Omega-3-acid ethyl esters are a prescription medication used alongside a proper diet to help lower very high triglyceride levels in the blood. By reducing these fat-like substances, this medicine may aid in preventing medical problems caused by clogged blood vessels, such as heart attacks and strokes. It's important to note that this medication is only available with a doctor's prescription.
What are Omega-3-Acid Ethyl Esters?
Omega-3-acid ethyl esters belong to a class of medications called antilipemic or lipid-regulating agents. These medications may work by decreasing the amount of triglycerides and other fats made in the liver.
Uses of Omega-3-Acid Ethyl Esters
The primary use of omega-3-acid ethyl esters is to lower very high triglyceride levels in the blood. High triglyceride levels can increase the risk of heart disease, stroke, and other cardiovascular conditions.Omega-3-acid ethyl esters are used together with lifestyle changes (diet, weight-loss, exercise) to reduce the amount of triglycerides (a fat-like substance) in the blood in people with very high triglycerides.
Beyond their primary use, omega-3-acid ethyl esters may also be prescribed for other conditions as determined by a healthcare provider. Some studies suggest potential benefits in secondary prevention after myocardial infarction (MI) and for the treatment of hypertriglyceridemia. There has also been off-label use for the prevention of angina, heart attacks, and strokes.
How to Take Omega-3-Acid Ethyl Esters
Prescription omega-3 fatty acids such as omega-3-acid ethyl esters (Lovaza, Omytrg), icosapent ethyl esters (Vascepa), and omega-3-carboxylic acids (Epanova) come as a liquid filled gel capsule to take by mouth. Epanova is usually taken once daily with or without food. Lovaza is usually taken one or two times a day with or without food. Omytrg is usually taken one or two times a day with food. Vascepa is usually taken two times a day with food. Nonprescription omega-3 fatty acids come as gel capsules to take by mouth as directed on the package label. Take omega-3 fatty acids at around the same time(s) every day. Follow the directions on your prescription label or on the package carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take omega-3 fatty acids exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.Swallow the capsules whole; do not split, crush, chew, or dissolve them. If you cannot swallow capsules whole, tell your doctor.
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Generally, omega-3-acid ethyl esters are taken by mouth with food, as directed by a doctor, usually once or twice a day. The capsules should be swallowed whole and not crushed, chewed, or dissolved.
The dosage is based on individual medical conditions and response to treatment. It is crucial to use this medication regularly to get the most benefit from it, taking it at the same time(s) each day to aid in remembering.
Before prescribing medicine for your condition your doctor will probably try to control your condition prescribing a personal diet for you. Carefully follow the special diet your doctor gave you. Such a diet may be low in fats, sugars, and/or cholesterol. Many people are able to control their condition by carefully following their doctor's orders for proper diet and exercise. Medicine is prescribed only when additional help is needed and is effective only when a schedule of diet and exercise is properly followed. Also, this medicine is less effective if you have overweight or obesity. It may be very important for you to go on a weight-reducing diet. However, check with your doctor before going on any diet.
Dosage and Administration
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For oral dosage form (capsules): For high triglycerides or fats in the blood: Adults-4 capsules per day taken as a single dose or 2 capsules two times a day. Children-Use and dose must be determined by your doctor.
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Important Considerations Before Use
Before taking omega-3 fatty acids,tell your doctor and pharmacist if you are allergic to omega-3 fatty acids including omega-3-acid ethyl esters, icosapent ethyl esters, and omega-3-carboxylic acids; fish, including shellfish (clams, scallops, shrimp, lobster, crayfish, crab, oyster, mussels, others); any other medications; or any of the ingredients in omega-3 fatty acid capsules. Ask your pharmacist for a list of the ingredients.tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while taking omega-3 fatty acids. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.tell your doctor if you have diabetes, atrial fibrillation or atrial flutter (conditions in which the heart beats irregularly); or liver, thyroid, or pancreatic disease.tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking omega-3 fatty acids, call your doctor.ask your doctor about the use of alcoholic beverages while you are taking omega-3- fatty acids.
Several factors should be considered before using omega-3-acid ethyl esters:
- Allergies: Inform your doctor if you have any unusual or allergic reactions to this medicine or any other medicines, including allergies to foods, dyes, preservatives, or animals.
- Pediatric Use: The safety and efficacy of omega-3-acid ethyl esters in the pediatric population have not been established.
- Geriatric Use: Studies have not demonstrated geriatric-specific problems that would limit the usefulness of omega-3-acid ethyl esters in the elderly.
- Breastfeeding: Weigh the potential benefits against the potential risks before taking this medication while breastfeeding, as there are no adequate studies in women for determining infant risk.
- Drug Interactions: Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.
