fish oil triglycerides (Rx)

Brand and Other Names:Omegaven
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Dosing & Uses

AdultPediatric

Not indicated

Dosage Forms & Strengths

injectable emulsion, single-dose emulsion

  • 5g/50mL
  • 10g/100mL

Nutrition-associated Cholestasis

Indicated as a source of calories and fatty acids in pediatric patients with parenteral nutrition-associated cholestasis (PNAC)

Recommended dose: 1 g/kg/day IV (maximum daily dose)

Initial rate of IV infusion should not exceed 0.05 mL/minute for the first 15-30 minutes of infusion

If tolerated, gradually increase until reaching the required rate after 30 minutes; maximum infusion rate should not exceed 1.5 mL/kg/hr, corresponding to 0.15 g/kg/hr

Clinical trial efficacy and safety

  • Effectiveness was established in 2 open-label clinical trials of 82 pediatric patients (aged 3 to 42 weeks), including preterm neonates with estimated gestational age of >24 weeks at birth
  • Safety was established in 189 pediatric patients (aged 19 days to 15 years); the most common adverse reactions were vomiting, agitation, and bradycardia

Dosage Modifications

Hypertriglyceridemia

  • If hypertriglyceridemia (triglycerides >250 mg/dL [neonates and infants] or >400 mg/dL [older children]) develops once fish oil triglycerides has been initiated at the recommended dosage, consider stopping the administration for 4 hr and obtain a repeat serum triglyceride level
  • Resume based on new result as indicated In patients with elevated triglyceride levels, consider other reasons for hypertriglyceridemia (eg, renal disease, other drugs)
  • If triglycerides remain at elevated levels, consider a reduced dose of 0.5-0.75 g/kg/day with an incremental increase to 1 g/kg/day; monitor triglyceride levels during treatment
  • Recommended duration for infusion is between 8-24 hr, depending on the clinical situation
  • Administer until direct bilirubin levels are <2 mg/dL or until the patient no longer requires PN

Dosing Considerations

Prior to administration, correct severe fluid and electrolyte disorders and measure serum triglycerides to establish a baseline level

Initiate dosing as soon as direct or conjugated bilirubin (DBil) levels are ≥2 mg/dL in pediatric patients who are expected to be PN-dependent for at least 2 weeks

Dosing depends on each patient’s energy requirements, which may be influenced by age, body weight, tolerance, clinical status, and ability to metabolize and eliminate lipids

When determining dose, take into account the energy supplied by dextrose and amino acids from PN, as well as energy from oral or enteral nutrition

Energy provided from lipid-based medications must also be taken into account (eg, propofol); contains 0.15-0.30 mg/mL of dl-alpha-tocopherol

Take into account the amount of alpha-tocopherol in fish oil triglyceride when determining the need for additional supplementation of vitamin E

Limitations of use

  • Not indicated for the prevention of PNAC; it is not been demonstrated that fish oil triglycerides prevents PNAC in parenteral nutrition (PN)-dependent patients
  • It has not been demonstrated that the clinical outcomes observed in patients treated with fish oil triglycerides are a result of the omega-6:omega-3 fatty acid ratio of the product
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                Monitor Closely (74)

                • abciximab

                  fish oil triglycerides will increase the level or effect of abciximab by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • alteplase

                  fish oil triglycerides will increase the level or effect of alteplase by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • anagrelide

                  fish oil triglycerides will increase the level or effect of anagrelide by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • antithrombin alfa

                  fish oil triglycerides will increase the level or effect of antithrombin alfa by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • antithrombin III

                  fish oil triglycerides will increase the level or effect of antithrombin III by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • apixaban

                  fish oil triglycerides will increase the level or effect of apixaban by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • argatroban

                  fish oil triglycerides will increase the level or effect of argatroban by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • aspirin

                  fish oil triglycerides will increase the level or effect of aspirin by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • aspirin rectal

                  fish oil triglycerides will increase the level or effect of aspirin rectal by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • betrixaban

                  fish oil triglycerides will increase the level or effect of betrixaban by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • bivalirudin

                  fish oil triglycerides will increase the level or effect of bivalirudin by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • cangrelor

                  fish oil triglycerides will increase the level or effect of cangrelor by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • celecoxib

                  fish oil triglycerides will increase the level or effect of celecoxib by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • cilostazol

                  fish oil triglycerides will increase the level or effect of cilostazol by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • citalopram

                  fish oil triglycerides will increase the level or effect of citalopram by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • clopidogrel

                  fish oil triglycerides will increase the level or effect of clopidogrel by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • dabigatran

                  fish oil triglycerides will increase the level or effect of dabigatran by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • dalteparin

