12, 2021 | Peer Reviewed: No | Publication Type: Original , Clinical Prospective, Clinical Retrospective, Preclinical

Treatment of SARS-CoV-2 infection with fenofibrate.

Metabolic Regulation of SARS-CoV-2 Infection
August 6, 2021 | Peer Reviewed: Yes | Publication Type: Original , Preclinical

The cholesterol-lowering drug fenofibrate significantly reduces cellular infection by SARS-CoV-2.

The Hyperlipidaemic Drug Fenofibrate Significantly Reduces Infection by SARS-CoV-2 in Cell Culture Models
June 8, 2021 | Peer Reviewed: No | Publication Type: Original , Theoretical

Repurposing of existing drugs to treat COVID-19.

Drug Repurposing of potential drug targets for treatment of COVID-19

Videos Discussing Fenofibrate’s Role in COVID

Fenofibrate effective in treatment of COVID-19 | Prof. Yaakov Nahmias | Hebrew University

Prof. Yaakov Nahmias | August 17, 2021

Hebrew University interventional open-label study led by Prof. Yaakov Nahmias on 15 severe COVID-19 patients requiring oxygen support shows that 145 mg/day fenofibrate (TriCor) reduced inflammation in 48 hours and eliminated the need for oxygen support within 5 to 7 days of hospitalization.

Cholesterol-lowering drug being tested at Penn Medicine to help fight COVID-19

ABC 30 | August 11, 2021

Two different studies in laboratories found the drug Fenofibrate reduced COVID-19 infection by up to 70%. Doctors say if this works in actual patients, it could have a major impact by helping to slow the spread of the virus and save lives.

SPARK Drug Repurposing Conference Tel Aviv University Oct 2020

MedInsight Research Institute | October 26, 2020

Generic Drug Repurposing for Covid-19. A conference hosted by Tel Aviv University, SPARK Tel Aviv, and the MedInsight Institute. Fenofibrate is one of the drugs discussed at this conference.

Israeli Scientists Identify Drug They Hope Can Downgrade COVID-19 to Common Cold Level

CBN News | July 17, 2020

Israeli scientists identify anti-cholesterol drug they hope can downgrade COVID-19 to common cold level

Coronavirus in Context: Can a Cholesterol Drug Fight COVID?

WebMD | June 29, 2020

Study going on about the role of lipid metabolism, and is there a strategy for some cholesterol-lowering medicines in the treatment of COVID-19. Dr. John Whyte, chief medical officer at WebMD discusses fenofibrate as a potential treatment for COVID-19.


Clinical Trials of Fenofibrate in COVID

December 30, 2020 | Hospital-Based, Community/Outpatient Based |

Fenofibrate as a Metabolic Intervention for Coronavirus Disease 2019 (COVID-19): A Randomized Controlled Trial

Hospital and community/outpatient-based; 160 mg/d, administered for 10 days

December 10, 2020 | Hospital-Based |

Controlled Trial of Fenofibrate for Patients With COVID-19 Requiring Hospitalization

145 mg daily (1/day); oral administration; 10 days

August 18, 2020 | Hospital-Based |

FEnofibRate as a Metabolic INtervention for Coronavirus Disease 2019

145 mg/d or dose-equivalent preparation of fenofibrate or fenofibric acid, for 10 days