LIPIDEM 200MG/ML EMULSION FOR INFUSION

Medium-Chain Triglycerides
Omega-3-Acid Triglycerides
Soya-Bean Oil

Source of information: Drugbank (External Link). Last updated on: 3rd July 18
*Trade Name used in the content below may not be the same as the HSA-registered product.

Active Ingredient / Synonyms

Caprylic/capric triglyceride | Caprylic/capric triglycerides | Coconut oil, fractioned | Fractionated coconut oil | Fractionated triglyceride of coconut oil | MCT | Medium chain triglyceride | Medium-chain glycerides | Triglycerides, medium-chain | Medium-chain triglycerides |

Description

Compared to long-chain fatty acids which are dietary fats that are composed of 2 to 22 carbon atoms in length, medium-chain triglycerides (MCTs) are composed of only 6 to 12 carbon links [F126, F128]. This shorter chain length gives MCTs properties that are unique, and perhaps pharmacologically advantageous over long-chain fatty acids [F128, F126]. In essence, the shorter chain length chemical profile of MCTs allow them to passively and directly diffuse across the gastrointestinal tract into the portal system without undergoing the prolonged and necessary sequential molecular modifications that long-chain fatty acids must undertake [F128, F126]. These kinds of pharmacodynamics ultimately allow for much quicker absorption and utilization of MCTs compared to long-chain triglycerides - making them important and rapid sources of calories and essential fatty acids for various medical conditions associated with malnutrition and malabsorption [F126, F128].

Indication

When incorporated as an active ingredient in combination with other active components like fish oils, soya oil, and olive oil as a prescription medication (SMOFLIPID), medium chain triglycerides (MCTs) constitute a therapy indicated for supplying energy, calories, and essential fatty acids to adult patients, as part of a parenteral nutrition regimen, when oral or enteral nutrition is impossible, insufficient, or contraindicated [F126, F127]. However, given the predominant indication of MCTs for acting as a source of calories and essential fatty acids, the use of MCTs alone or as a component part of various unique, individual patient-tailored composite regimen therapies, MCTs are also ultimately indicated for a wide range of health conditions that involve energy deficiency, malnutrition, or disturbances in the ordinary absorption of dietary fats [A33175, F128]. Such conditions can include Crohn's disease, Waldmann disease, weight maintenance in AIDS, cachexia, and various disturbances in patient bile secretion (like cholestasis, disturbances in hepatic-intestinal circulation of bile acids, intestinal dysbacteriosis), or in pancreatic lipase secretion (like pancreatic failure in the course of cystic fibrosis) [A33175, F128].

Mechanism of Action

Absorption of larger long-chain triglycerides (LCT) requires specific processing in the digestive tract, like emulsification with bile [A33175]. This process is aimed at obtaining the maximum surface for digestion (lipolysis with breakage of ester bonds of triglycerides and with the release of monoglycerides, free fatty acids, and glycerol) [A33175]. The process of digestion of fats occurs largely in the duodenum and initial segment of the jejunum [A33175]. Lipases are found in the pancreatic juice and the brush border [A33175]. Once the aforementioned bonds are broken and the fatty acids and monoglycerides are absorbed into an enterocyte, they undergo resynthesis to triglycerides, in the presence of ligase, co-enzyme A, and ATP. Chylomicrons are formed. They get to the lymph and only then can they be transported to blood and destination organs [A33175]. Release of fats from chylomicrons requires the presence of plasmatic lipases, and only then can they be metabolised or stored as a reserve in the fatty tissue [A33175]. Conversely, hydrolysis of medium chain triglycerides (MCTs, which is faster than LCT hydrolysis anyway) does not require bile and lipase [A33175]. Without hydrolysis, they may also be absorbed by the enterocytes and they do not require re-esterification [A33175]. From enterocytes they are directly absorbed into the portal vein and then transported mainly to the liver. Thus, absorption of MCT is faster than that of LCTs [A33175]. Their metabolism is facilitated as well because they are metabolised by the liver almost completely (only when the liver’s metabolic abilities are exceeded the process is taken over by peripheral tissues) with energy release, regardless of the presence of carnitine (which is necessary for the transport of long-chain fatty acids through the mitochondrial membrane) [A33175]. Thanks to this the availability of medium-chain fatty acids for mitochondrial oxidation is better [A33175]. This means that MCT are an easy and quick source of energy [A33175]. However, it should be borne in mind that quantities of MCT exceeding the abilities of the liver are metabolised peripherally in a carnitine-dependent mechanism, which can increase the demand for it [A33175]. On the other hand, it has been observed that on the enterohormonal pathway (an important element of which is a MCT-induced increase of the YY peptide concentration and a decrease in cholecystokinin release) MCT cause a decrease of appetite and consequently a decrease in energy intake [A33175]. They also interfere with the metabolism of the fatty tissue, by hindering the creation of a deposit from long chain acids [A33175]. It has been proven that an MCT-enriched diet modulates metabolism of fats, which is manifested as a decrease in the concentration of triglycerides and cholesterol [A33175]. Moreover, unlike LCT, MCT do not affect the release of cholecystokinin or the emptying of the gallbladder and they do not increase the secretion of pancreatic enzymes [A33175]. They can speed up the intestinal passage by affecting the release of the YY peptide, but only in the distal sections of the intestine [A33175]. Moreover, it has been found that MCT facilitate absorption of calcium [A33175].

