Omegaven
Omegaven is an intravenous (IV) lipid supplement that's made with fish oil. It's a source of calories and fatty acids for children with liver problems caused by long-term parenteral nutrition (or TPN). This condition is called parenteral nutrition-associated cholestasis (PNAC). Omegaven is given as an infusion into the vein over 8 to 24 hours, depending on your child's needs. Side effects include vomiting and restlessness.
What is Omegaven?
What is Omegaven used for?
Lipid supplement for children with liver problems from long-term nutrition through the vein (also called parenteral nutrition-associated cholestasis or PNAC)
How Omegaven works
Omegaven is an IV lipid (fat) supplement for children who can't receive nutrition by mouth.
Omegaven contains fish oil, which is a good source of omega-3 fatty acids. Omega-3 fatty acids have many important roles in the body. They provide energy and help cells work properly. They also help your child's body systems work as they should. These include the heart, blood vessels, lungs, immune system, liver, and hormones.
Drug Facts
What are the side effects of Omegaven?
Common Side Effects
- Vomiting (46%)
- Irritated or restless behavior (35%)
- Low heart rate (35%)
- Episodes of pauses in breathing (apnea; 20%)
- Viral infection (16%)
- Skin redness (12%)
Other Side Effects
- Rash
- Swollen area of pus
- Redness at injection site
- Stiff muscles
Serious Side Effects
- Serious allergic reaction: hives, itching, flushing, breathing very fast, trouble breathing, fast heart rate, skin turning blue, fever, confusion, swelling of face or throat
- Serious infection: fever, trouble breathing, cough, diarrhea, stomach pain, weakness, sweating, chills
Source: DailyMed
Pros and cons of Omegaven
Pros
Helps provide a source of calories and essential fats to children with PNAC
Shown to improve PNAC by lowering inflammation
Possible to give at home
Cons
Not a good option if your child has an allergy to fish or egg, since it contains fish oil and egg proteins
Not used to prevent PNAC
Not approved for use in adults
Pharmacist tips for Omegaven
Make sure your child follows up with the nutrition team and gets blood tests on time while taking Omegaven. The team will check fluid and electrolyte levels, blood sugar levels, liver and kidney function, and blood cell count to make sure it's safe. They'll also check the fatty acid and lipid levels. This helps the team see how well your child is absorbing Omegaven and if the dose needs to be changed.
Usually, each Omegaven infusion takes 8 to 24 hours. How long it specifically takes depends on a few things. This includes your child's dose and how well their body breaks down and absorbs fat. Their prescriber will calculate how fast your child should get the medication (the infusion rate).
If you're giving Omegaven at home, talk to your child's nutrition team to learn how to give it safely. It's important to follow the instructions to avoid hurting your child or wasting the medication. Never infuse Omegaven at a faster speed than prescribed. Ask the nutrition team if you're not sure how much to give, how fast to infuse, or how long it should take.
Store Omegaven bottles at room temperature, and keep it in the box until you're ready to use it. Once it's connected to the infusion set, the Omegaven infusion should be completed within 12 hours unless otherwise instructed. Follow the nutrition team's instructions if they give you a specific way to infuse.
Tell the healthcare team if your child is taking blood thinners like warfarin (Coumadin) or aspirin. Taking these medications with Omegaven might raise the risk of bleeding. The care team might periodically check your child's risk for bleeding after starting Omegaven.
Frequently asked questions about Omegaven
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What are the risks and warnings for Omegaven?
Omegaven can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of serious harm if it's infused too fast
Risk factors: Premature or low-weight babies
There have been reports of serious harm in children who got the Omegaven infusion too fast. This harm has included breathing problems and even death. Premature babies and babies who are small for their age are at higher risk.
Your child's nutrition team will carefully calculate the dose and speed for the Omegaven infusion based on your child's weight. They'll also check your child's triglyceride levels to see how well their body breaks down Omegaven. If you're giving Omegaven to your child at home, ask the nutrition team if you're not sure how much of the medication to give or how fast to give it.
Serious allergic reactions
Risk factors: Allergy to fish or eggs
Omegaven can cause allergic reactions. It contains fish oil and egg proteins, so people with allergies to these products might be at risk. Signs of an allergic reaction can include breathing very fast, trouble breathing, fast heart rate, nausea, and vomiting. It can also include bluish skin, flushing, hives, dizziness, fever, and confusion. If your child has any of these symptoms, stop the Omegaven infusion right away and get medical help.
Risk of infections
Risk factors: Weak immune system | Not properly cleaning or replacing IV catheters | Not completing the Omegaven infusion within 12 hours of opening it
It's possible for bacteria to grow inside Omegaven. This raise your child's risk of infection.
To avoid infections, make sure to keep your child's catheter (tube) clean. This helps prevent contamination. Also, make sure you know how to prepare and give Omegaven to your child properly. The Omegaven infusion should be completed within 12 hours of hooking it up to the infusion set. If you need to mix Omegaven with parenteral nutrition, the time limits for infusing the mixture are different.
Contact a member of the nutrition team if your child develops signs of an infection. Look out for fever, chills, sweating, and low appetite. Also check the site of your child's IV catheter often for redness, swelling, and discharge. These are also signs of infection.
