Lovaza vs. Vascepa for Lowering Triglycerides

When we eat, our body stores extra fat it doesn’t need as triglycerides. When we need energy, our body taps into the stored triglycerides and releases them.

But, having too many triglycerides can put you at higher risk of heart disease. Heart disease is one of the leading causes of death in the U.S. The term includes a wide range of heart conditions, from an abnormal heartbeat (such as atrial fibrillation) to heart attack. Additionally, high triglycerides can cause inflammation of the pancreas (pancreatitis).

Omega-3 fatty acid medications such as Lovaza (omega-3 fatty acid ethyl esters) and Vascepa (icosapent ethyl) help lower triglyceride levels. These are prescription-only medications.

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In this article, we'll discuss how these medications work and whether one is more effective for lowering triglycerides.

What are omega-3s?

Omega-3 fatty acids (often just called omega-3s) are molecules that help our bodies build cells. They also give us energy. Salmon, olive oil, and walnuts are examples of foods that include omega-3s.

There are many kinds of omega-3s. The three main types are:

• ALA (alpha-linolenic acid)

• EPA (eicosapentaenoic acid)

• DHA (docosahexaenoic acid)

What are Lovaza and Vascepa?

Lovaza and Vascepa are FDA-approved prescription omega-3s. Lovaza was FDA-approved in 2004 and contains EPA and DHA. Vascepa was FDA-approved in 2012 and contains EPA only.

While both medications contain omega-3s, they’re FDA-approved for different reasons. While both Lovaza and Vascepa are approved to lower triglyceride levels in adults with very high triglycerides (500 mg/dL or higher), only Vascepa is approved to lower the risk of some heart problems in adults who are taking a statin cholesterol medication and have triglyceride levels of 150 mg/dL or higher. The person also must also have either heart disease, or diabetes with at least two other risk factors for heart disease, such as high blood pressure.

Lovaza and Vascepa should be used in combination with a healthy diet. 

How do omega-3s help lower triglycerides?

Omega-3s such as EPA and DHA lower triglycerides by lowering very-low-density-lipoprotein (VLDL) levels. Let’s dig into how this works.

Lipoproteins are substances that transport various fats throughout the body. Certain lipoproteins carry triglycerides. These lipoproteins are called VLDLs. 

Triglycerides can rise to a dangerous level when the body has too much VLDL. When VLDL is lowered, triglycerides can’t be transported as widely throughout the body.

Besides decreasing VLDL levels, EPA and DHA also lower triglycerides by making lipoprotein lipase more active in the body. Lipoprotein lipase is an enzyme (protein) that breaks down triglycerides.

Do omega-3s affect cholesterol?

Cholesterol is a substance found in our blood. Like triglycerides, it’s a type of fat. We need cholesterol to keep our cells healthy. But as with triglycerides, too much cholesterol can raise your risk of heart disease.

Some research shows that DHA raises low-density lipoprotein (LDL) levels. LDL is known as the “bad” cholesterol. But, the question of whether DHA raises LDL is complicated.

More recent evidence — including a 2020 study of over 9,000 people — found that DHA doesn’t raise LDL. In this study, DHA actually lowered LDL. The American Heart Association believes there’s no strong evidence that prescription medications containing DHA raise LDL in people with high triglycerides. But, in the two trials that led to Lovaza’s FDA approval, adults receiving Lovaza had raised LDL levels during treatment. So, Lovaza still carries a warning for raised LDL levels. Talk to your healthcare provider if you’re concerned about Lovaza’s potential effects on your LDL levels.

The other main type of cholesterol is high-density lipoprotein (HDL) — the “good” cholesterol. Adequate levels of HDL can lower your risk of heart attack and stroke. DHA is known to raise HDL levels.

How do Lovaza and Vascepa compare to over-the-counter fish oils?

There are many types of omega-3 supplements available over the counter (OTC). But Lovaza and Vascepa are the only two prescription-only omega-3s.

The most common type of OTC omega-3 supplement is fish oil.

Are there OTC alternatives to Lovaza and Vascepa?

No. There are some major differences between OTC fish oils and prescription omega-3 products, including:

• Quality of ingredients. Prescription medications are regulated and approved by the FDA. Their contents are pure and consistent — each pill has the same ingredients in the same quantities. OTC supplements are not regulated by the FDA and may not be of high or consistent quality.

• Incorrect labeling. It’s been shown that OTC fish oil supplements may have a different amount of EPA or DHA than what is stated on the label. They also may contain contaminants or substances that can counteract the benefits of omega-3s.

