Neonatal Drug Therapy Manual

Lipid Emulsions 20% (SMOFlipid)

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Lipid injectable emulsion comprised of 30% soybean oil, 30% medium chain triglycerides, 25% olive oil and 15% fish oil
Original Date: 
March 2021
  • Source of calories and essential fatty acids and omega-3 fatty acids to patients needing parenteral nutrition therapy
  • IV continuous infusion through a peripheral or central catheter
  • Initiate a 1 g/kg/day and advance daily by 0.5 - 1 g/kg/day to target dose of 3 g/kg/day 
  • Lower dosage is recommended with hyperbilirubinemia and severe liver insufficiency.
Side Effects: 
  • Endocrine and metabolic : blood triglycerides increased 
  • Hepatic: cholestasis, hyperbilirubinemia, abnormal hepatic function tests 
Parameters to Monitor: 
  •  Triglycerides (daily while increasing dose then weekly once stable)
  •  Liver functions tests 
  •  Coagulation parameters (monthly)
Reconstitution and Stability: 
  • Syringe hang time: 24 hours
  • Tubing change time: 24 hours

The co-infusion of drugs and parenteral nutrition should be avoided.  If a separate site is not available, the drug may be given through a separate line that has a Y-connection to the parenteral nutrition as close to the patient as possible.

- Y-site Compatible: acetaminophen, ampicillin, cefotaxime, dexmedetomidine, dobutamine, dopamine, epinephrine, fentanyl, furosemide, heparin, hydromorphone, insulin, ketamine, meropenem, metronidazole, midazolam, morphine, norepinephrine, penicillin, piperacillin/tazobactam, vancomycin, zidovudine


Incompatible: acyclovir, amiodarone, ceftazidime, ceftriaxone, ciprofloxacin, famotidine, fluconazole, gentamicin, hydrocortisone, milrinone, pantoprazole, rocuronium, sodium bicarbonate, tobramycin

  • 20% lipid = 2 Kcal/mL

-  Emma L Ross, PharmD, BCPPS, Allison Salinas, PharmD, Kirsten Petty, PharmD, Cheng Her, PhD, John F Carpenter, PhD, Compatibility of medications with intravenous lipid emulsions: Effects of simulated Y-site mixing, American Journal of Health-System Pharmacy, Volume 77, Issue 23, 1 December 2020, Pages 1980–1985,


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