From the Guidelines
For patients with hypertriglyceridemia and triglyceride levels exceeding 500 mg/dL, a prescription-strength omega-3 fatty acid supplement of 2-4 grams per day is recommended. This is based on the most recent and highest quality study, which suggests that prescription omega-3 fatty acid preparations, such as Lovaza, Vascepa, or Epanova, are effective in reducing triglyceride levels by 20-50% in people with very high levels 1.
Key Considerations
- Prescription omega-3 products are more concentrated and effective than over-the-counter fish oil supplements, and are indicated as an adjunct to diet to reduce triglyceride levels in adult patients with severe hypertriglyceridemia (triglycerides ≥500 mg/dL) 1.
- The medication should be taken with meals to improve absorption and reduce potential side effects like fishy taste or mild digestive issues.
- Omega-3s work by decreasing the liver's production of VLDL (very low-density lipoprotein) and triglycerides while also increasing the breakdown of fatty acids.
- Regular blood tests will be needed to monitor progress, and the healthcare provider may adjust the dosage based on the patient's triglyceride response.
Comparison with Other Studies
While other studies, such as those published in 2011 and 2014, also support the use of omega-3 fatty acid supplements for hypertriglyceridemia, the 2021 study provides the most up-to-date and highest quality evidence for the recommended dosage of 2-4 grams per day 2, 3.
Safety and Efficacy
The safety and efficacy of prescription omega-3 fatty acid preparations have been established in multiple randomized controlled trials, and they are generally well tolerated, with common adverse effects including eructation, dyspepsia, and taste perversion 1. However, it is essential to evaluate the patient for gastrointestinal disturbances, skin changes, and bleeding when using EPA and/or DHA for the management of severe hypertriglyceridemia 3.
From the FDA Drug Label
The effects of icosapent ethyl 4 grams per day were assessed in a randomized, placebo- controlled, double-blind, parallel-group study of adult patients (76 on icosapent ethyl, 75 on placebo) with severe hypertriglyceridemia. Patients whose baseline TG levels were between 500 and 2,000 mg/dL were enrolled in this study for 12 weeks Icosapent ethyl capsules are prescription medicine used: along with a low-fat and low-cholesterol diet to lower high levels of triglycerides (fats) in adults.
The recommended omega-3 (fatty acid) dosage for hypertriglyceridemia with levels exceeding 500 milligrams per deciliter (mg/dL) is 4 grams per day of icosapent ethyl 4.
From the Research
Omega-3 Fatty Acid Dosage for Hypertriglyceridemia
The recommended omega-3 fatty acid dosage for hypertriglyceridemia with levels exceeding 500 mg/dL is as follows:
- A total EPA and DHA dose of approximately 2-4 g/day is recommended for triglyceride lowering 5, 6, 7
- A dose of 4 g/day of EPA and DHA can reduce triglyceride levels by 45% and very low-density lipoprotein cholesterol levels by more than 50% in patients with triglyceride levels above 500 mg/dL 5, 6
Forms of Omega-3 Fatty Acids
Different forms of omega-3 fatty acids are available, including:
- Omega-3 fatty acid ethyl esters (OM3EE), a mixture of OM3FA ethyl esters, primarily EPA and DHA 8
- Icosapent ethyl (IPE), EPA ethyl esters 8
- Omega-3 carboxylic acids (OM3CA), a mixture of OM3FAs in free fatty acid form, primarily EPA, DHA, and docosapentaenoic acid 8
Efficacy and Safety
The use of omega-3 fatty acids for hypertriglyceridemia is supported by several studies, which demonstrate their efficacy and safety:
- Omega-3 fatty acids have been shown to be effective in reducing triglyceride levels and are well tolerated, with a low rate of adverse events and treatment-associated discontinuations 5, 8, 6, 9, 7
- The use of prescription omega-3 fatty acids at a dose of 4 g/d is supported by a 25% reduction in major adverse cardiovascular events in the REDUCE-IT trial 6