Pemafibrate, as a novel lipid-lowering drug, is mainly used for the treatment of specific types of hyperlipidemia. Its use requires special attention to liver function monitoring and adjustment for special populations. The following will explain from two aspects: the scope of indications and key precautions.

1. Scope of indications

(1) Primary hyperlipidemia: suitable for adult primary hypercholesterolemia or mixed hyperlipidemia, especially for patients with statin intolerance.

(2) Hypertriglyceridemia: For patients with severe hypertriglyceridemia and serum triglycerides ≥ 500mg/dL, the risk of pancreatitis can be significantly reduced.

2. Medication precautions

(1) Basic monitoring requirements

Liver function monitoring: ALT/AST must be tested before medication, and rechecked every 3 months during treatment. If there is a ≥ 3-fold increase in ULN, medication should be discontinued.

Creatine kinase testing: When unexplained muscle pain occurs, immediately check the CK value. If CK>5 times the normal upper limit, treatment should be interrupted.

(2) Taboo population

Severe renal insufficiency: eGFR<30ml/min is contraindicated as obstruction of prototype drug excretion may lead to accumulation toxicity.

Patients with active liver disease, including those with Child Pugh score B/C cirrhosis, may experience worsening liver function.

(3) Medication for special populations

Elderly patients: It is recommended to reduce the initial dose by half (0.1mg/day) as a decrease in clearance rate may lead to an increase in exposure.

Pregnant women: Animal experiments have shown embryotoxicity, and women of childbearing age should take reliable contraceptive measures during medication.

(4) Drug interactions

Combined use with warfarin: may enhance anticoagulant effect, closely monitor INR values, and adjust warfarin dosage if necessary.

Combined use with cyclosporine: can increase the blood concentration of pembrolizumab by 2-3 times, and combination use is prohibited.