                  fish oil triglycerides will increase the level or effect of dalteparin by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • defibrotide

                  fish oil triglycerides will increase the level or effect of defibrotide by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • desirudin

                  fish oil triglycerides will increase the level or effect of desirudin by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • desvenlafaxine

                  fish oil triglycerides will increase the level or effect of desvenlafaxine by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • diclofenac

                  fish oil triglycerides will increase the level or effect of diclofenac by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • diflunisal

                  fish oil triglycerides will increase the level or effect of diflunisal by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • dipyridamole

                  fish oil triglycerides will increase the level or effect of dipyridamole by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • duloxetine

                  fish oil triglycerides will increase the level or effect of duloxetine by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • edoxaban

                  fish oil triglycerides will increase the level or effect of edoxaban by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • enoxaparin

                  fish oil triglycerides will increase the level or effect of enoxaparin by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • epoprostenol

                  fish oil triglycerides will increase the level or effect of epoprostenol by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • eptifibatide

                  fish oil triglycerides will increase the level or effect of eptifibatide by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • escitalopram

                  fish oil triglycerides will increase the level or effect of escitalopram by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • etodolac

                  fish oil triglycerides will increase the level or effect of etodolac by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • fenoprofen

                  fish oil triglycerides will increase the level or effect of fenoprofen by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • fluoxetine

                  fish oil triglycerides will increase the level or effect of fluoxetine by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • flurbiprofen

                  fish oil triglycerides will increase the level or effect of flurbiprofen by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • fluvoxamine

                  fish oil triglycerides will increase the level or effect of fluvoxamine by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants

                • fondaparinux

                  fish oil triglycerides will increase the level or effect of fondaparinux by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • heparin

                  fish oil triglycerides will increase the level or effect of heparin by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • ibrutinib

                  fish oil triglycerides will increase the level or effect of ibrutinib by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • ibuprofen

                  fish oil triglycerides will increase the level or effect of ibuprofen by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • ibuprofen IV

                  fish oil triglycerides will increase the level or effect of ibuprofen IV by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • ibuprofen/famotidine

                  fish oil triglycerides will increase the level or effect of ibuprofen/famotidine by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • iloprost

                  fish oil triglycerides will increase the level or effect of iloprost by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • indomethacin

                  fish oil triglycerides will increase the level or effect of indomethacin by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • ketoprofen

                  fish oil triglycerides will increase the level or effect of ketoprofen by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • ketorolac

                  fish oil triglycerides will increase the level or effect of ketorolac by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • ketorolac intranasal

                  fish oil triglycerides will increase the level or effect of ketorolac intranasal by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • levomilnacipran

                  fish oil triglycerides will increase the level or effect of levomilnacipran by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • meclofenamate

                  fish oil triglycerides will increase the level or effect of meclofenamate by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • mefenamic acid

                  fish oil triglycerides will increase the level or effect of mefenamic acid by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • meloxicam

                  fish oil triglycerides will increase the level or effect of meloxicam by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • milnacipran

                  fish oil triglycerides will increase the level or effect of milnacipran by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • nabumetone

                  fish oil triglycerides will increase the level or effect of nabumetone by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • naproxen

                  fish oil triglycerides will increase the level or effect of naproxen by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • oxaprozin

                  fish oil triglycerides will increase the level or effect of oxaprozin by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • paroxetine

                  fish oil triglycerides will increase the level or effect of paroxetine by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • piroxicam

                  fish oil triglycerides will increase the level or effect of piroxicam by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • prasugrel

                  fish oil triglycerides will increase the level or effect of prasugrel by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • protein C concentrate

                  fish oil triglycerides will increase the level or effect of protein C concentrate by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • reteplase

                  fish oil triglycerides will increase the level or effect of reteplase by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • rivaroxaban

                  fish oil triglycerides will increase the level or effect of rivaroxaban by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • salsalate

                  fish oil triglycerides will increase the level or effect of salsalate by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • sertraline

                  fish oil triglycerides will increase the level or effect of sertraline by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • sulindac

                  fish oil triglycerides will increase the level or effect of sulindac by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • tenecteplase

                  fish oil triglycerides will increase the level or effect of tenecteplase by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • ticagrelor

                  fish oil triglycerides will increase the level or effect of ticagrelor by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • ticlopidine

                  fish oil triglycerides will increase the level or effect of ticlopidine by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • tirofiban

                  fish oil triglycerides will increase the level or effect of tirofiban by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • tolmetin

                  fish oil triglycerides will increase the level or effect of tolmetin by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • treprostinil

                  fish oil triglycerides will increase the level or effect of treprostinil by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • venlafaxine

                  fish oil triglycerides will increase the level or effect of venlafaxine by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • vilazodone

                  fish oil triglycerides will increase the level or effect of vilazodone by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • vorapaxar

                  fish oil triglycerides will increase the level or effect of vorapaxar by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • vortioxetine

                  fish oil triglycerides will increase the level or effect of vortioxetine by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                • warfarin

                  fish oil triglycerides will increase the level or effect of warfarin by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

