Which medications in the drug class Omega-3 Acids are used in the treatment of Hypertriglyceridemia?

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

Omega-3 Acids

Prescription omega-3 acids (fish oil) are available and have shown to be effective in lowering very high serum triglycerides (≥ 500 mg/dL).

Icosapent (Vascepa)

Ethyl ester of eicosapentaenoic acid indicated as an adjunct to diet to reduce triglyceride levels in adult patients with severe hypertriglyceridemia (> 500 mg/dL). It is also indicated as adjunctive therapy for cardiovascular event risk reduction in adults whose TG levels are 150 mg/dL or higher and in whom established cardiovascular disease is present (or in whom, in the absence of established cardiovascular disease, diabetes exists, along with two or more additional cardiovascular disease risk factors). Reduces hepatic VLDL-TG synthesis and/or secretion; enhances TG clearance from circulating VLDL particle; may also increase beta-oxidation, inhibits acyl-CoA:1,2-diacylglycerol acyltransferase (DGAT), decreases lipogenesis in liver, and increases plasma lipoprotein lipase activity. Icosapent does not increase LDL-cholesterol.

Omega-3 fatty acids (Lovaza, Vascazen, Omtryg)

Omega-3-acid ethyl esters were the first prescription omega-3-acid. These are purified fish oil, without heavy metals and polychlorinated biphenyl (PCBs). Content of EPA and DHA vary between each brand.

This agent is theorized to reduce triglyceride synthesis in the liver. EPA and DHA are poor enzyme substrates for triglyceride synthesis in the liver, and they inhibit esterification of other fatty acids. Potential mechanisms of action include acyl CoA:1,2-diacylglycerol acyltransferase inhibition, increased hepatic mitochondrial and peroxisomal beta-oxidation, decreased hepatic lipogenesis, and increased plasma lipoprotein lipase activity.

Omega-3-acid ethyl esters are indicated as adjunctive treatment to dietary changes to reduce very high triglyceride levels (ie, >500 mg/dL).

Clinical trials show significant reduction in non–HDL, triglyceride, total cholesterol, VLDL, and apo B levels from baseline when combined with simvastatin compared with simvastatin and placebo. Monotherapy with omega-3-acid ethyl esters reduces median triglyceride, VLDL, and non–HDL levels from baseline.

Omega-3 carboxylic acids (Epanova)

Omega 3 acids are thought to inhibit acyl CoA:1,2-diacylglycerol acyltransferase. Increased mitochondrial and peroxisomal beta-oxidation in liver , decreased hepatic lipogenesis, and increased activity of plasma lipoprotein lipase activity may also be possible mechanisms. Omega 3 carboxylic acids is the first prescription omega-3 product in free fatty acid form approved in the United States. It is indicated as an adjunct to diet in patients with severe hypertriglyceridemia (ie, TG ≥ 500 mg/dL).


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