What is the starting dose of Vascepa (icosapent ethyl) for an adult with severe hypertriglyceridemia?

Vascepa Starting Dose

The starting dose of Vascepa (icosapent ethyl) for adults with severe hypertriglyceridemia (≥500 mg/dL) is 4 g/day, administered as 2 g twice daily with food. 1

FDA-Approved Dosing

• For severe hypertriglyceridemia (≥500 mg/dL): Icosapent ethyl 4 g/day (2 g twice daily) as an adjunct to diet 2, 3
• For cardiovascular risk reduction: Icosapent ethyl 4 g/day (2 g twice daily) in patients with triglycerides ≥150 mg/dL who have established cardiovascular disease or diabetes with ≥2 additional risk factors, as an adjunct to maximally tolerated statin therapy 1, 4

Administration Details

• Take with food: Icosapent ethyl should be administered with meals to optimize absorption 1
• Dosing schedule: 2 g capsules twice daily (total 4 g/day) 1, 2
• No dose titration required: The approved dose is 4 g/day from initiation—there is no lower starting dose or gradual titration 2, 3

Clinical Context for Dosing

For severe hypertriglyceridemia (≥500 mg/dL):

• The 4 g/day dose reduces triglycerides by approximately 20-33% without increasing LDL-C 2, 3
• This indication focuses on preventing acute pancreatitis 1
• Icosapent ethyl is used as adjunctive therapy to fibrates in this population, not as monotherapy 5

For cardiovascular risk reduction (triglycerides 135-499 mg/dL):

• The REDUCE-IT trial demonstrated that icosapent ethyl 4 g/day (2 g twice daily) reduced major adverse cardiovascular events by 25% when added to statin therapy 1
• This indication requires patients to be on maximally tolerated statin therapy with controlled LDL-C (41-100 mg/dL) but elevated triglycerides 1
• Patients must have either established cardiovascular disease or diabetes with ≥2 additional cardiovascular risk factors 1, 4

Important Prescribing Considerations

• Monitor for atrial fibrillation: Icosapent ethyl at 4 g/day is associated with increased risk of atrial fibrillation (3.1% vs 2.1% with placebo) 5, 6
• Not interchangeable with other omega-3 products: Over-the-counter fish oil supplements are not equivalent to prescription icosapent ethyl and should not be substituted 5
• Safety profile: Icosapent ethyl 4 g/day has a tolerability profile similar to placebo, with the most common adverse effects being gastrointestinal disturbances and skin changes 1, 2

Common Pitfall to Avoid

Do not start at a lower dose (e.g., 2 g/day) and titrate up. The FDA-approved and evidence-based dose is 4 g/day from initiation. The REDUCE-IT trial, which demonstrated cardiovascular benefit, used 4 g/day throughout the study. 1, 3