{"id":56667,"date":"2023-01-22T16:17:51","date_gmt":"2023-01-22T21:17:51","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=56667"},"modified":"2024-11-20T14:01:56","modified_gmt":"2024-11-20T19:01:56","slug":"vascepa-alternatives","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/vascepa-alternatives\/","title":{"rendered":"Vascepa alternatives: What can I take instead of Vascepa?"},"content":{"rendered":"

Omega-3 fatty acids<\/span><\/a> are polyunsaturated fats that perform vital functions in the body, yet are essential nutrients which means you need to get them from your diet. Unsaturated fats, like omega-3 fatty acids, are sometimes referred to as the \u201cgood\u201d or \u201chealthy\u201d fats and are healthier alternatives to saturated, or \u201cbad\u201d fats, which are known to increase the risk of heart disease and stroke.\u00a0<\/span><\/p>\n

There are three main types of omega-3 fatty acids, EPA (eicosapentaenoic acid), DHA (docosahexaenoic acid), and ALA (alpha-linolenic acid). Both EPA and DHA are found in fish, while ALA is found in plants. We can turn some ALA from our diet into EPA and eventually DHA. Still, this process provides only a minimal amount of EPA and DHA. Therefore, dietary sources are critical. Fish is an excellent source of omega-3 fatty acids for most healthy people. The <\/span>American Heart Association (AHA) <\/span><\/a>recommends that adults consume a 3.5-ounce serving of cooked (roughly \u00be cup) flaked fatty fish (e.g., tuna, salmon, etc.) twice a week. Omega-3 fatty acids come with a handful of potential cardiovascular health benefits, including a reduction of triglycerides.\u00a0<\/span><\/p>\n

High triglycerides in your blood, known as hypertriglyceridemia, increase the risk of atherosclerosis, subsequently increasing the risk of <\/span>heart disease<\/span><\/a> and stroke. Vascepa (icosapent ethyl) is a highly purified form of EPA manufactured by Amarin Pharma, Inc. and approved by the Food and Drug Administration (FDA) as an adjunctive agent in patients with severe hypertriglyceridemia or for cardiovascular risk reduction in patients with hypertriglyceridemia. Evidence suggests a <\/span>dose<\/span><\/a> of 2 g twice daily (in addition to a <\/span>statin<\/span><\/a>) may <\/span>prevent a cardiovascular event<\/span><\/a> in approximately 1 in 21 high-cardiovascular risk patients over five years compared to a placebo. Therefore, in patients whose triglycerides remain elevated (defined as greater than or equal to 150 mg\/dL) after lifestyle changes and optimal low-density lipoprotein (LDL) lowering therapy or those who warrant additional cardiovascular disease risk reduction.\u00a0<\/span><\/p>\n

Vascepa is recommended over other therapies to lower triglycerides. However, Vascepa alone only modestly lowers triglycerides, and adverse effects of Vascepa include the development of atrial fibrillation in about 1 in 71 patients. It may also increase the risk of bleeding and is <\/span>expensive<\/span><\/a>. Here, we will discuss Vascepa alternatives that might be considered in patients with hypertriglyceridemia.<\/span><\/p>\n

What can I take in place of Vascepa?<\/span><\/h2>\n

Cardiovascular disease is impacted by <\/span>cholesterol<\/span><\/a> carried by triglyceride-rich lipoproteins. Non-fasting triglycerides persistently greater than or equal to 175 mg\/dL (fasting greater than or equal to 150 mg\/dL) is a risk-enhancing factor for cardiovascular disease. Acute pancreatitis is associated with triglycerides greater than or equal to 500 mg\/dL, and especially greater than or equal to 1,000 mg\/dL. The general approach to <\/span>high triglycerides<\/span><\/a> is to implement lifestyle interventions, identify secondary causes of hypertriglyceridemia, and then consider pharmacologic interventions based on the patient scenario.\u00a0<\/span><\/p>\n

Prescription medications should be considered as contributing factors to high triglycerides, and those known to increase triglycerides include atypical antipsychotics, steroids, beta-blockers, diuretics, certain oncology drugs, and other immunosuppressants. Conditions that contribute to hypertriglyceridemia include poorly controlled <\/span>diabetes mellitus<\/span><\/a>, uncontrolled <\/span>hypothyroidism<\/span><\/a>, <\/span>rheumatoid arthritis<\/span><\/a>, and <\/span>systemic lupus erythematosus<\/span><\/a>, <\/span>among others. After reversible causes are removed, lifestyle modifications are adapted, or contributing conditions are optimally managed, pharmacologic approaches can be considered.\u00a0<\/span><\/p>\n

