Icosapent ethyl

How it works

It provides purified EPA which lowers plasma triglycerides through reduced hepatic VLDL-triglyceride synthesis and increased clearance, with additional proposed anti-inflammatory and membrane-stabilising effects.

Prescribing in practice

• It is indicated as an adjunct to statin therapy in high-cardiovascular-risk patients with elevated triglycerides and should be prescribed within the eligibility criteria in NICE technology appraisal guidance.
• An increased incidence of atrial fibrillation or flutter has been reported, so be alert to new palpitations or arrhythmia.
• There may be an increased bleeding risk, particularly with concurrent antiplatelet or anticoagulant therapy.

Monitoring

Monitor the lipid profile, and remain alert for new atrial fibrillation or signs of bleeding during treatment.

Counselling the patient

• Continue your statin and a healthy diet alongside this medicine.
• Report palpitations or an irregular heartbeat.
• Report any unusual bruising or bleeding, especially if you take other blood-thinning medicines.

Evidence & guidelines

The REDUCE-IT trial showed that icosapent ethyl reduced cardiovascular events in statin-treated patients with raised triglycerides, and NICE recommends it within defined criteria.