Omegaven

Indications

Intravenous fat emulsion (lipid emulsion) is a source of energy and essential fatty acids given directly into a vein as part of parenteral nutrition (feeding through a drip) for patients who cannot eat or absorb enough food through the gut, for example after major surgery, with severe bowel disease, serious illness or in premature babies. It is a hospital-only product.

How It Works

The emulsion contains tiny droplets of fat (usually from soybean oil, olive oil, fish oil and/or medium-chain triglycerides) mixed with egg phospholipids and glycerol. Once in the blood, the fat droplets are handled much like fat from food: they are broken down and used for energy, and they supply essential fatty acids the body cannot make itself.

Dosage and Administration

It is given only by a doctor or nurse in hospital as a slow intravenous infusion, either alone or mixed into a nutrition bag with amino acids and glucose. The dose and infusion rate depend on the patient's weight, age, energy needs and blood fat levels, and are set by the medical team. Blood tests are done regularly during treatment.

Interactions

• Heparin given with the infusion may temporarily increase fat clearance from the blood.
• Soybean oil contains vitamin K, which may reduce the effect of Warfarin.
• Fat in the blood can interfere with some laboratory tests if samples are taken during or soon after infusion.
• Only compatible medicines and solutions should be mixed with the emulsion, as directed by the pharmacist.

Contraindications

• Allergy to egg, soy, fish or peanut protein, or to any ingredient.
• Severe hyperlipidaemia (very high blood fats) or severe disorders of fat metabolism.
• Shock or unstable circulation, severe blood clotting disorders.
• Severe liver failure.

Side Effects

Possible effects include a slight rise in temperature, chills, flushing, nausea, headache and back or chest discomfort during infusion. Blood fats and liver tests may rise with long use. Too fast an infusion can cause "fat overload" with fever, liver enlargement, low platelets and breathing difficulty.

Medical staff will stop the infusion and act urgently if there is breathing difficulty, chest tightness, swelling of the face or throat, a sudden rash, or a drop in blood pressure. Tell the nurse straight away about any of these signs.

Pregnancy and Lactation

It may be used in pregnancy and breastfeeding when parenteral nutrition is needed, if the doctor decides it is necessary.

Precautions and Warnings

Used only under close hospital supervision. Blood fats, blood sugar, liver function, electrolytes and blood counts are monitored. Extra care is needed in newborns and premature babies, people with kidney or liver problems, severe infection, pancreatitis or diabetes. The infusion line must be kept sterile to avoid infection.

Overdose

Too much or too fast infusion can cause fat overload syndrome. The infusion is stopped and supportive treatment is given by the medical team.

Therapeutic Class

Parenteral nutrition product; intravenous lipid emulsion.

Storage

Store below 25°C. Do not freeze; discard if frozen. Hospital product: store and handle as directed on the pack.