- Other Interactions: Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
- Other Medical Problems: The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Allergy to fish or shellfish
- Diabetes
- Hypothyroidism (underactive thyroid)
- Heart rhythm problem (e.g., atrial fibrillation or flutter)
- Pancreas problem
- Liver disease
Potential Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.Check with your doctor immediately if any of the following side effects occur:Incidence not known Bleeding gums chest tightness cough coughing up blood difficulty with breathing or swallowing dizziness fast or irregular heartbeat headache hives, itching, or skin rash increased menstrual flow or vaginal bleeding nosebleeds paralysis prolonged bleeding from cuts puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue red or black, tarry stools red or dark brown urine sweating unusual tiredness or weakness Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: Less common Acid or sour stomach bad, unusual, or unpleasant (after) taste belching bloated or full feeling change in taste excess air or gas in the stomach heartburn indigestion stomach discomfort, upset, or pain Incidence not known Diarrhea difficulty having a bowel movement (stool) loss of appetite nausea or vomiting passing of gas stomach fullness Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. Call your doctor for medical advice about side effects.
Omega-3-acid ethyl esters, like all medications, can cause side effects. Not everyone experiences these side effects, and some may go away as the body adjusts to the medicine. Common side effects include:
- Burping
- Upset stomach
- Change in taste
- Acid or sour stomach
- Bad, unusual, or unpleasant (after) taste
- Belching
- Bloated or full feeling
- Change in taste
- Excess air or gas in the stomach
- Heartburn
- Indigestion
- Stomach discomfort, upset, or pain
Less common side effects can include diarrhea, difficulty having a bowel movement (stool), loss of appetite, nausea or vomiting, passing of gas, and stomach fullness.
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More serious side effects, though less common, require immediate medical attention:
- Bleeding gums
- Chest tightness
- Cough
- Coughing up blood
- Difficulty with breathing or swallowing
- Dizziness
- Fast or irregular heartbeat
- Headache
- Hives, itching, or skin rash
- Increased menstrual flow or vaginal bleeding
- Nosebleeds
- Paralysis
- Prolonged bleeding from cuts
- Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- Red or black, tarry stools
- Red or dark brown urine
- Sweating
- Unusual tiredness or weakness
Any side effects should be reported to a healthcare professional.
Interactions with Other Medications and Substances
Omega-3-acid ethyl esters may interact with other medicines and supplements. Before taking omega-3-acid ethyl esters, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.
In particular, make sure that you discuss if you are using any of the following before taking omega-3-acid ethyl esters.Aspirin, which is in many prescription and OTC products, including those for pain, swelling, and feverA blood thinner, which is a medicine used to treat or prevent blood clotsAn antiplatelet medicine, such as aspirin/dipyridamole, cilostazol, clopidogrel (Plavix), or ticagrelor (Brilinta), which is a medicine used to prevent blood clots
Certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur.
It is unknown if drinking alcohol will affect omega-3-acid ethyl esters, but drinking large amounts of alcohol can increase your triglyceride levels. It is best to limit the amount of alcohol you drink.
How Omega-3-Acid Ethyl Esters Work
Omega-3-acid ethyl esters seem to work by helping your body break down triglycerides in your blood and decreasing the amount of triglycerides your liver makes. Together, these effects may help lower your triglyceride levels.
Although the mechanism of action of omega-3 fatty acids, including omega-3 EE, is not fully understood, a number of effects of omega-3 EE that can positively interfere with the development or worsening of CV disease have been reported. Available evidence seems to suggest that EPA and DHA might differ in the mechanisms by which they exert their beneficial effect on the CV system.
One notable effect is the reduction in triglyceride (TG) levels. Clinical studies have demonstrated a dose-dependent reduction in TG levels, typically ranging from 10% to 33%, with more significant reductions observed in patients with higher baseline TG levels.
Omega-3 EE administration is followed by EPA and DHA absorption. EPA and DHA concentrations in plasma phospholipids are related to the level of EPA and DHA incorporated into cell membranes. Omega-3 fatty acids are metabolized via three main pathways. Fatty acids are first transported to the liver for incorporation into lipoproteins, and then channeled to peripheral lipid stores.
Influence on LDL Cholesterol
The elevation in LDL-C levels observed with omega-3 EE seems to result from conversion of VLDL-C. Of note, the observed increase in LDL-C levels typically reflects a shift to larger, less atherogenic LDL particles.
Storage Instructions
Omega-3-acid ethyl esters should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place. Do not freeze omega-3-acid ethyl esters and protect them from light.
Importance of Lifestyle Changes
It is very important to continue to follow your doctor's advice about diet and exercise. This medicine does not take the place of diet and exercise. You may be asked to follow a cholesterol-lowering diet that you will start before and continue during your treatment with this medicine. Follow all recommendations from your health care provider.
Omega-3 Fatty Acids and Cardiovascular Health
Since the first evidence showing a protective effect against coronary artery disease (CAD), reported more than 30 years ago, several epidemiologic and clinical studies have indicated an inverse relationship between a diet rich in fish and cardiovascular (CV) morbidity and mortality. Two compounds of the omega-3 fatty acid class, namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), were presumed to be the active ingredients in fish.
Several studies have investigated the role of isolated and combined EPA and DHA in the form of EE, especially with respect to CV disease prevention.