omega-3-acid ethyl esters 90: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
omega-3-acid ethyl esters 90: clinical details
Prescribing considerations
- Confirm endogenous hypertriglyceridaemia and inadequate response to dietary measures; the selected products are not indicated for exogenous type I hyperchylomicronaemia.
- Review cardiovascular history because atrial fibrillation is a recognised risk; discontinue if atrial fibrillation develops, using clinical judgement and appropriate assessment.
- Consider bleeding risk around trauma or surgery and when anticoagulants are used.
- Evidence is limited in older people, renal impairment, hepatic impairment, children and adolescents, secondary hypertriglyceridaemia—particularly uncontrolled diabetes—and concurrent fibrate use.
- Check for fish sensitivity and product-specific soya, peanut or excipient allergy.
Contraindications and cautions
- Hypersensitivity to omega-3-acid ethyl esters 90 or another listed excipient.
- Soya hypersensitivity; product information also warns against use in people allergic to peanut because relevant formulations may contain soya-derived material.
Monitoring
- Assess triglycerides and the wider lipid profile because LDL cholesterol can increase.
- Monitor for symptoms or recurrence of atrial fibrillation.
- Check prothrombin time or other appropriate anticoagulation measures when used with warfarin, including when treatment is stopped.
- Monitor liver transaminases in patients with signs of hepatic injury.
Clinical pharmacology
EPA and DHA ethyl esters undergo hydrolysis and are incorporated into plasma phospholipids and cholesterol esters. They reduce hepatic triglyceride synthesis, increase fatty-acid beta-oxidation and lower VLDL; thromboxane A2 production and bleeding time may also be affected.
Formulation and product differences
- Both selected products are soft gelatin capsules containing EPA and DHA ethyl esters.
- Omacor contains soya lecithin and an antioxidant mixed with vegetable oil such as soya oil.
- Teromeg uses sunflower lecithin in the shell, but its alpha-tocopherol may contain vegetable oil such as soya oil.
- Teromeg has a product-specific in-use period after first opening; follow the label and leaflet supplied with the pack.
omega-3-acid ethyl esters 90 preparations and strengths
Capsule
Route: Oral
Strengths: 1000 mg
omega-3-acid ethyl esters 90 interactions
The main documented interaction concern is an increased effect on bleeding time.
Warfarin and other oral anticoagulants
Additional coagulation monitoring may be needed when omega-3-acid ethyl esters are started or stopped, with anticoagulant adjustment if clinically required.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.