Smoflipid
SMOFlipid is the first and only injectable lipid supplement that contains 4 different kinds of fats: soybean oil, medium chain triglycerides, olive oil, and fish oil. It's for people on total parenteral nutrition (TPN) who aren't able to eat or drink. It can be used by children, including babies who are born before their due date, as well as adults. Some common side effects caused by SMOFlipid include nausea, vomiting, and infections.
What is SMOFlipid?
What is SMOFlipid used for?
- Lipid supplement for people on total parenteral nutrition (TPN) who can't eat or drink
How SMOFlipid works
SMOFlipid provides fat as a source of calories and essential fatty acids. Fatty acids are important for giving you energy as well as helping many processes in your body's cells to work properly.
Drug facts
Side effects of SMOFlipid
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Adults:
- Nausea (9%)
- Vomiting (7%)
- High blood sugar (5%)
Children:
- Low red blood cell count (18%)
- Vomiting (9%)
- Liver damage (6%)
- Infection (6%)
Less Common Side Effects
Adults:
- Passing gas
- Fever
- Stomach pain
- High blood triglycerides
- High blood pressure
Children:
- Cholestasis (slowed flow of bile from the liver)
- Fever
SMOFlipid serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious allergic reactions: hives, itching, swelling of face or tongue, difficulty breathing
- Serious infections: fever, difficulty breathing, diarrhea, weakness, cough, stomach pain, sweating, chills
- Severe response to infection (sepsis): fever, feeling cold or clammy, feeling confused, sleepiness, fast and shallow breathing
- Liver damage: yellowing of your skin or the whites of your eyes, fatigue, low appetite, nausea, vomiting, stomach discomfort
The following SMOFlipid side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Shortness of breath
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
Pros and cons of SMOFlipid
Pros
- Well-balanced source of fat since it contains four different types of fat
- Works well to provide a source of calories and essential fatty acids to people who can't eat or drink
- Appears to be safer compared to other available lipid supplements
- Can be used in people of all ages
Cons
- Has risk of liver problems
- Brand name only, which can be expensive
- Only given by injection through the veins
- Might raise your risk of infection
Pharmacist tips for SMOFlipid
- Tell your provider if you're taking warfarin (Coumadin) because SMOFlipid can cause warfarin (Coumadin) to work less well and put you at risk for clots. You might need to have your INR monitored more often when starting SMOFlipid. Get medical help right away if you experience symptoms of a blood clot, including chest pain, trouble breathing, warmth or swelling in your legs, or weakness on one side of your body.
- If you're going to use SMOFlipid at home, make sure you understand how to correctly give yourself the medication to avoid potentially hurting yourself or wasting the medication.
- Store SMOFlipid at room temperature and keep it in the outer wrapping until you're ready to use it. After removing the outer wrapping, infuse it right away. If not used right away, store the bag in the refrigerator for no longer than 24 hours.
Common questions about SMOFlipid
While SMOFlipid is commonly given to people in the hospital, it's also given at home to people who need TPN long-term due to certain medical conditions, such as short bowel syndrome.
SMOFlipid is the only injectable lipid supplement that contains four different kinds of fats: soybean oil, medium chain triglycerides, olive oil, and fish oil. These oils provide you with the fatty acids and calories your body needs to work properly.
The infusion time will depend your age and dose of SMOFlipid. Typically, each infusion takes 12 to 24 hours. Your provider will calculate your infusion rate for you. Contact your provider if you're not sure how fast you should be infusing SMOFlipid or how long your infusion needs to be.
Yes, your provider will order tests to check your health before you start this medication and also regularly throughout treatment. Some tests you can expect include those that check your fluid and electrolyte levels, blood sugar levels, liver and kidney health, and complete blood count. You'll also be tested for levels of essential fatty acids to make sure you're getting the proper amount of them from SMOFlipid to lower your risk for essential fatty acid deficiency. In addition, you'll have your triglyceride level monitored as well. A high triglyceride level either means your body isn't absorbing the SMOFlipid or your dose of SMOFlipid is too high. Ask your provider if you have any questions about these tests.
