Which prescription fish oil capsules are available to treat hypertriglyceridemia (high triglyceride levels)?

Updated: Jul 23, 2021
  • Author: Mary Ellen T Sweeney, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Several prescription fish oil capsules have been approved by the FDA to treat triglyceride levels of more than 500 mg/dL. A report by Hilleman and Smer states that omega-3 fatty acid products available in prescription formulations have been found to significantly reduce triglycerides. In patients with baseline triglyceride levels of 500 mg/dL or greater taking 4 g/day of a prescription product, decreases compared with placebo ranged from 12.2% to 51.6%. Unlike the supplements, the prescription products are subject to FDA approval, and their safety and efficacy must be established prior to marketing. Currently, prescription capsules contain either a combination of EPA and DHA or EPA alone. [77] There is some concern regarding the use of DHA in patients with dyslipidemia, since high-dose omega-3 products containing DHA increase LDL cholesterol levels; the impact on HDL cholesterol levels varies.

One example of a prescription product is Lovaza. One 1-g capsule contains at least 900 mg of ethyl esters of omega-3 fatty acids (~465 mg of EPA and 375 mg of DHA). Another prescription omega-3 fatty acid product, Omtryg, was approved by the FDA in 2014 and contains EPA and DHA in the same amounts as Lovaza. [81]

A third prescription fish oil is an ultra-pure omega fatty acid that contains an ethyl ester of EPA, icosapent ethyl (Vascepa). Each 1-g icosapent capsule contains at least 96% EPA and no DHA. Past studies suggest that highly purified EPA may lower triglyceride (TG) levels without increasing LDL cholesterol levels. [78, 79]


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