omega-3-acid ethyl esters

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omega-3-acid ethyl esters


Pharmacologic class: Combination ethyl esters of omega-3 fatty acids, principally eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)

Therapeutic class: Lipid-regulating agent

Pregnancy risk category C


Unclear. May include inhibition of acyl-CoA: 1,2-diacylglycerol acyltransferase, increased mitochondrial and peroxisomal β-oxidation in the liver, decreased lipogenesis in the liver, and increased plasma lipoprotein lipase activity; may reduce synthesis of triglycerides in the liver because EPA and DHA are poor substrates for the enzymes responsible for triglyceride synthesis, and EPA and DHA inhibit esterification of other fatty acids.


Capsules: 1 g

Indications and dosages

Adjunct to diet to reduce triglyceride levels in patients with severe (500 mg/dl or greater) hypertriglyceridemia

Adults: 4 g P.O. daily as a single 4-g dose or as 2-g dose P.O. b.i.d.


• Hypersensitivity to drug or its components


Use cautiously in:

• hepatic impairment

• hypersensitivity to fish or shellfish

• pregnant or breastfeeding patients

• children (safety and efficacy not established).


• Administer capsules whole with meals.

• Assess triglyceride levels carefully before starting therapy, and identify other causes (such as diabetes mellitus, hypothyroidism, or drugs) of high triglyceride levels; manage as appropriate.

• Ensure patient is on appropriate lipid-lowering diet before starting drug.

Adverse reactions

GI: vomiting, constipation, GI disorder, eructation, dyspepsia

Hepatic: increased liver enzyme levels

Skin: pruritus, rash

Other: taste perversion


Drug-drug. Anticoagulants, other drugs affecting coagulation (such as aspirin, NSAIDs): prolonged bleeding time

Drug-diagnostic tests. ALT, AST, LDL-C: increased levels

Patient monitoring

• Monitor hepatic function tests in patients with hepatic impairment.

• Monitor LDL-C and triglyceride levels periodically.

Patient teaching

• Tell patient to take capsules whole with meals and not to break open, crush, dissolve, or chew them.

• Instruct patient to tell prescriber if he's allergic to fish.

• Advise patient to maintain lipid-lowering diet.

• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

omega-3-acid ethyl esters

(ohme-ga three as-id eth-il es-ters) ,


(trade name)


Therapeutic: lipid lowering agents
Pharmacologic: fatty acids
Pregnancy Category: C


Hypertriglyceridemia (triglycerides ≥500 mmg/dL) in adults; used with specific diet.


Inhibits synthesis of triglycerides.

Therapeutic effects

Lowering of triglycerides.


Absorption: Well absorbed.
Distribution: Unknown.
Metabolism and Excretion: Incorporated into phospholipids.
Half-life: Unknown.

Time/action profile (lowering of triglycerides)

POunknown2 mounknown


Contraindicated in: Hypersensitivity.
Use Cautiously in: Allergy/hypersensitivity to fish; Obstetric / Lactation: Pregnancy or lactation; Pediatric: Safety not established.

Adverse Reactions/Side Effects


  • altered taste
  • eructation


  • rash


Drug-Drug interaction

May ↑ risk of bleeding with aspirin or warfarin.


Oral (Adults) 4 g/day; may be given as a single dose or 2 g twice daily.


Gelatin capsules (oil-filled): 1 g Cost: $196.69 / 100

Nursing implications

Nursing assessment

  • Obtain a diet history, especially with regard to fat consumption.
  • Lab Test Considerations: Monitor serum triglyceride levels prior to and periodically during therapy.
    • Monitor serum ALT periodically during therapy. May cause ↑ serum ALT without concurrent ↑ in AST levels.
    • Monitor serum LDL cholesterol levels periodically during therapy. May cause ↑ in serum LDL levels.

Potential Nursing Diagnoses

Noncompliance (Patient/Family Teaching)


  • Do not confuse Lovaza with lorazepam.
  • An appropriate lipid-lowering diet should be followed before therapy and should continue during therapy.
  • Oral: May be taken as a single 4-g dose or as 2 g twice daily. May be administered with meals. Swallow capsules whole; do not break 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 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.
  • Emphasize the importance of follow-up exams to determine effectiveness.

Evaluation/Desired Outcomes

  • Lowering of serum triglyceride levels. Patients who do not have an adequate response after 2 mo of treatment should be withdrawn from therapy.
References in periodicals archive ?
MacKay, "just like Lovaza [a pharmaceutical lipid-regulating product that contains 900 mg of ethyl esters of omega-3 fatty acids from fish oil] already has.
Scientists randomly assigned 358 people who had just suffered a myocardial infarction to take four capsules of either prescription Lovaza fish oil or a placebo each day with meals.
Therefore, the studies examined found Lovaza [R] to be about 56% more effective than Vascepa[R] at triglyceride lowering when comparing median percent changes.
Its most selling products include Advair, Adovart, Flovent, Augmentin, Lovaza and Lamictal.
Under McGill's supervision, the first group received metformin alone; the second received metformin plus rosiglitazone (Avandia); and the third received metformin plus Lovaza, which is a kind of fish oil.
Lovaza (omega-3-acid ethyl esters) Capsules Prescribing Information.
They include niacin or nicotinic acid; statins, such as atorvastatin (Lipitor), simvastatin (Zocor), or rosuvastatin (Crestor); fibrates, such as fenofibrate (Lofibra, TriCor) and gemfibrozil (Lopid); and omega-3 fatty acid supplements (either in the prescription form, Lovaza, or as over-the-counter supplements).
Alicia Clayton writes that she takes LOVAZA, a medication made from omega-3 fish oil, to control her cholesterol.
Many already prescribe omega-3 fish oil capsules, including GlaxoSmithKline's Lovaza, to reduce triglycerides, a type of blood fat linked to clogged arteries.
Zetia, Vyotrin, Simcor, Lescol, Livalo and Lovaza are set to expire between 2012 and 2014.
While it is not known for sure how exactly Lovaza works, it is assumed that the medication reduces the synthesizing of triglycerides in the liver as well as breaking down the triglycerides in the blood.