Problems related to receiving too much lipids (fat overload syndrome)
Although rare, Omegaven can put your child at risk for fat overload syndrome. This is a condition where your child's body can't break down fats properly, causing the fats to build up in the blood. This problem usually goes away after stopping Omegaven.
If your child has a fever, headaches, breathing problems, and sudden bleeds, stop the Omegaven infusion and call their nutrition team right away. These can be signs of fat overload syndrome.
High triglyceride (fat) levels
Risk factors: Lipid or cholesterol problems | High blood sugar (diabetes) | Children identified as obese
The healthcare team will check your child's triglyceride (fat) levels before starting Omegaven to make sure it's safe. Children with very high triglyceride levels can't use Omegaven. This is because the medication can make their fat levels dangerously high. High triglyceride levels can raise the risk of pancreatitis (inflammation of the pancreas).
The healthcare team will regularly check your child's triglyceride levels during treatment. If the levels get too high, they might need to stop Omegaven until the levels go down. Then, your child might be able to restart treatment at a lower dose.
Aluminum toxicity
Risk factors: Kidney problems | Preterm babies | Long-term use
Omegaven contains aluminum. Aluminum can build up to toxic levels in children with kidney problems. This includes babies who were born early because they have underdeveloped kidneys. Too much aluminum in your child's body can lead to bone and brain problems.
Let your child's healthcare team know if your child has kidney problems. This makes sure they know to look out for signs of aluminum toxicity.
Omegaven dosage forms
Typical dosing for Omegaven
Omegaven is given as an infusion into the vein (intravenously or IV). It's usually given over 8 to 24 hours. Your child's prescriber will determine how fast your child will receive the infusion (the infusion rate).
The dose differs for each person. This is because it's based on your child's weight (in kg units), age, and medical conditions. It also depends on how well their body can absorb and break down fats.
In general, the dose typically ranges between 0.5 gram/kg and 1 gram/kg of Omegaven per day. Your child's prescriber will calculate the dose to make sure your child is getting the appropriate amount they need.
Omegaven contraindications
Allergy to fish or eggs
Severe bleeding problems (related to problems with forming blood clots)
Severely high triglyceride levels (greater than 1,000 mg/dL)
What are alternatives to Omegaven?
Lipid supplement for children with liver problems from long-term nutrition through the vein (also called parenteral nutrition-associated cholestasis or PNAC)
Lipid supplement for people on total parenteral nutrition (TPN) who can't eat or drink
Omegaven images
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References
Best studies we foundAgency for Toxic Substances and Disease Registry. (2008). Public health statement: Aluminum.
Agency for Toxic Substances and Disease Registry. (2015). ToxFAQs™ for aluminum.
Anez-Bustillos, L., et al. (2016). Review: Lipid formulations for the adult and pediatric patient: Understanding the differences. Nutrition in Clinical Practice.
Canella, P. R. B. C., et al. (2021). Lipid emulsion therapy in women with recurrent pregnancy loss and repeated implantation failure: The role of abnormal natural killer cell activity. Journal of Cellular and Molecular Medicine.
Fresenius Kabi USA, LLC. (2023). Intralipid- i.v. fat emulsion emulsion [package insert]. DailyMed.
Fresenius Kabi USa, LLC. (2023). Omegaven- fish oil injection, emulsion [package insert]. DailyMed.
Hill, S., et al. (2018). ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Home parenteral nutrition. Clinical Nutrition.
Hojsak, I., et al. (2014). Fat overload syndrome after the rapid infusion of SMOFlipid emulsion. JPEN Journal of Parenteral and Enteral Nutrition.
Kondamudi, N. P., et al. (2023). Apnea in children. StatPearls.
Marchand, G. J., et al. (2023). Effect of a 20% intravenous fat emulsion therapy on pregnancy outcomes in women with RPL or RIF undergoing IVF/ICSI: A systematic review and meta-analysis. Journal of Clinical and Translational Research.
Mirtallo, J. M., et al. (2020). ASPEN lipid injectable emulsion safety recommendations, part 1: Background and adult considerations. Nutrition in Clinical Practice.
Mirtallo, J. M., et al. (2021). ASPEN lipid injectable emulsion safety recommendations, part 2: Neonate and pediatric considerations. Nutrition in Clinical Practice.
Mogensen, K. M., et al. (2024). Intravenous feeding. Merck Manual Consumer Version.
Orphanet. (n.d.). Parenteral nutrition-associated cholestasis.
Park, H. W., et al. (2015). Parenteral fish oil-containing lipid emulsions may reverse parenteral nutrition-associated cholestasis in neonates: A systematic review and meta-analysis. The Journal of Nutrition.
Pradelli, L., et al. (2023). Omega-3 fatty acids in parenteral nutrition – A systematic review with network meta-analysis on clinical outcomes. Clinical Nutrition.
Sabbatini, S., et al. (2023). 104: Conversion from SMOFlipid® to Omegaven® as a salvage therapy for severe intestinal failure associated liver disease. Transplantation.
Trop-Steinberg, S., et al. (2024). Effect of omega-3 supplements or diets on fertility in women: A meta-analysis. Heliyon.
U.S. Food and Drug Administration. (2018). Drug trials snapshots: Omegaven.
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