Clofibrate

Clofibrate (trade name Atromid-S) is a lipid-lowering agent used for controlling the high cholesterol and triacylglyceride level in the blood. It belongs to the class of fibrates. It increases lipoprotein lipase activity to promote the conversion of VLDL to LDL, and hence reduce the level of VLDL. It can increase the level of HDL as well.

Clofibrate
Clinical data
AHFS/Drugs.comMicromedex Detailed Consumer Information
Pregnancy
category
  • AU: B1
Routes of
administration		By mouth
ATC code
Legal status
Legal status
  • US: Discontinued
Pharmacokinetic data
Protein bindingVariable, 92–97% at therapeutic concentrations
MetabolismHydrolyzed to clofibric acid; hepatic glucuronidation
Elimination half-lifeHighly variable; average 18–22 hours. Prolonged in renal failure
ExcretionRenal, 95 to 99%
Identifiers
IUPAC name
  • ethyl 2-(4-chlorophenoxy)-2-methylpropanoate
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.010.253
Chemical and physical data
FormulaC12H15ClO3
Molar mass242.70 g·mol−1
3D model (JSmol)
Boiling point148 °C (298 °F)
SMILES
  • Clc1ccc(OC(C(=O)OCC)(C)C)cc1
InChI
  • InChI=1S/C12H15ClO3/c1-4-15-11(14)12(2,3)16-10-7-5-9(13)6-8-10/h5-8H,4H2,1-3H3 Y
  • Key:KNHUKKLJHYUCFP-UHFFFAOYSA-N Y
  (verify)

It was patented in 1958 by Imperial Chemical Industries and approved for medical use in 1963.[1] Clofibrate was discontinued in 2002 due to adverse effects.

Complications and controversies

It can induce SIADH, syndrome of inappropriate secretion of antidiuretic hormone ADH (vasopressin). Clofibrate can also result in formation of cholesterol stones in the gallbladder.

The World Health Organization Cooperative Trial on Primary Prevention of Ischaemic Heart Disease using clofibrate to lower serum cholesterol observed excess mortality in the clofibrate-treated group despite successful cholesterol lowering (47% more deaths during treatment with clofibrate and 5% after treatment with clofibrate) than the non-treated high cholesterol group. These deaths were due to a wide variety of causes other than heart disease, and remain "unexplained".[2]

References
  1. Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 474. ISBN 9783527607495.
  2. "WHO cooperative trial on primary prevention of ischaemic heart disease with clofibrate to lower serum cholesterol: final mortality follow-up. Report of the Committee of Principal Investigators". Lancet. 2 (8403): 600–4. September 1984. doi:10.1016/s0140-6736(84)90595-6. PMID 6147641. S2CID 2473318.
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