• Lower amounts of EPA and/or DHA. The amount of omega-3s needed to benefit the heart or lower triglycerides is typically much higher than the amount of omega-3s in OTC fish oil. It’s likely that you would need to take multiple doses of an OTC product to reach a prescription dose. But this can be unsafe and expose you to more side effects.

Lovaza vs. Vascepa: Which is better?

Lovaza and Vascepa are similarly effective at lowering triglycerides. But, there is research showing that Vascepa helps prevent heart problems in some adults. In the REDUCE-IT study, Vascepa lowered the risk of cardiovascular problems (such as heart attack and stroke) by 25% in people with high triglycerides who were already taking a statin.

Only Vascepa is recommended by medical guidelines as an option to lower the risk of heart problems in adults with high triglycerides. Lovaza is FDA-approved only for lowering triglycerides.

What are Lovaza and Vascepa dosages?

It’s important to have a healthy lifestyle before starting Lovaza or Vascepa. A healthy diet low in sugar, alcohol, and unhealthy fats can help lower triglycerides.

Both Lovaza and Vascepa capsules should be swallowed whole.

Lovaza dosing

Lovaza comes as a 1 g capsule. Each capsule contains 465 mg of EPA and 375 mg of DHA. The daily dose of Lovaza is 4 g, taken as either:

• Four capsules once daily with food

• Two capsules twice daily with food

Vascepa dosing

Vascepa comes as a 0.5 g or 1 g capsule. The daily dose is 4 g, taken as either:

• Four 0.5 g capsules twice daily with food

• Two 1 g capsules twice daily with food

What are the known side effects of Lovaza and Vascepa?

The most common side effects of Lovaza are:

• Burping

• Fishy taste in the mouth

• Stomach upset

• Altered taste

• Constipation

• Rash

Lovaza also can cause higher liver enzyme levels. If you have existing liver issues, your healthcare provider might want to run blood tests to check on your liver function while you’re taking Lovaza.

The most common side effects of Vascepa include:

• Muscle and bone pain

• Swelling in the arms and legs

• Constipation

• Gout

• Atrial fibrillation

• Diarrhea

• Stomach pain

• Mouth pain

As with Lovaza, your provider may also check your liver enzyme levels while you’re taking Vascepa if you have existing liver issues.

Lovaza and Vascepa use omega-3s from fish sources. It’s not known if people with fish or shellfish allergies might have an allergic reaction to these medications. Talk to your healthcare provider if you have a fish or shellfish allergy.

Lovaza and Vascepa should be used with caution in people with atrial fibrillation. Both medications may raise the risk of having issues with heart rhythm. The risk is greatest for people who already have heart rhythm problems. Talk to your healthcare provider if you have an abnormal heart rhythm condition.

What interactions do Lovaza and Vascepa have?

Lovaza and Vascepa may interact with medications that prevent blood clotting, such as anticoagulant or antiplatelet medications. This is because omega-3s may affect how some of your blood cells work, according to some studies. But, it isn’t clear how significant the risk is.

Other studies have found that omega-3s don’t raise the risk of bleeding. In fact, studies have found that higher omega-3 levels in the blood are associated with a lower risk of bleeding in people who just had surgery.

Still, let your healthcare provider know if you take any medications that affect blood clotting, such as warfarin (Coumadin, Jantoven), aspirin, or clopidogrel (Plavix). They’ll likely want to monitor you for signs of bleeding if you’re on one of these medications as well as Lovaza or Vascepa.

How long should I take Lovaza or Vascepa?

There’s no universal recommendation for how long to stay on Lovaza or Vascepa. It’s possible you may need to take either long term. Your healthcare provider will check your triglycerides during treatment to see if the medications are working for you.

If Lovaza or Vascepa is helping to lower your triglycerides, and you're not having bothersome side effects, your healthcare provider may ask you to continue taking it.

How to save on Lovaza and Vascepa

Lovaza and Vascepa are available as brand-name medications. But you can also find them as lower-cost generics. GoodRx can help you navigate the many ways to save on your prescription.

• Save with GoodRx. GoodRx can help you save over 75% off the average retail price of the generic versions of Lovaza and Vascepa. Generic Lovaza’s price at certain pharmacies is as low as $31.29 with a free GoodRx discount. Generic Vascepa’s price at certain pharmacies is as low as $225.87 with a free GoodRx discount.

• Find exclusive savings: Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase a 30-day supply of Vascepa at an exclusive cash price of $98.40.

• Save with a copay savings card. If you have commercial insurance or are uninsured, and meet eligibility requirements, brand-name Vascepa’s price may be as little as $9 per prescription if you use the manufacturer’s savings card. Brand-name Lovaza’s price may be as little as $5 for a 30-day supply if you have commercial insurance and use the manufacturer’s savings card.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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