Yes, SMOFlipid has been studied and shown to be safe and work well in children of all ages, including premature babies (babies who are born early).
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Risks and warnings for SMOFlipid
SMOFlipid 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.
Liver problems
SMOFlipid, like other plant-based lipid IV supplements, can cause liver problems. But the risk for liver problems with SMOFlipid is lower compared to other lipid supplements. To be safe, your provider will order labs regularly while you're receiving SMOFlipid to check your liver. Contact your provider if you notice any yellowing of your skin or the whites of your eyes, tiredness, low appetite, nausea, vomiting, or stomach discomfort since these can be signs of liver damage.
Serious allergic reactions
- Risk factors: Allergy to fish, egg, soybean, or peanut protein
SMOFlipid can cause allergic reactions. Symptoms of these reactions include breathing very fast, difficulty breathing, fast heart rate, skin turning blue, vomiting, nausea, chest pain, dizziness, hives, and chills. If any of these occur, stop the SMOFlipid infusion immediately and seek medical help right away.
Risk of infections
- Risk factors: Weak immune system | Not properly cleaning or replacing IV catheters
It's possible for bacteria to grow inside SMOFlipid and this can put you at risk for infections. To avoid infections, make sure to maintain your catheter (tube) by keeping it clean to prevent contamination. Contact your provider if you're not sure how to do this or if you develop signs of an infection (e.g., fever or chills). Check the site of your IV catheter frequently for redness, swelling, and discharge, which are also signs on an infection.
Too much IV lipids (fat overload syndrome)
Though rare, SMOFlipid can put you at risk for fat overload syndrome, a condition where your body can't break down fats properly and the fats build up in your blood. This problem typically goes away when the SMOFlipid is stopped. If you get any of these symptoms of fat overload syndrome, such as fever, headaches, breathing problems, and sudden bleeds, stop the SMOFlipid infusion and contact your provider right away.
High triglyceride (fat) levels
- Risk factors: Lipid problems | Obesity | High blood sugar | Metabolic syndromes
SMOFlipid can't be used by people who already have very high triglyceride (fat) levels because this supplement can cause their fat levels to become dangerously high. This can lead to problems that affect your pancreas, lungs, and brain. Your provider will monitor your triglyceride levels before and while you're getting SMOFlipid, and might need to stop this supplement if your levels get too high.
Aluminum toxicity
- Risk factors: Kidney problems | Preterm babies | Long-term use
SMOFlipid contains aluminum, which can build up in people with kidney problems, including in babies born before their kidneys were fully developed. Too much aluminum in your body can lead to brain and bone problems. Let your provider know if you have kidney problems because they'll need to look out for signs of aluminum toxicity.
SMOFlipid dosage
Typical dosage for SMOFlipid
The dose of SMOFlipid is highly variable because it's based on your weight, age, your body's ability to absorb and break down fats, and your medical condition. Your provider will calculate your dose of SMOFlipid to make sure you're getting the appropriate amount you need.
SMOFlipid is given as an injection into the veins (intravenous or IV) over 12 to 24 hours. Your provider will determine your infusion rate.
- Children (ages 12 years and older) to adults: The typical starting dose is 1 gram/kg to 2 grams/kg of body weight per day. The maximum dose is 2.5 grams/kg per day.
- Children (ages 2 up to 12 years old): The typical starting dose is 1 gram/kg to 2 grams/kg per day. The maximum dose is 3 grams/kg per day.
- Children (less than 2 years old): The typical starting dose is 0.5 grams/kg to 1 gram/kg per day. The maximum dose is 3 grams/kg per day.
SMOFlipid contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because SMOFlipid will not be safe for you to take.
- Allergy to fish, egg, soybean, or peanut protein
- Severely high triglyceride levels (greater than 1000 mg/dL) caused by medical problems that make it difficult for you to break down lipids
SMOFlipid images
