omega-3-carboxylic acids

General

Pronunciation:
o-me-ga 3 car-box-i-lik a-sids


Trade Name(s)

  • Epanova

Ther. Class.
lipid-lowering agents

Pharm. Class.
fish oil derivatives

Indications

Adjunct to diet in the treatment of severe hypertriglyceridemia (TG ≥500 mg/dL).

Action

Proposed mechanisms include ↑ activity of liver enzymes, ↓ hepatic lipogenesis, ↑ lipoprotein lipase activity and ↓ TG synthesis.

Therapeutic Effect(s):

↓ TG levels.

Pharmacokinetics

Absorption: Enters circulation via thoracic duct lymphatic system following absorption in the small intestine.

Distribution: Fish oils enter breast milk.

Metabolism and Excretion: Omega-3 fatty acids primarily eicapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are mainly metabolized by the liver.

Half-life: EPA–37 hr; DHA–46hr.

TIME/ACTION PROFILE (blood levels of EPA/DHA)

ROUTEONSETPEAKDURATION
PO unknown5–9 hrunknown

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity.

Use Cautiously in:

  • Hypersensitivity to fish or shellfish
  • Hepatic impairment (monitor liver enzymes);
  • Geri: Consider age related decreases in renal, hepatic and cardiac function, concurrent diseases and drug therapies (consider ↓ initial dose);
  • OB: Use only if potential benefit justifies potential risk to the fetus;
  • Lactation: Use cautiously if breastfeeding (enters breast milk, effects in infant are not known);
  • Pedi: Safety and effectiveness not established.

Adverse Reactions/Side Effects

GI: diarrhea, abdominal pain/discomfort, eructation, ↑ liver enzymes, nausea

Hemat: ↑ bleeding time

Metabolic: ↑ LDL-C levels

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

  • May ↑ risk of bleeding with anticoagulants or antiplatelet agents.
  • Beta blockers, thiazide diuretics, and estrogens ↑ TG and should be discontinued or modified prior to treatment.

Route/Dosage

PO: (Adults) 2 grams once daily or 4 grams once daily.

Availability

Capsules : 1 g

Assessment

  • Obtain a diet history, especially with regard to fat consumption.
  • Determine if patient has an allergy to fish or shellfish.

Lab Test Considerations: Monitor serum triglyceride levels prior to and periodically during therapy.

  • Monitor serum ALT and AST periodically during therapy. May cause ↑ serum ALT and AST levels.
  • Monitor serum LDL cholesterol levels periodically during therapy. May cause ↑ in serum LDL cholesterol levels.

Potential Diagnoses

Implementation

  • An appropriate lipid-lowering diet should be followed before therapy and should continue during therapy.
    • Discontinue or changes medications that may ↑ hypertriglyceridemia (beta blockers, thiazide diuretics, estrogens) if possible prior to therapy.
  • PO: May be taken as a single 4-g dose or as 2 g twice daily. May be administered without regard to meals. Swallow capsules whole; do not open, dissolve, or chew.

Patient/Family Teaching

  • Instruct patient to take medication as directed, not to skip doses or double up on missed doses. Take missed doses as soon as remembered, but if a day is missed, do not double doses the next day. Medication helps control but does not cure elevated serum triglyceride levels. Advise patient to read Patient Information sheet prior to starting therapy and with each Rx refill in case of changes.
  • Advise patient that this medication should be used in conjunction with diet restrictions (fat, cholesterol, carbohydrates, alcohol), exercise, weight loss in overweight patients, and control of medical problems (such as diabetes mellitus and hypothyroidism) that may contribute to hypertriglyceridemia.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding
  • Emphasize the importance of follow-up exams to determine effectiveness.

Evaluation/Desired Outcomes

Lowering of serum triglyceride levels.

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