Neonatal Drug Therapy Manual

Lipid Emulsion 10% (Omegaven)- SPECIAL ACCESS PROGRAM

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.

Updated March 18, 2025 - 5:05pm

Alternate Name(s): 
lipid emulsion, fat emulsion, fish oil emulsion
Classification: 
Parenteral Caloric Agent
Original Date: 
September 2024
Indications: 
  • Source of calories and essential fatty acids in pediatric patients with parenteral nutrition-associated cholestasis (PNAC) 
  • Not indicated for the prevention of PNAC  
Administration: 
  • IV infusion through a peripheral or central catheter
  • Maximum rate should not exceed 1.5 mL/kg/hour (0.15 g/kg/hour)
Dosage: 
  • Recommended and maximum dose is 1 g/kg/day

  • If triglycerides are already elevated, consider starting with a reduced dose of 0.5 – 0.75 g/kg/day 

  • It is recommended to add an infusion of SMOFlipid® 1 gram/kg/day as well, to avoid certain fatty acid deficiencies and to provide enough calories for growth
Side Effects: 
  • hypertriglyceridemia
  • prolonged bleeding time
  • vomiting
  • abnormal LFTs
  • rare: pleural or pericardial effusion (risk of lipids in general, especially for preterm or SGA infants)
Parameters to Monitor: 
  • Triglycerides
  • LFTs 
  • Bilirubin
  • Coagulation parameters (monthly)
Reconstitution and Stability: 
  • Syringe hang time: 24 hours
  • Tubing change time: 24 hours
Compatibility: 

Note that less compatibility information exists for Omegaven® vs SMOFlipid® or Intralipid®

Compatible: ampicillin, dexmedetomidine, norepinephrine (< 16 mcg/mL)

Incompatible: meropenum

Notes: 
  • Caloric content: 1.12 kcal/mL
  • Effects of Omegaven® typically take 4-6 weeks after initiation.   
  • In infants who fail to respond, holding the SMOFlipid® running with the Omegaven® may improve the bilirubin, accepting a period of inadequate calories. Close monitoring of growth and fatty acid deficiency is required.
  • Omegaven contains fish oil and egg phospholipids
References: 

Special thanks to pharmacy student Erika Murphy for work on this monograph

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