title: 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.
  
  
  OBJECTIVE
  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%.
authors.affiliation: Department of Pharmacotherapy, University of North Texas System College of Pharmacy, University of North Texas Health Science Center.
authors.forename: Amulya
authors.initials: A
authors.lastname: Tatachar
authors.affiliation: Department of Pharmacy, Parkland Health and Hospital System.
authors.forename: Margaret
authors.initials: M
authors.lastname: Pio
authors.affiliation: Department of Pharmacy, Parkland Health and Hospital System.
authors.forename: Denise
authors.initials: D
authors.lastname: Yeung
authors.affiliation: Department of Pharmacy, Parkland Health and Hospital System.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Moss
authors.affiliation: Department of Pharmacy, Parkland Health and Hospital System.
authors.forename: Diem
authors.initials: D
authors.lastname: Chow
authors.affiliation: Department of Pharmacy, Parkland Health and Hospital System.
authors.forename: Steven
authors.initials: S
authors.lastname: Boatright
authors.affiliation: Department of Pharmacy, Parkland Health and Hospital System.
authors.forename: Marissa
authors.initials: M
authors.lastname: Quinones
authors.affiliation: Department of Pharmacy, Parkland Health and Hospital System.
authors.forename: Annie
authors.initials: A
authors.lastname: Mathew
authors.affiliation: Department of Pharmacy, Parkland Health and Hospital System.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hulstein
authors.affiliation: Department of Clinical Sciences, UT Southwestern Medical Center.
authors.forename: Beverley
authors.initials: B
authors.lastname: Adams-Huet
authors.affiliation: Division of Nutrition and Metabolic Diseases, Center for Human Nutrition, Department of Internal Medicine, UT Southwestern Medical Center. Electronic address: Zahid.ahmad@utsouthwestern.edu.
authors.forename: Zahid
authors.initials: Z
authors.lastname: Ahmad
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D011345:Fenofibrate / Q000008:administration & dosage; D005395:Fish Oils / Q000008:administration & dosage*; D015248:Gemfibrozil / Q000008:administration & dosage; D006779:Hospitals, Public; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000008:administration & dosage*; D014280:Triglycerides / Q000097:blood*
chemical_list: D005395:Fish Oils; D000960:Hypolipidemic Agents; D004366:Nonprescription Drugs; D014280:Triglycerides; D015248:Gemfibrozil; D011345:Fenofibrate
keywords: Fenofibrate; Fish oil; Gemfibrozil; Hypertriglyceridemia; Marine omega-3 fatty acids