#lovaza

All patients should receive general measures (ie, address modifiable causes, manage atherosclerotic cardiovascular disease [ASCVD] risk, implement lifestyle modification [eg, dietary changes, reduction in alcohol consumption]) and optimal low-density lipoprotein lowering therapy for 4 to 12 weeks before considering triglyceride lowering therapy. For patients whose triglycerides remain ≥500 mg/dL and who do not warrant icosapent ethyl for additional ASCVD risk reduction, any prescription strength omega-3 fatty acid (including icosapent ethyl) or a fibrate (fenofibrate preferred) is reasonable.

No, Lovaza and Vascepa are not the same. They are distinct prescription omega-3 fatty acid formulations with different compositions and, importantly, different FDA-approved indications.

Lovaza (omega-3-acid ethyl esters USP) contains both EPA and DHA as ethyl esters, with approximately 465 mg of EPA and 375 mg of DHA per 1-gram capsule. [1] In contrast, Vascepa (icosapent ethyl) contains only highly purified EPA as an ethyl ester, providing 1 gram of EPA per capsule with essentially no DHA. [2-3]

The most clinically significant difference lies in their FDA-approved indications. Both are approved as adjuncts to diet for reducing triglyceride levels in adults with severe hypertriglyceridemia (≥500 mg/dL). [1-2][4] However, Vascepa has an additional cardiovascular outcomes indication based on the REDUCE-IT trial: it is approved to reduce the risk of myocardial infarction, stroke, coronary revascularization, and unstable angina in patients with elevated triglycerides (≥150 mg/dL) who are on maximally tolerated statin therapy and have either established cardiovascular disease or diabetes with additional risk factors. [2][4-5] Lovaza does not have this cardiovascular risk reduction indication. [1]

Their lipid effects also differ. While both lower triglycerides substantially, Lovaza increases LDL-C by approximately 45% in patients with severe hypertriglyceridemia, whereas Vascepa decreases LDL-C by approximately 6.5%. [2] This distinction may be clinically relevant when selecting therapy for patients with mixed dyslipidemia.

Brand Name: Lovaza

Generic Available

Common Dosage Forms*:

Liquid-Filled Gel Capsule: Each 1-gram capsule contains at least 900 mg of the ethyl esters of omega-3 fatty acids (including approximately 465 mg EPA and 375 mg DHA.

FDA Indications/Dosages:

As an adjunct to diet to reduce triglyceride (TG) levels in adult patients with very high (500 mg/dL) triglyceride levels: Patients should be on an appropriate lipid-lowering diet and continue the diet throughout treatment. The normal daily dose is 4 grams (4 capsules) daily either in one or two doses with meals.

Monitor: Lipid panel

Pharmacology/Pharmacokinetics: The mechanism of action of omega-3-fish oils is not completely understood. Potential mechanisms of action include inhibition of acyl CoA: 1,2-diacylglycerol acyltransferase; increased mitochondrial and peroxisomal beta-oxidation in the liver; decreased lipogenesis in the liver; and increased plasma lipoprotein lipase activity. Omega-3 fish oils may reduce the synthesis of triglycerides (TGs) in the liver because EPA and DHA are poor substrates for the enzyme responsible for TG synthesis, and EPA and DHA inhibit esterification of other fatty acids.

Drug Interactions: Use with anticoagulants may increase bleeding times.

Contraindications/Precautions: Contraindicated in patients hypersensitive to any component of this medication. Use with caution in patients allergic to fish. Losing excessive body weight, decreasing alcohol intake, and increasing physical exercise should be attempted before initiating drug therapy. Diseases which contribute to hyperlipidemia, such as diabetes or hypothyroidism, should be treated accordingly. Plasma triglyceride levels can be increased by estrogen therapy, thiazide diuretics, and beta-blockers. Discontinuation of these agents should be considered before initiating drug therapy. Pregnancy Category C.

Adverse Effects: Adverse effects are usually mild and include belching (4.9%), miscellaneous infection (4.4%), flu-like symptoms (3.5%), dyspepsia (3.1%), taste perversion (2.7%), back pain (2.2%), rash (1.8%), and angina (1.8%).

Patient Consultation:

Take with meals.

Closely follow prescribed diet.

Contact a physician if the above side effects are severe or persistent.

Store in a cool, dry place away from sunlight and children.

Omega 3 acid ethyl esters (Lovaza)

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