Statins should be initiated per lipid guidelines (to achieve goal LDL cholesterol and HDL cholesterol levels). They can also reduce triglycerides by 10%-30% depending upon the statin and dose. Statins are the lipid-lowering agent of choice, given the robust evidence supported by clinical trials for reducing cardiovascular events, including death. Non-statin medications, like Vascepa and its alternatives, have a more limited role. A non-statin may be indicated for patients who cannot tolerate the recommended statin dose or who do not achieve the expected response\u2014a 50% LDL reduction with a high-dose statin, achieving an LDL goal of less than or equal to 70 mg\/dL, or who have persistently elevated triglycerides. Specific scenarios may make an alternative to Vascepa more appropriate for certain individuals.\u00a0<\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
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Compare Vascepa alternatives<\/span><\/h2>\n<\/th>\n<\/tr>\n<\/thead>\n

Drug name<\/b><\/td>\nUses<\/b><\/td>\nDosage<\/b><\/td>\nSavings options<\/b><\/td>\n<\/tr>\n
Vascepa (icosapent ethyl)\u00a0<\/span><\/td>\nHypertriglyceridemia; cardiovascular risk reduction with hypertriglyceridemia<\/span><\/td>\n2 g by mouth twice daily with meals<\/span><\/td>\nVascepa coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Lovaza (omega-3 ethyl esters)<\/span><\/td>\nHypertriglyceridemia<\/span><\/td>\n4 g by mouth once daily or 2 g by mouth twice daily<\/span><\/td>\nLovaza coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Zetia (ezetimibe)\u00a0<\/span><\/td>\nHomozygous familial hypercholesterolemia; primary hyperlipidemia; secondary prevention of atherosclerotic cardiovascular events after acute coronary syndrome<\/span><\/td>\n10 mg by mouth once daily<\/span><\/td>\nZetia coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Tricor (fenofibrate)\u00a0<\/span><\/td>\nHypertriglyceridemia<\/span><\/td>\n48 mg to 145 mg by mouth once daily, with or without food<\/span><\/td>\nTricor coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Lopid (gemfibrozil)\u00a0<\/span><\/td>\nHypertriglyceridemia<\/span><\/td>\n600 mg by mouth twice daily, taken 30 minutes before breakfast and dinner<\/span><\/td>\nLopid coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Niacor (niacin)\u00a0<\/span><\/td>\nDyslipidemia<\/span><\/td>\n250 mg by mouth once daily; increase frequency and\/or dose every 4 to 7 days to desired response or therapeutic dose (1.5 g to 2 g daily in 2 to 3 divided doses); may continue to increase at 2- to 4-week intervals to a maximum daily dose of 6 g daily in 3 divided doses<\/span><\/td>\nNiacor coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Top 5 Vascepa alternatives<\/span><\/h3>\n

The following are the most common alternatives to Vascepa.<\/span><\/p>\n

1. Lovaza (omega-3-acid ethyl esters)<\/h3>\n

Lovaza<\/span><\/a> can be considered in patients greater than or equal to 20 years of age with severe hypertriglyceridemia-defined as triglycerides exceeding 500 mg\/ despite being on an optimized statin to reduce pancreatitis risk. This is a prescription omega-3 supplement that provides both EPA and DHA, whereas Vascepa only provides EHA. The dose is either 4 grams once daily or 2 grams twice daily. Still, each gram of Lovaza contains approximately 465 mg of EPA and 375 mg of DHA. <\/span>Lovaza<\/span> capsules should be administered whole and taken with food to improve tolerability. Caution should be used in patients given an increased risk of bleeding reported with Lovaza, especially in those already receiving anticoagulants like warfarin or other agents with antiplatelet properties. Use should be avoided in patients with known allergy or hypersensitivity to fish and\/or shellfish due to the risk of an allergic reaction. Like Vascepa, atrial fibrillation or flutter risk exists in those with a history of either cardiac rhythm abnormality or within the first several months of therapy.\u00a0<\/span>
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RELATED: <\/b>Vascepa vs. Lovaza: Differences, similarities, and which is better for you<\/b><\/a><\/p>\n

2. Zetia (ezetimibe)<\/h3>\n

Zetia<\/span><\/a> is an alternative to Vascepa for patients with cardiovascular disease and high triglycerides despite optimized statin when low-density lipoprotein (LDL) remains greater than or equal to 70 mg\/dL\u2014especially if LDL remains greater than or equal to 100 mg\/dL and the patient is considered very high risk. Patients initiated on Zetia can expect to see approximately an 8% decline in triglycerides; when used in combination with a statin, an additional 14% reduction in triglycerides could be observed. Zetia works by blocking cholesterol absorption and is an inexpensive option taken as a 10 mg tablet once daily. It is associated with severe <\/span>side effects<\/span> that may make it difficult to tolerate.<\/span><\/p>\n

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