Pharmacodynamics

Medium chain triglycerides (MCTs) are considered a fast acting source of calories and essential fatty acids for patients with malnutrition, malabsorption, or particular fatty-acid metabolism disorders because they can passively and directly diffuse across the gastrointestinal tract into the portal system without undergoing the prolonged and necessary sequential molecular modifications that long-chain fatty acids must undertake [F126]. These kinds of pharmacodynamics allow for much quicker absorption and utilization of MCTs compared to long-chain triglycerides [F128]. In contrast, albumin-bound long-chain fatty acids do not readily enter peripheral organs and are predominantly metabolised by the liver with a preference for re-esterification to phospholipids or triglycerides and therefore potentially fat storage [F126]. MCFAs are subjected to a lower re-esterification rate than LCFAs with a reduced tendency to fat storage than LCTs [F126]. Subsequently, MCTs are predominantly catabolized, rather than stored as adipose tissue and are therefore utilized as an immediate source of energy, considering it does not require energy to absorb, use, or store MCTs [F126].

Pharmacokinetics

Absorption:

The absorption of medium chain triglycerides is considered rapid [A33175, L2895, F126, F127, F128] but that both long-chain triglycerides and medium chain triglycerides share a similar absorption, which is an absorption rate of about 95% - similar to that of other ingested fats [L784].

Distribution:

The apparent volumes of distribution have been researched as approximately 4.5 L for medium chain triglycerides and 19 L for medium chain fatty acids in a typical 70-kg subject [A33174].

Metabolism:

In capillaries, both medium chain triglycerides (MCTs) and long-chain triglycerides (LCTs) are hydrolysed by lipoprotein lipase to glycerol and free fatty acids, and medium chain fatty acids (MCFAs) and long chain fatty acids (LCFAs), respectively [F126]. MCTs are hydrolysed at a faster rate than LCTs and therefore have a faster elimination rate [F126]. Free MCFAs then readily enter the liver, kidney, heart and other peripheral organs where they are oxidised by β-oxidation and the citric acid cycle to carbon dioxide and water [F126]. Alternatively, via the ketogenesis pathway, the β-oxidation of fatty acids generates the acetyl-CoA that can lead to the formation of ketone bodies like acetoacetate and β-hydroxybutyrate [F126].

Elimination:

Readily accessible data regarding the route of elimination of medium chain fatty acids is not available.

Half-life

The plasma half-life of medium chain triglycerides is recorded to be 11 minutes and that of medium chain fatty acids is about 17 minutes [A33174].

Clearance

The clearance of medium chain triglycerides in healthy control subjects was measured to be about 1.93 +/- 0.34 mL.kg-1.min-1 [A33179].

Toxicity

The excess use of medium chain triglycerides (MCTs) can lead to increased plasma levels of medium chain dicarboxylic acids, 3-hydroxy fatty acids and ketone bodies [F126]. Hyperketonaemia was observed in repeat-dose toxicity studies with SMOFLIPID [F126]. If excess MCTs are administered, the capacity of extrahepatic tissues to use ketone bodies is saturated and this may be of particular concern in some diabetes patients [F126]. The increased level of ketone bodies aggravates metabolic acidosis and accelerates the breakdown of homeostatic mechanisms [F126].

Source of information: Drugbank (External Link). Last updated on: 3rd July 18
*Trade Name used in the content below may not be the same as the HSA-registered product.

Active Ingredient / Synonyms

Not Available

Description

Not Available

Indication

Not Available

Mechanism of Action

Not Available

Pharmacodynamics

Not Available

Pharmacokinetics

Absorption:

Not Available

Distribution:

Not Available

Metabolism:

Not Available

Elimination:

Not Available

Half-life

Not Available

Clearance

Not Available

Toxicity

Not Available

Source of information: Drugbank (External Link). Last updated on: 3rd July 18
*Trade Name used in the content below may not be the same as the HSA-registered product.

Active Ingredient / Synonyms

Not Available

Description

Not Available

Indication

Not Available

Mechanism of Action

Not Available

Pharmacodynamics

Not Available

Pharmacokinetics

Absorption:

Not Available

Distribution:

Not Available

Metabolism:

Not Available

Elimination:

Not Available

Half-life

Not Available

Clearance

Not Available

Toxicity

Not Available

References

  1. Health Science Authority of Singapore - Reclassified POM
  2. Drugbank

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Approval Information

LIPIDEM 200MG/ML EMULSION FOR INFUSION was registered with Health Science Authority of Singapore by B. BRAUN SINGAPORE PTE LTD. It is marketed with the registration number of SIN13614P with effective from 2009-03-16.

This product contains 100g/1000ml of Medium-Chain Triglycerides, 20g/1000ml of Omega-3-Acid Triglycerides, and 80g/1000ml of Soya-Bean Oil in the form of EMULSION.

The medicine was manufactured by B. Braun Melsungen AG in GERMANY

It is a Presciption Only Medicine which can only be obtained from a doctor or a dentist, or from a pharmacist with a prescription from a Singapore-registered doctor or dentist.

Anatomical Therapeutic Chemical (ATC) Classification

ATC Code: B05BA02

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