There are currently three fibric acid derivatives available in the US to lower TGs - gemfibrozil, fenofibrate, and clofibrate. Clofibrate is rarely used since it is associated with the development of certain gastrointestinal cancers. Both gemfibrozil and fenofibrate can lower TG levels by 33-50% while also raising HDL 15-33% and lowering LDL 10-20%. Both are associated with muscle inflammation, but when used in combination with a statin, gemfibrozil seems to confer a greater risk of injury. Therefore, fenofibrate is preferred when used in combination with a statin.

In summary, a variety of medication can be useful in controlling TG levels in those people who are at risk for heart disease who cannot achieve a level < 150mg/dl through diet and exercise. Fish oil seems to be a reasonable first step since it is non-prescription and relatively safe. Nicotinic acid and fibric acids can be quite effective as add on therapy and generally are well tolerated.