                Minor (0)

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                  Adverse Effects

                  >10%

                  Vomiting (46%)

                  Agitation (35%)

                  Bradycardia (35%)

                  Apnea (20%)

                  Viral infection (16%)

                  Erythema (12%)

                  1-10%

                  Rash (8%)

                  Abscess (7%)

                  Neutropenia (7%)

                  Hypertonia (6%)

                  Incision site erythema (6%)

                  Postmarketing Reports

                  Life-threatening hemorrhage following a central venous catheter change reported in a 9-month-old infant with intestinal failure who received PN with fish oil triglyceride as the sole lipid source; infant had no prior history of bleeding, coagulopathy, or portal hypertension

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                  Warnings

                  Contraindications

                  Known hypersensitivity to fish or egg protein or to any of the active ingredients or excipients

                  Severe hemorrhagic disorders due to a potential effect on platelet aggregation

                  Severe hyperlipidemia or severe disorders of lipid metabolism characterized by hypertriglyceridemia (serum triglyceride concentrations >1000 mg/dL)

                  Cautions

                  Fat overload syndrome reported with IV lipid emulsions; reduced or limited ability to metabolize lipids accompanied by prolonged plasma clearance may result in this syndrome, which is characterized by a sudden deterioration in the patient's condition including fever, anemia, leukopenia, thrombocytopenia, coagulation disorders, hyperlipidemia, hepatomegaly, deteriorating liver function, and central nervous system manifestations (eg, coma); syndrome is usually reversible when the lipid infusion discontinued

                  Administering PN to severely malnourished patients may result in refeeding syndrome, which is characterized by the intracellular shift of potassium, phosphorus, and magnesium as the patient becomes anabolic; thiamine deficiency and fluid retention may also develop; closely monitor severely malnourished patients and slowly increase their nutrient intake Impaired lipid metabolism with hypertriglyceridemia may occur in conditions such as inherited lipid disorders, obesity, diabetes mellitus, and metabolic syndrome; serum triglyceride levels >1000 mg/dL have been associated with an increased risk of pancreatitis; measure serum triglycerides before the start of infusion (baseline value), and regularly throughout treatment (see Dosage Modifications)

                  Fish oil triglyceride contains no more than 25 mcg/L of aluminum; aluminum may reach toxic levels with prolonged IV administration if kidney function is impaired; patients with impaired kidney function, including preterm infants, who receive parenteral levels of aluminum at greater than 4-5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity

                  Monitor serum triglycerides, fluid and electrolyte status, blood glucose, liver and kidney function, coagulation parameters, and complete blood count throughout treatment

                  Monitor patients for laboratory evidence of essential fatty acid deficiency (EFAD) is recommended; consider laboratory tests determining serum fatty acids levels values to help determine adequacy of essential fatty acid status; increasing essential fatty acid intake (enterally or parenterally) is effective in treating and preventing EFAD

                  Lipids contained in fish oil triglyceride may interfere with some laboratory blood tests (eg, hemoglobin, lactate dehydrogenase, bilirubin, and oxygen saturation) if blood is sampled before lipids have cleared from the bloodstream; lipids are normally cleared after a period of 5-6 hr once the lipid infusion is stopped

                  Infections

                  • Lipid emulsions, such as fish oil triglyceride, can support microbial growth and are an independent risk factor for the development of bloodstream infections; risk of infection is increased in patients with malnutrition-associated immunosuppression, long-term use and poor maintenance of IV catheters, or immunosuppressive effects of other conditions or concomitant drugs; monitor for signs and symptoms of early infections including fever and chills, laboratory tests results indicating possible infection (including leukocytosis and hyperglycemia), and frequently inspect IV catheter site for edema, redness, and discharge
                  • Ensure aseptic technique in catheter placement and maintenance, as well as in the preparation and administration of the drug to decrease risk of infection

                  Hypersensitivity Reactions

                  • Drug contains fish oil and egg phospholipids, which may cause hypersensitivity reactions
                  • Signs or symptoms of a hypersensitivity reaction include: tachypnea, dyspnea, hypoxia, bronchospasm, tachycardia, hypotension, cyanosis, vomiting, nausea, headache, sweating, dizziness, altered mentation, flushing, rash, urticaria, erythema, fever, or chills
                  • If a hypersensitivity reaction occurs, stop infusion immediately and initiate appropriate treatment and supportive measures

