In August 2007, I wrote a series of articles about high triglycerides and heart disease. In summary, high triglycerides moderately increase your risk of heart disease. A normal level is <150mg/dl and a high level is >200mg/dl. Certain conditions such as obesity, low thyroid levels, and certain medications can contribute to increasing triglyceride levels. The main cause of high levels appears to be genetic. Diet and exercise can reduce triglycerides by up to 33% but often times medication is recommended. Niacin (nicotinic acid) and fibric acid derivatives are commonly prescribed. I had mentioned that fish oil can be beneficial because of its omega-3-fatty acid component but failed to mention that a prescription "fish oil" was available called Omacor.
Now Omacor is no longer to be found. What happened and why is there a need for prescription fish oil?
Omega-3-fatty acids are unsaturated fats found naturally in fish oil, i.e. salmon. The good omega 3s found in fish oil that help lower triglycerides are DHA (docosahexanoic acid) and EPA (eicosapentaenoic acid). Studies have shown that ingesting a total of 2-4 grams/day of good omega 3 may decrease triglyceride levels by up to 45% and the effect is dose dependent. One could reach this amount by eating a significant amount of fatty fish per day, but supplements seem to be an easier way. Omega-3 supplements are considered a "food" by the FDA and therefore not subject to the strict regulations of a "drug". As a result, many over the counter omega-3 supplements have emerged and may not contain a significant amount of DHA and EPA. For example, my wife bought a large 200 count bottle of Safeway Select fish oil supplements. The label in red says "Heart Health". It contains a total of 300mg of good omega-3 (180mg EPA+120mg DHA) per serving (each serving is one rather large sized soft gel capsule). If I wanted to ingest 4 grams of good omega-3/day, I would have to swallow 13 of these soft gel capsules per day. The bottle would last me a little over 2 weeks! (You do the math).
Given the above mathematics, a purified concentrated form of the good omega-3s was created - Omacor. Omacor was made by Reliant pharmaceutical and received FDA approval in 2004 for the treatment of high triglycerides (>500mg/dl) as an adjunct to diet therapy. Omacor is naturally derived through a unique purification process with each final capsule containing 375mg of DHA and 465mg of EPA (a total of 840mg of good omega 3). Since it is a prescription medication, it is also subject to much more scrutiny and regulation than over the counter supplements. It is very safe although periodic liver function and lipid tests are recommended. Interestingly in some people Omacor may increase LDL levels. More common side effects include belching and an upset stomach.
So, where is Omacor? Reliant pharmaceutical is still manufacturing omega3-fatty acids but they are selling it under a different name - Lovaza. It turns out that there may be some prescribing confusion with Omacor and Amicar (a drug used in the treatment of acute bleeding syndromes and unlikely to help lower triglycerides). The FDA requested that Reliant change the name and this went into effect in August 2007. The size, strength, and ingredients of Lovaza are the same as Omacor. Only the name has changed.