omega-3-acid ethyl esters
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.
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
• Monitor hepatic function tests in patients with hepatic impairment.
• Monitor LDL-C and triglyceride levels periodically.
• 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) ,
ClassificationTherapeutic: lipid lowering agents
Pharmacologic: fatty acids
Time/action profile (lowering of triglycerides)
Adverse Reactions/Side Effects
- altered taste
Drug-Drug interactionMay ↑ risk of bleeding with aspirin or warfarin.
- 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 DiagnosesNoncompliance (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.
- 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.
- Lowering of serum triglyceride levels. Patients who do not have an adequate response after 2 mo of treatment should be withdrawn from therapy.