icosapent ethyl: clinical use

Prescribing considerations

• Confirm that use is adjunctive to statin therapy and matches the licensed cardiovascular-risk population.
• Use caution with fish or shellfish hypersensitivity because the active ingredient is obtained from fish oil.
• Review previous atrial fibrillation or flutter and concurrent antithrombotic treatment.
• Consider hereditary fructose intolerance and allergies to soya or peanut because of the excipients.
• There is no relevant licensed use for cardiovascular-risk reduction in people under 18 years.

Contraindications and cautions

• Hypersensitivity to icosapent ethyl, soya or another formulation excipient.

Monitoring

• Assess for evidence of atrial fibrillation or flutter; obtain an ECG when clinically indicated.
• Monitor periodically for bleeding with anticoagulants or antiplatelet medicines.
• In hepatic impairment, check ALT and AST before treatment and subsequently as clinically indicated.

Clinical pharmacology

The prodrug is de-esterified during absorption to EPA, which is extensively incorporated into circulating lipids. EPA is mainly cleared through hepatic beta-oxidation; CYP metabolism is minor and renal excretion does not occur.

Formulation and product differences

• The selected product is a soft gelatin capsule containing soya lecithin, maltitol and sorbitol.
• Capsules are supplied in moisture-protective bottles or blisters and must be swallowed whole.