icosapent ethyl

(eye-koe-sa pent eth-il) icosapentethyl,

Vascepa

(trade name)

Classification

Therapeutic: lipid lowering agents
Pharmacologic: omega 3 acids
Pregnancy Category: C

Indications

Adjunct in the reduction of triglycerides in adult patients with hypertriglyeridemia (≥500 mg/dL); used in conjuction with diet/exercise.

Action

Decreases hepatic production of triglycerides and increases triglyceride clearance.

Therapeutic effects

Reduction in triglycerides as part of a program to reduce cardiovascular morbidity and mortality.

Pharmacokinetics

Absorption: Converted during absorption to the active metabolite eicosapentaenoic acid (EPA), which is then absorbed in the small intestine and enters systemic circulation through the lymphatic system.Distribution: Most EPA circulates incorporated into phospholipids, triglycerides and cholesteryl esters. Enters breast milk.Metabolism and Excretion: Mostly metabolized by the liver, some metabolism results in liberation of acetyl Coenzyme A which the Krebs cycle uses to produce energy. No renal elimination.Half-life: 89 hr.

Time/action profile (EPA levels)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	5 hr	unknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity.Use Cautiously in: Hypersensitivity to fish/shellfish; Diabetes mellitus, hypothyroidism and excess alcohol intake may ↑ triglycerides and should be managed prior to treatment; Obstetric: Use during pregnancy only if potential maternal benefit outweighs potential risk to fetus; Lactation: Use cautiously during lactation; Pediatric: Safe and effective use in children has not been established.

Adverse Reactions/Side Effects

Hematologic

prolonged bleeding time

Musculoskeletal

arthralgia

Interactions

Drug-Drug interaction

Beta-blockers, thiazides and estrogens may ↑ triglycerides and should be discontinued/changed prior to treatment. May ↑ risk of bleeding with anticoagulants or antiplatelet agents.

Route/Dosage

Oral (Adults) 2 g twice daily.

Availability

Capsules: 1 g

Nursing implications

Nursing assessment

Obtain a dietary history, especially with regard to fat consumption.
Assess for allergy to fish and shellfish.
Lab Test Considerations: Monitor lipid and triglyceride levels prior to and periodically during therapy.
- Monitor ALT and AST levels periodically in patients with liver impairment.

Potential Nursing Diagnoses

Noncompliance (Patient/Family Teaching)

Implementation

Oral: Administer 2 capsules twice daily with food. Swallow capsules whole; do not open, crush, dissolve, or chew.

Patient/Family Teaching

Instruct patient to take as directed. Take missed doses as soon as remembered unless almost time for next dose; do not double doses. Do not discontinue without consulting health care professional.
Advise patient to eat a well balanced, low fat and low cholesterol diet, exercise regularly, and avoid alcohol intake.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications, especially anticoagulants.
Advise female patient to notify health care professional if pregnancy is planned or suspected, or if breastfeeding.

Evaluation/Desired Outcomes

Decrease in triglyceride levels.