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Over-the-counter fish oil use in a county hospital: Medication use evaluation and efficacy analysis.

Abstract

BACKGROUND

Little is known about the use and effectiveness of over-the-counter (OTC) fish oil supplements for triglyceride (TG) lowering.

OBJECTIVES

To (1) perform a medication-use evaluation (MUE) and (2) assess the efficacy of OTC fish oil.

METHODS

Retrospective, observational cohort study using electronic medical records and the pharmacy database from Parkland Health and Hospital System in Dallas, Texas. Parkland is a tax-supported county institution that provides patients with single-brand OTC fish oil. Two separate analyses were conducted. Six hundred seventeen patients (prescribed fish oil between July 1, 2012, and August 31, 2012) were included in the MUE analysis and 235 patients (109 fish oil, 72 fenofibrate, and 54 gemfibrozil, prescribed between January 1, 2012, and July 31, 2013) were included in the efficacy analysis. The main outcome measure for the MUE was fish oil prescribing habits including dosages and patient adherence, as defined by medication possession ratio. The main outcome measure for the efficacy analysis was change in lipids measured using the last value before fish oil treatment and the first value after fish oil treatment.

RESULTS

MUE: 617 patients received prescriptions for OTC fish oil. Sixty-four percent were prescribed a total daily dose of 2000 mg. Only 25% of patients were adherent. Efficacy analysis: despite being prescribed suboptimal doses, fish oil reduced TGs by 29% (95% confidence interval, 34.3-22.7). Compared with fish oil therapy, fibrate therapy resulted in a greater TG reduction: 48.5% (55.1-41.0) with fenofibrate and 49.8% (57.6-40.5) with gemfibrozil (P < .0001, both medications compared with fish oil).

CONCLUSIONS

Health care providers prescribe suboptimal doses of fish oil, and adherence is poor. Even at low doses (2 g/d), though, fish oil lowers TGs by 29%.

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  • Authors+Show Affiliations

    ,

    Department of Pharmacotherapy, University of North Texas System College of Pharmacy, University of North Texas Health Science Center.

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    Department of Pharmacy, Parkland Health and Hospital System.

    ,

    Department of Pharmacy, Parkland Health and Hospital System.

    ,

    Department of Pharmacy, Parkland Health and Hospital System.

    ,

    Department of Pharmacy, Parkland Health and Hospital System.

    ,

    Department of Pharmacy, Parkland Health and Hospital System.

    ,

    Department of Pharmacy, Parkland Health and Hospital System.

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    Department of Pharmacy, Parkland Health and Hospital System.

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    Department of Pharmacy, Parkland Health and Hospital System.

    ,

    Department of Clinical Sciences, UT Southwestern Medical Center.

    Division of Nutrition and Metabolic Diseases, Center for Human Nutrition, Department of Internal Medicine, UT Southwestern Medical Center. Electronic address: Zahid.ahmad@utsouthwestern.edu.

    Source

    MeSH

    Adult
    Aged
    Female
    Fenofibrate
    Fish Oils
    Gemfibrozil
    Hospitals, Public
    Humans
    Hypolipidemic Agents
    Male
    Middle Aged
    Nonprescription Drugs
    Triglycerides

    Pub Type(s)

    Clinical Trial
    Comparative Study
    Journal Article
    Multicenter Study
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    26073390

    Citation

    Tatachar, Amulya, et al. "Over-the-counter Fish Oil Use in a County Hospital: Medication Use Evaluation and Efficacy Analysis." Journal of Clinical Lipidology, vol. 9, no. 3, 2015, pp. 326-33.
    Tatachar A, Pio M, Yeung D, et al. Over-the-counter fish oil use in a county hospital: Medication use evaluation and efficacy analysis. J Clin Lipidol. 2015;9(3):326-33.
    Tatachar, A., Pio, M., Yeung, D., Moss, E., Chow, D., Boatright, S., ... Ahmad, Z. (2015). Over-the-counter fish oil use in a county hospital: Medication use evaluation and efficacy analysis. Journal of Clinical Lipidology, 9(3), pp. 326-33. doi:10.1016/j.jacl.2015.02.004.
    Tatachar A, et al. Over-the-counter Fish Oil Use in a County Hospital: Medication Use Evaluation and Efficacy Analysis. J Clin Lipidol. 2015;9(3):326-33. PubMed PMID: 26073390.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Over-the-counter fish oil use in a county hospital: Medication use evaluation and efficacy analysis. AU - Tatachar,Amulya, AU - Pio,Margaret, AU - Yeung,Denise, AU - Moss,Elizabeth, AU - Chow,Diem, AU - Boatright,Steven, AU - Quinones,Marissa, AU - Mathew,Annie, AU - Hulstein,Jeffrey, AU - Adams-Huet,Beverley, AU - Ahmad,Zahid, Y1 - 2015/02/21/ PY - 2014/07/09/received PY - 2015/02/06/revised PY - 2015/02/17/accepted PY - 2015/6/16/entrez PY - 2015/6/16/pubmed PY - 2016/3/11/medline KW - Fenofibrate KW - Fish oil KW - Gemfibrozil KW - Hypertriglyceridemia KW - Marine omega-3 fatty acids SP - 326 EP - 33 JF - Journal of clinical lipidology JO - J Clin Lipidol VL - 9 IS - 3 N2 - BACKGROUND: Little is known about the use and effectiveness of over-the-counter (OTC) fish oil supplements for triglyceride (TG) lowering. OBJECTIVES: To (1) perform a medication-use evaluation (MUE) and (2) assess the efficacy of OTC fish oil. METHODS: Retrospective, observational cohort study using electronic medical records and the pharmacy database from Parkland Health and Hospital System in Dallas, Texas. Parkland is a tax-supported county institution that provides patients with single-brand OTC fish oil. Two separate analyses were conducted. Six hundred seventeen patients (prescribed fish oil between July 1, 2012, and August 31, 2012) were included in the MUE analysis and 235 patients (109 fish oil, 72 fenofibrate, and 54 gemfibrozil, prescribed between January 1, 2012, and July 31, 2013) were included in the efficacy analysis. The main outcome measure for the MUE was fish oil prescribing habits including dosages and patient adherence, as defined by medication possession ratio. The main outcome measure for the efficacy analysis was change in lipids measured using the last value before fish oil treatment and the first value after fish oil treatment. RESULTS: MUE: 617 patients received prescriptions for OTC fish oil. Sixty-four percent were prescribed a total daily dose of 2000 mg. Only 25% of patients were adherent. Efficacy analysis: despite being prescribed suboptimal doses, fish oil reduced TGs by 29% (95% confidence interval, 34.3-22.7). Compared with fish oil therapy, fibrate therapy resulted in a greater TG reduction: 48.5% (55.1-41.0) with fenofibrate and 49.8% (57.6-40.5) with gemfibrozil (P < .0001, both medications compared with fish oil). CONCLUSIONS: Health care providers prescribe suboptimal doses of fish oil, and adherence is poor. Even at low doses (2 g/d), though, fish oil lowers TGs by 29%. SN - 1933-2874 UR - https://www.unboundmedicine.com/medline/citation/26073390/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S1933-2874(15)00060-4 DB - PRIME DP - Unbound Medicine ER -