Parenteral nutrition (lipid emulsion)
Injectable lipid emulsions (intravenous fat) provide calories and essential fatty acids to patients who cannot eat — for example on parenteral nutrition in hospital. Fat is a concentrated energy source and prevents essential fatty acid deficiency, which would cause dry skin, growth delay and neurological problems.
Also known as: Intralipid, Lipofundin, emulsão lipídica, lipid emulsion
Warfarin + lipid emulsion: the vitamin K content of lipids may reduce INR.
Soybean oil-based lipid emulsions (such as Intralipid) contain vitamin K, the natural antidote to warfarin: dietary/intravenous vitamin K reactivates the vitamin K-dependent clotting factors and reduces the anticoagulant effect, lowering INR. In anticoagulated patients receiving parenteral nutrition with lipid emulsion, the vitamin K load can make INR lower and more variable, increasing thrombotic risk if not compensated. Monitor INR more frequently after starting (or changing) the lipid emulsion and adjust the warfarin dose according to the values.
Warfarin + lipid emulsion: the vitamin K in soybean lipids may reduce INR. Monitor INR.
Lipid emulsions contain vitamin K, which antagonises the warfarin effect.
Periodic INR.
Signs of thrombosis or sub-therapeutic INR.
Monitor INR during parenteral nutrition with lipids.
DailyMed (FDA) — approved Warfarin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=541c9a70-adaf-4ef3-94ba-ad4e70dfa057 ; approved Lipid emulsion label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=61e025f1-a38e-4af2-9e18-13ea12977cf5 — additional reference: Prontuário Terapêutico do INFARMED (11th ed., 2012)
Oral lipids add to the lipid load of the emulsion.
Consider oral fat intake when calculating the lipid dose.
EMC-UK (MHRA) — approved Lipid emulsion SmPC: https://www.medicines.org.uk/emc/product/15164/smpc
In pancreatitis patients, lipid infusion should be cautious.
Use with caution and monitor triglycerides.
EMC-UK (MHRA) — approved Lipid emulsion SmPC: https://www.medicines.org.uk/emc/product/15164/smpc
Lipid emulsion worsens hypertriglyceridaemia and may precipitate pancreatitis.
Contraindicated in severe uncontrolled hypertriglyceridaemia.
EMC-UK (MHRA) — approved Lipid emulsion SmPC: https://www.medicines.org.uk/emc/product/15164/smpc
Intravenous lipid emulsion should only be used when enteral nutrition is not possible.
Use under specialist guidance, monitoring triglycerides.
Limited data; prefer enteral nutrition when possible.
No specific additional contraception.
EMC-UK (MHRA) — approved Lipid emulsion SmPC: https://www.medicines.org.uk/emc/product/15164/smpc
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Provides calories (about 1.1–2 kcal/mL depending on concentration) and essential fatty acids. Pharmacodynamics are not fully characterised; the main effect is metabolic (energy and structural substrate).
The emulsion triglycerides are hydrolysed by lipoprotein lipase into free fatty acids, which are oxidised by beta-oxidation (main energy-producing pathway) or used in membrane structure, as precursors of bioactive molecules (prostaglandins) and as regulators of gene expression.
Administration is exclusively intravenous; bioavailability is complete by definition of the route. Clearance depends on lipoprotein lipase and tissue uptake capacity.
Linoleic (omega-6) and alpha-linolenic (omega-3) acids are metabolised in a common biochemical pathway through successive desaturation and elongation steps. The infusion is metabolised according to the patient energy needs and oxidative capacity.
Classical half-life does not apply (endogenous substrate); infused triglycerides are cleared within hours, with fatty acids entering body metabolic pools.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
