Icosapent ethyl (Vazkepa)
Icosapent ethyl is a new treatment for people who have their cholesterol levels under control but may still be at risk of heart disease for other reasons, particularly raised triglycerides.
What is icosapent ethyl?
Icosapent ethyl (brand name Vazkepa) is a highly-purified omega 3 fatty acid (a type of fat that's present in fish oil) known as eicosapentaenoic acid (EPA). It is a new treatment for people with diseases of the heart and blood vessels (known as cardiovascular disease or CVD).
It's available for people who have LDL cholesterol which is well controlled with statins but who may still be at risk of serious events such as heart attacks and strokes due to other reasons (this is known as residual risk).
Raised blood triglycerides are considered to be a marker of risk for future heart attacks and strokes. Clinical trials have shown that icosapent ethyl can help lower this risk in people who are known to have cardiovascular disease, who have well controlled LDL cholesterol levels on statins, but who have raised triglycerides.
How does it work?
Although the way it works is not completely understood, icosapent ethyl is thought to help lower the risk of heart attacks and strokes in a number of different ways. These include improving the ‘lipoprotein profile’ (the different types of cholesterol in the blood) by lowering triglyceride levels. This medicine:
- reduces the amount of triglycerides released from the liver
- reduces the production of VLDL, a lipoprotein that is very high in triglycerides
- increases lipoprotein lipase, the enzyme used in the build-up and break down of triglycerides. This means more triglycerides are removed from VLDL and chylomicrons – the main lipoproteins that carry triglycerides in the blood.
Other mechanisms are thought to include:
- stabilizing cell membranes, which improves the function of the lining of the blood vessels
- anti-clotting effects
- anti-inflammatory and anti-oxidative properties.
All of these are thought to help stabilize hardened parts of the arteries known as atherosclerotic plaques, helping to lower the risk of heart attacks and strokes.
Who can have icosapent ethyl?
Icosapent ethyl is available on the NHS. In England, Wales and Northern Ireland the National Institute for Health and Care Excellence (NICE) have recommended icosapent ethyl for people who are already taking a statin, who also have:
Cardiovascular disease with a history of any of the following (read more about these on our high cholesterol page) :
- heart attack or unstable angina (chest pain) needing hospitalization
- coronary or other arterial revascularization procedures such as PCI (Percutaneous Coronary Intervention)
- coronary heart disease
- stroke
- peripheral arterial disease.
Plus an LDL cholesterol level above 1.04mmol/L and below or equal to 2.6mmol/L)
And a fasting triglyceride level of 1.7mmol/L or above.
Scotland is expected to provide its own guidance in the near future.
How do you take it and what's the dose?
Icosapent ethyl comes as a capsule you take by mouth. The recommended dose is two 998mg capsules, twice a day. You should take them with or just after a meal.
It is not recommended during pregnancy or breastfeeding, or for children and young adults under 18.
Can you take it with other medication?
No significant interactions with other medicines have been observed, which means it should be fine to take it with other medications.
Icosapent ethyl should be taken with a statin.
Are there any side effects?
Like all medications, icosapent ethyl can sometimes cause side effects. The most commonly-reported side effects include the following:
- Palpitations
- Burping
- Constipation
- Gout (painful swelling in the joints because of a build up of uric acid)
- Bruising (particularly if taking anti-clotting medicine)
- Pain in muscles, bones and joints
- Swelling in the legs and feet
- Skin reactions / rash
Report any side effects to your doctor or pharmacist.
The yellow card scheme also allows you to report suspected side effects of any medicine you’re taking.
Reports of side effects are taken seriously by the manufacturer and the Medicines and Healthcare Products Regulatory Agency (MHRA).
Monitoring
During your treatment, your doctor may carry out blood tests to check for any problems with your liver and to check how your blood is clotting.
Your doctor will consider this medicine carefully if you are taking antithrombotic treatment to prevent blood clots, or if you have a history of atrial fibrillation or flutter (types of irregular heart beat).
Does it lower the risk of heart attacks and strokes?
Clinical trial evidence from REDUCE IT showed that the risk of cardiovascular events was lower among those who received icosapent ethyl compared with those who received a dummy pill (placebo).