Omega-3-Carboxylic Acid (Epanova) for Hypertriglyceridemia

Hypertriglyceridemia is a prevalent yet under-addressed condition, often seen in association with uncontrolled diabetes mellitus, obesity, and physical inactivity. The control of triglyceride (TG) levels is essential to prevent the development of coronary artery disease and pancreatitis associated with hypertriglyceridemia. Omega-3-carboxylic acid (Epanova) is the third prescription omega-3 fatty acid product approved in the United States as an adjunct to diet for treating severe hypertriglyceridemia (>= 500 mg/dL). At the approved dosage, it reduced baseline serum TG levels by 25-30% in a placebo-controlled study. It reduced serum TG levels by an additional 8-15% in patients who were already taking statin therapy. It appeared to have a better bioavailability profile compared with an equivalent dose of omega-3-acid ethyl ester (Lovaza) in both low-fat and high-fat diets. However, evidence behind the effects of omega-3-carboxylic acid on cardiovascular morbidity and mortality, and pancreatitis risk, is lacking. Overall, it is well tolerated, but may induce common gastrointestinal side effects, such as abdominal pain, nausea, and diarrhea. At this time, omega-3-carboxylic acid is an alternative adjunct therapy (in addition to diet) for hypertriglyceridemia. Its potential clinical benefits over other omega-3 formulations have yet to be evaluated.