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Intravenous Lipid Emulsions Brand Names
Clinolipid | Intralipid | Liposyn II | Liposyn III | Nutrilipid | Omegaven | Smoflipid
What is Intravenous Lipid Emulsions
Intravenous lipid emulsions (ILEs) are fat emulsions primarily indicated as a source of calories and essential fatty acids for parenteral nutrition and as a source of essential fatty acids when a deficiency occurs when oral or enteral nutrition is not possible, insufficient, or contraindicated.
ILEs are also used off-label for lipid rescue therapy (LRT) in cases of potentially fatal local anesthetic toxicity and cases of lipophilic agent overdose or poisoning when there is hemodynamic instability unresponsive to resuscitation measures, such as fluid replacement, inotropes, and vasopressors.
ILEs are primarily composed of medium-chain triglycerides (MCTs) and long-chain triglycerides (LCTs) and/or fish oil triglycerides, egg phospholipids, and glycerol. They are classified into various generations based on their fatty acid derivative as well as their inflammatory response.
First-generation ILEs are composed of 100% soybean oil (i.e., Intralipid, Nutrilipid) and are considered pro-inflammatory. Second-generation ILEs are comprised of a 50:50 ratio of MCTs to soybean oil.
Third-generation ILEs are olive-oil containing products with an 80:20 ratio of olive oil to soybean oil. Second- and third-generation lipid emulsions are considered inflammatory neutral.
Fourth-generation ILEs are fish-oil containing products in varying ratios and are considered anti-inflammatory. SMOFlipid is comprised of soybean oil, MCTs, olive oil, and fish oil in a 30:30:25:15 ratio, while Omegaven is 100% fish oil. About 60% of the content of first-generation ILEs is in the form of linoleic acid (omega-6; 50%) and alpha-linolenic acid (omega-3; 10%).
Additionally, they contain LCTs. ILEs with high concentrations of omega-6 have been shown to be pro-inflammatory, and studies have suggested a link between LCTs and an increase in the risk of infection and parenteral nutrition-associated liver disease (PNALD).
Thus, newer generations of ILEs were developed with a different composition of fatty acids in order to reduce these complications.
Omegaven has a total omega-3 fatty acid content of 40% to 54%, compared to an approximately 2% to 4% omega-6 fatty acid content.
Although clinical data have supported the use of newer generation ILEs for their reduction in inflammatory response, outcomes and adverse reaction data are limited.
Most ILEs are indicated for adults and pediatric patients as young as neonates; however, SMOFlipid is only indicated for adults in the US.
However, it is used off-label in other countries for pediatric patients as young as neonates.
Omegaven is indicated as a source of calories and essential fatty acids for pediatric patients with parenteral nutrition-associated cholestasis (PNAC).
Indications
- calcium-channel blocker toxicity
- essential fatty acid deficiency
- essential fatty acid deficiency prophylaxis
- lipid resuscitation therapy
- nutritional supplementation
- parenteral nutrition-associated cholestasis
Side Effects
- abdominal pain
- agitation
- aluminum toxicity
- apnea
- back pain
- bleeding
- bradycardia
- chest pain (unspecified)
- cholecystitis
- cholelithiasis
- cholestasis
- cyanosis
- diaphoresis
- diarrhea
- dizziness
- drowsiness
- dysgeusia
- dyspepsia
- dyspnea
- elevated hepatic enzymes
- erythema
- fat overload syndrome
- fever
- flatulence
- flushing
- headache
- hepatitis
- hepatomegaly
- hyperglycemia
- hypertension
- hypertonia
- hypertriglyceridemia
- infection
- injection site reaction
- jaundice
- leukocytosis
- leukopenia
- nausea
- neutropenia
- parenteral nutrition-associated liver disease
- phlebitis
- pruritus
- rash
- sinus tachycardia
- splenomegaly
- steatosis
- thrombocytopenia
- vomiting
Monitoring Parameters
- blood glucose
- CBC
- INR
- LFTs
- prothrombin time (PT)
- serum bilirubin (total and direct)
- serum cholesterol profile
- serum creatinine/BUN
- serum electrolytes
- serum triglycerides
Contraindications
- bleeding
- bone fractures
- breast-feeding
- children
- cholelithiasis
- cholestasis
- chronic lung disease (CLD)
- chronic obstructive pulmonary disease (COPD)
- coagulopathy
- diabetes mellitus
- egg hypersensitivity
- electrolyte imbalance
- fish hypersensitivity
- hepatic disease
- hepatitis
- hyperlipidemia
- hypertriglyceridemia
- immunosuppression
- infants
- infection
- laboratory test interference
- malnutrition
- neonates
- obesity
- pancreatitis
- peanut hypersensitivity
- pregnancy
- premature neonates
- pulmonary disease
- refeeding syndrome
- renal impairment
- respiratory distress syndrome
- soya lecithin hypersensitivity
- trauma
Interactions
- Acebutolol
- Acetaminophen; Aspirin, ASA; Caffeine
- Angiotensin II receptor antagonists
- Angiotensin-converting enzyme inhibitors
- Anticoagulants
- Antithrombin III
- Apixaban
- Argatroban
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Atenolol
- Atenolol; Chlorthalidone
- Bendroflumethiazide; Nadolol
- Beta-adrenergic blockers
- Betaxolol
- Betrixaban
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Bivalirudin
- Brimonidine; Timolol
- Calcium-channel blockers
- Carteolol
- Carvedilol
- Central-acting adrenergic agents
- Dabigatran
- Dalteparin
- Danaparoid
- Desirudin
- Dorzolamide; Timolol
- Doxazosin
- Edoxaban
- Enoxaparin
- Eplerenone
- Epoprostenol
- Esmolol
- Fondaparinux
- Heparin
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Propranolol
- Labetalol
- Lepirudin
- Levobetaxolol
- Levobunolol
- Loop diuretics
- Mecamylamine
- Metoprolol
- Nadolol
- Nebivolol
- Nebivolol; Valsartan
- Penbutolol
- Pentosan
- Phenoxybenzamine
- Pindolol
- Platelet Inhibitors
- Potassium-sparing diuretics
- Prazosin
- Propranolol
- Reserpine
- Rivaroxaban
- Thiazide diuretics
- Thrombolytic Agents
- Timolol
- Tinzaparin
- Vasodilators
- Warfarin