                  Pulmonary lipid accumulation

                  • Deaths in preterm infants after infusion of soybean oil-based IV lipid emulsions have been reported in medical literature; risk of pulmonary lipid accumulation with fish oil triglycerides is unknown
                  • Preterm and small-for-gestational-age infants have poor clearance of IV lipid emulsion and increased free fatty acid plasma levels following lipid emulsion infusion; consider this risk due to poor lipid clearance when administering IV lipid emulsions
                  • Monitor for signs and symptoms of pleural or pericardial effusion

                  Drug interaction overview

                  • Prolonged bleeding time in patients reported with oral omega-3 fatty acids taking antiplatelet agents or anticoagulants
                  • Clinical trials of IV fish oil triglycerides did not observe bleeding times that exceeded normal limit or clinically significant bleeding episodes; however, the prescribing information recommends periodic monitor of bleeding time in patients receiving fish oil triglycerides receiving concomitant antiplatelet agents or anticoagulants
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                  Pregnancy

                  Pregnancy

                  There are no available data on use in pregnant women to establish a drug associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes

                  Animal reproduction studies have not been conducted with fish oil triglycerides

                  Lactation

                  No data are available regarding the presence of fish oil triglycerides from fish oil triglycerides in human milk, the effects on the breastfed infant, or the effects on milk production

                  Lactating women receiving oral omega-3 fatty acids have been shown to have higher levels of fatty acids in their milk

                  Pregnancy Categories

                  A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                  B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                  C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                  D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                  X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                  NA: Information not available.

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                  Pharmacology

                  Mechanism of Action

                  Fish oil triglycerides provides a biologically utilizable source of calories and essential fatty acids

                  Fatty acids serve as an important substrate for energy production

                  Most common mechanism of action for energy production derived from fatty acid metabolism is beta oxidation

                  Fatty acids are also important for membrane structure and function, as precursors for bioactive molecules (such as prostaglandins), and as regulators of gene expression

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                  Administration

                  IV Administration

                  Administer alone or as part of a PN admixture for central or peripheral IV infusion

                  When administered with dextrose and amino acids, choosing central or peripheral venous route depends on the osmolarity of the final infusate; solutions with osmolarity of >900 mOsm/L (central vein) Use a 1.2 micron in-line filter during administration

                  Use a dedicated line for PN Infused concurrently into the same vein as dextrose-amino acid solutions (as part of PN) by a Y-connector located closest to the infusion site; flow rates of each solution should be controlled separately by infusion pumps

                  Avoid multiple connections; do not connect multiple medications in series

                  Turn off pump before the bottle runs dry

                  Use a vented infusion set when infusing from the bottle; do not use infusion sets and lines that contain di-2-ethylhexyl phthalate (DEHP) Infusion sets that contain polyvinyl chloride (PVC) components have DEHP as a plasticizer

                  Prior to infusion, visually inspect for particulate matter and discoloration

                  Discard the bottle if any particulates or discoloration are observed

                  Gently invert the bottle before use

                  Use only if the emulsion is homogeneous and the container is undamaged; strict aseptic techniques must be followed; hang the bottle using the attached hanger and start infusion

                  Also see Storage

                  Storage

                  Unused bottle

                  • Store <25°C (77°F); avoid excessive heat; do not freeze
                  • If accidentally frozen, discard product

                  Opened bottle

                  • Once the bottle is connected to the infusion set, use immediately
                  • Complete infusion within 12 hr when using a Y-connector
                  • Infuse admixtures containing fish oil triglycerides immediately
                  • If not used immediately, store up to 6 hr at room temperature or up to 24 hr under refrigeration
                  • Complete the infusion within 24 hours after removal from storage
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                  Images

                  No images available for this drug.
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                  Patient Handout

                  A Patient Handout is not currently available for this monograph.
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                  Formulary

                  FormularyPatient Discounts

                  Adding plans allows you to compare formulary status to other drugs in the same class.

                  To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

                  Adding plans allows you to:

                  • View the formulary and any restrictions for each plan.
                  • Manage and view all your plans together – even plans in different states.
                  • Compare formulary status to other drugs in the same class.
                  • Access your plan list on any device – mobile or desktop.

                  The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                  Tier Description
                  1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                  2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                  3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                  4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  NC NOT COVERED – Drugs that are not covered by the plan.
                  Code Definition
                  PA Prior Authorization
                  Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                  QL Quantity Limits
                  Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                  ST Step Therapy
                  Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                  OR Other Restrictions
                  Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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                  Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.