General Information About Epanova (Omega-3 Carboxylic Acids)

Omega-3 fatty acid supplements can lower lipids and support heart health. Brian A. Jackson, istockphoto

Epanova (omega-3 carboxylic acids) is a medication used to lower triglyceride levels in anyone who has been diagnosed with very high triglycerides (equal to or greater than 500 mg/dL) in conjunction with a healthy diet. Even though having very high triglyceride levels can place you at risk for developing pancreatitis or having cardiovascular disease, studies have not examined Epanova’s direct effect on these conditions.

There are two types of omega-3 fatty acids included in Epanova - DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid). Epanova differs from other over-the-counter omega-3 fatty acid preparations in that omega-3 fats are in a more concentrated form and have undergone more extensive testing to examine their safety and effectiveness.

The EVOLVE study is the first pivotal study that examined the safety and effectiveness of Epanova. In this study, participants with triglyceride levels ranging from 500 to 2000 mg/dL had their triglyceride levels lowered by at least 31%. Epanova was approved by the FDA in May 2014. The drug was designed to lower the amount of capsules taken to lower triglyceride levels in comparison to other prescription omega-3 fatty acid brands.

How Does Epanova Work?

Although the mechanism is not completely known, it is thought that Epanova may help to lower the amount of triglycerides made in the liver by supplying components – DHA and EPA – that are poor building blocks for making triglycerides.

How Should You Take Epanova?

The recommended dose is two, 1000 mg capsules or four 1000 mg capsules once a day in addition to following a lipid-lowering diet. Epanova can be taken with or without food. Capsules should not be crushed or split and should be swallowed whole. Your healthcare provider will decide whether or not Epanova is right for you, as well as the dose you should be taking based on your triglyceride levels and how well you tolerate the medication.

What Side Effects Should I Expect While Taking Epanova?

The most common side effects include:

  • Belching
  • Diarrhea
  • Nausea
  • Abdominal Pain

Additionally, individuals taking Epanova in studies also experienced fatigue, constipation, vomiting, abdominal distention and painful joints in studies.

Who Should Consult with Their Healthcare Provider Before Taking Epanova

If you have one or more of the following conditions, you should discuss this with your healthcare provider before beginning Epanova:

  • The omega-3 fatty acids used to make Epanova are gathered from fish sources, so you should not take Epanova if you are allergic to fish or shellfish. Additionally, if you have an allergy to other ingredients in Epanova, you should not take this medication.
  • If you have liver disease or elevated liver enzymes, Epanova could elevate your liver enzymes further. Your healthcare provider may monitor your liver enzymes (such as AST and ALT levels) while taking Epanova. Epanova has not been extensively studied in individuals with hepatic or kidney disease.
  • Epanova may increase your LDL cholesterol levels. Because of this, your healthcare provider may want to monitor your lipids during treatment with Epanova -  especially if your LDL levels are already elevated.
  • Epanova is listed in Pregnancy Category C. There have not been adequate studies conducted in pregnant women, so it is not known if Epanova can have an effect on your pregnancy or your child. Animal studies have been conducted, but are mixed – with some rabbit studies showing evidence of fetal malformations when the mothers were taking at least 2 times more than the recommended human dose. Your healthcare provider will weigh the benefits to your health versus the possible risks to your unborn child when deciding to prescribe Epanova to you.
  • Studies have shown that Epanova can be secreted in breast milk. It is not known if this can have an effect on the infant if the breast milk is consumed. If you are breastfeeding, you should let your healthcare provider know.

Can Epanova Interact with Any Medications that I Am Taking?

The following medications may interact with Epanova:

  • Anticoagulants or "blood thinners" - including aspirin and Coumadin (warfarin) - may increase your likelihood of bleeding while taking Epanova. If you take any type of drug that thins your blood, your healthcare provider may need to monitor you more closely for side effects, change your dose, or recommend that you discontinue one of the drugs.

Bottom Line

Epanova is only indicated in individuals who have very high triglyceride levels, so your healthcare provider may decide to use lifestyle modifications and other methods to lower your triglycerides if they are only slightly elevated. There haven’t been a lot of studies comparing Epanova to other prescription omega-3 fatty acids. However, one study – the ECLIPSE study – suggests that Epanova is more available in the body after ingestion in comparison to Lovaza.

When taking Epanova, your healthcare provider will regularly monitor your triglycerides, LDL levels, liver enzymes, and other parameters to make sure that you are responding well to therapy and are not experiencing any side effects. Before taking Epanova, you should let your healthcare provider know of any other medications you are taking – including any type of herbal medications or over-the-counter products.


Epanova [package insert]. Astra Zeneca Pharmaceuticals: Wilmington DE. Revised 5/2014

Micromedex 2.0.  Truven Health Analytics, Inc. Greenwood Village, CO.  Available at:  Accessed February 10, 2016
Kastelein JJP, Make KC, Susekov A et al. Omega-3 free fatty acids for the treatment of severe hypertriglyceridemia: The Epanova for the lowering of very high triglycerides (EVOVLE) trial. J Clin LIpidol 2014;8:94-106

Davison MH, Johnson J, Rooney MW, et al. A novel omega-3 fatty acid formulation has dramatically improved bioavailability during low fat diet compared with omega-3 acid ethyl esters: The ECLIPSE (Epanova compared to Lovaza in a pharmacokinetic single-dose evaluation) study. J Cin Lipidol 2012;6:573-584.

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