Omega-3-acid ethyl esters

How it works

They reduce hepatic synthesis of triglycerides and very-low-density lipoprotein, lowering serum triglyceride concentrations; the precise mechanisms include effects on fatty acid metabolism and substrate availability.

Prescribing in practice

• They may modestly prolong bleeding time and should be used with caution in patients on anticoagulants or antiplatelet agents and around surgery.
• Routine post-myocardial-infarction use is no longer generally recommended, as later evidence did not confirm a consistent cardiovascular benefit for this preparation; its main role is in hypertriglyceridaemia.
• Caution is advised in those with fish or seafood allergy and in hepatic impairment; consult the SPC.

Monitoring

Monitor the fasting lipid profile, and liver function where there is hepatic impairment.

Counselling the patient

• Advise taking the capsules with food to reduce indigestion and fishy aftertaste.
• Tell the patient to mention this medicine before any surgery or if they take blood-thinning drugs.

Evidence & guidelines

Omega-3-acid ethyl esters lower triglycerides but later trials did not confirm broad cardiovascular benefit for this preparation; refer to current prescribing references.