Clofibrate (Atromid S - ICI) is the drug most widely used in this country for reducing abnormally high plasma lipids, and for treating xanthomatosis.1 It is not effective in all forms of hyperlipidaemia, but until now it has not been known to raise lipid levels. A recent report, however, describes four patients with primary biliary cirrhosis and hypercholesterolaemia in whom clofibrate raised the serum cholesterol. In three of the patients the skin xanthomas became more severe. When clofibrate was discontinued the cholesterol level fell again. The explanation for this surprising effect so far remains obscure. Clofibrate did not affect bilirubin, alkaline phosphatase and transaminase levels.2 We conclude that the drug should not be used in patients with biliary cirrhosis.
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