medium-chain triglycerides + omega-3-acid triglycerides + soya bean oil, refined: clinical use

Prescribing considerations

• Confirm that oral or enteral nutrition is impossible, insufficient or contraindicated and provide other required parenteral nutrients and fluid.
• Correct fluid, electrolyte and acid–base disturbances before infusion; consider refeeding-related electrolyte shifts in depleted patients.
• Use caution where triglyceride clearance may be impaired, including diabetes, pancreatitis, hypothyroidism with hypertriglyceridaemia, sepsis, metabolic syndrome, or hepatic, renal or cardiac dysfunction.
• Confirm compatibility before Y-site administration or admixture.
• A September 2025 MHRA communication requires a lipid-compatible 1.2 micrometre filter for affected glass-bottle presentations until further notice; check the supplied presentation and current safety instructions.

Contraindications and cautions

• Hypersensitivity to an active substance, excipient, egg, fish, peanut or soya protein
• Severe hypertriglyceridaemia, coagulopathy, intrahepatic cholestasis or hepatic insufficiency
• Severe renal insufficiency without renal replacement therapy
• Acute thromboembolism, fat embolism or acidosis
• Life-threatening circulatory instability, inadequate tissue oxygenation, acute pulmonary oedema or decompensated cardiac failure
• Acute phase of myocardial infarction or stroke, unstable metabolic states, or uncorrected fluid and electrolyte disturbance

Monitoring

• Serum triglycerides and evidence of impaired lipid clearance
• Fluid balance, electrolytes and acid–base status
• Blood-cell count, coagulation, hepatic and renal function
• Blood glucose and total lipid and glucose provision where metabolism is impaired
• Triglycerides and bilirubin in infants at risk of hyperbilirubinaemia
• Clinical signs of allergy, infection, metabolic intolerance or fat overload

Clinical pharmacology

An oil-in-water emulsion containing rapidly oxidised medium-chain triglycerides, soya-derived long-chain triglycerides and omega-3 triglycerides. Lipolysis releases glycerol and fatty acids for oxidation, storage, membrane incorporation and lipid-mediator synthesis; renal elimination is negligible.

Formulation and product differences

• Milky-white intravenous oil-in-water emulsion supplied in single-use glass bottles.
• Contains egg phospholipids, glycerol, sodium oleate, alpha-tocopherol, sodium hydroxide and water for injections.
• Protect from freezing and light; in children younger than 2 years protect the entire administration system from light.
• Current MHRA filtering precautions may differ by bottle presentation and shelf-life status.