Pemafibrate, as a novel selective PPAR α agonist, has side effects mainly involving liver dysfunction and muscle symptoms, most of which can be alleviated through monitoring and intervention measures. The following system explains common side effects and corresponding relief methods to help patients safely take medication.

1. Common side effects and mitigation measures

(1) Abnormal liver function: Approximately 5% -10% of patients experience elevated ALT/AST levels. It is recommended to check liver function before medication and have a follow-up every 3 months during treatment. Mild abnormalities (<3 times ULN) can continue medication and strengthen monitoring, while moderate to severe cases require reduction or discontinuation of medication.

(2) Muscle symptoms: including muscle pain (3% -8%) and elevated creatine kinase. During medication, avoid vigorous exercise. If there is persistent muscle pain or weakness, the CK value should be immediately tested. If CK>5 times ULN, medication should be suspended.

(3) Gastrointestinal reactions: nausea (4% -6%), diarrhea (3% -5%), etc. It is recommended to take medication after meals. Mild symptoms can be relieved on their own, and if diarrhea persists, electrolytes should be supplemented to prevent dehydration.

2. Serious side effects to be wary of

(1) Rhabdomyolysis: rare but potentially life-threatening, characterized by darkened urine color and severe muscle pain. Once suspected, medication should be stopped immediately, intravenous fluids should be administered, and renal function should be monitored. If necessary, blood purification therapy should be administered.

(2) Severe liver injury: When jaundice, coagulation abnormalities, or symptoms of hepatic encephalopathy occur, permanent discontinuation of medication is required and liver protection treatment should be initiated. Patients with active liver disease should be excluded before medication.

3. Precautions for special populations

(1) Renal insufficiency: eGFR<30ml/min is contraindicated, and moderate impairment requires a 50% reduction. Regularly monitor urinary protein as it may increase the burden on the kidneys.

(2) Elderly patients are more prone to muscle side effects. It is recommended to reduce the initial dose by half and increase the frequency of CK monitoring (every 1-2 months).