lipid emulsion (soybean, medium-chain triglyceride, olive, and fish oils; [SMOF])

Action and Spectrum

Actions and Spectrum: 

SMOF contains different fatty acids, including essential fatty acids such as omega-6 (linoleic acid) and omega-3 (eicosapentaenoic acid – EPA and docosahexaenoic acid – DHA).  SMOF, a lipid emulsion, provides a concentrated source of calories.

The fatty acids in SMOF are metabolized to release energy, essential for patients who require parenteral nutrition and cannot meet their nutritional needs orally or enterally. They may modulate inflammatory responses and be beneficial in conditions characterized by inflammation.

Drug Interaction

Adverse Reaction

Frequency not defined 

Hypertension 

Thrombophlebitis 

Tachycardia 

Skin rash 

Urinary tract infection 

Sepsis 

Dizziness 

Headache 

Thrombocytopenia 

Pneumonia 

Fever 

Black Box Warning

Black Box Warning: 

None 

Contraindication / Caution

Contraindication/Caution: 

Contraindications: 

• Hypersensitivity 
• Hyperlipidemia 

Cautions: 

• Liver dysfunction 
• Pancreatitis 
• Coagulopathy 
• Infection risk 
• Pediatric & neonatal use 
• Drug interactions 

Pregnancy / Lactation

Pregnancy consideration:  

No risks were found in usage during pregnancy. 

Breastfeeding warnings:  

The drug should be taken during lactation if the benefits outweigh the risks. 

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies do not show fetal risks in the first or later trimester.        
• <b>Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.       
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.        
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.        
• Category N: No data for the drug under this category is available. 

Pharmacology

Pharmacology: 

Omega-3 fatty acids in fish oil, such as DHA and EPA, have anti-inflammatory properties. These fatty acids may modulate inflammatory responses and be beneficial in conditions associated with inflammation. SMOF is used in patients who require intravenous nutritional support due to malnutrition, intestinal failure. It is often used in critically ill patients or those undergoing surgery who need additional nutritional support. 

Pharmacodynamics: 

SMOF provides essential fatty acids, including linoleic acid and alpha-linolenic acid. These fatty acids are essential for various physiological processes, including cell membrane structure, nerve function, and hormone synthesis. 

Pharmacokinetics: 

Absorption 

MCTs are easily absorbed in the small intestine and are transported directly to the liver through the portal vein for rapid metabolism and utilization as an energy source.  

Distribution 

After absorption, the individual components of SMOF are distributed throughout the body via the bloodstream. They are transported to various tissues, including adipose tissue, liver, heart, and brain, serving as an energy source or incorporating them into cellular structures, such as cell membranes. 

Metabolism 

Linoleic acid from soybean oil is metabolized in the liver through a series of enzymatic reactions, including desaturation and elongation, to produce other fatty acids and lipid intermediates. 

Medium-Chain Triglycerides (MCTs) are rapidly metabolized in the liver to produce energy, primarily through beta-oxidation. 

Oleic acid from olive oil undergoes beta-oxidation in the liver and other tissues for energy production.  

Elimination and Excretion 

The elimination of the individual components of SMOF occurs primarily through the liver and the gastrointestinal tract. Some metabolites of the fatty acids may be excreted in bile and eliminated through feces. A small portion of the metabolites may also be excreted in the urine. 

Adminstartion

Administration: 

The administration of lipid emulsion, such as SMOF is typically done intravenously. Lipid emulsions are administered to patients who require parenteral nutrition, meaning they cannot meet their nutritional needs through oral or enteral (tube feeding) routes. 

Patient Information Leaflet

Patient information leaflet 

Generic Name:  Lipid emulsion (soybean, medium-chain triglyceride, olive, and fish oils; [SMOF]) 

Why use lipid emulsion [SMOF])? 

Lipid emulsions a form of nutritional support provided through intravenous administration when a patient cannot receive adequate nutrients orally or enterally (through the gastrointestinal tract). SMOF lipid emulsions provide a balanced mixture of fatty acids, contributing to the patient’s caloric and nutritional needs.

Lipid emulsions, including SMOF, are a concentrated source of calories. They provide a high-energy density and are particularly useful for patients with increased caloric requirements or who cannot consume sufficient calories orally.