Severe hypertriglyceridaemia
Fasting serum triglycerides above 500 mg/dL (5.6 mmol/L). Increases the risk of acute pancreatitis. Therapy includes lifestyle change, correction of secondary causes, fibrates, and high-dose omega-3 polyunsaturated fatty acids.
ICD-10 E78.12 drugs
Also known as: Triglycerides above 500 mg/dL
Drugs used for this condition
- AOmega-3 triglycerides (EPA and DHA)First line · Lipid-modifying agents. Omega-3 polyunsaturated fatty acidsHigh-dose omega-3 PUFA (2–4 g EPA+DHA daily) reduces triglycerides by 20–50% in patients with severe hypertriglyceridaemia. The 2019 AHA Science Advisory lists high-dose omega-3 as a first-line option when triglycerides exceed 500 mg/dL (5.6 mmol/L) to reduce acute pancreatitis risk. Omacor and similar products with at least 84% EPA+DHA content are registered for this indication.
- BGemfibrozilSecond line · Lipid-lowering agent of the fibrate classGemfibrozil is a fibrate that lowers triglycerides. It is prescribed for very high hypertriglyceridemia when diet fails and acute pancreatitis becomes a threat. The FDA label defines that group precisely: triglycerides above 2000 mg/dL, and between 1000 and 2000 mg/dL the drug is considered for people with prior pancreatitis. Below 1000 mg/dL pancreatitis risk is generally absent and the drug is not needed. The 2019 ESC/EAS guidelines place fibrates in the same position: they cut pancreatitis risk, not myocardial infarction risk. Spanish authors Lahoz and Mostaza describe the same approach for familial and polygenic hypertriglyceridemia in Clin Investig Arterioscler 2021. Diet, alcohol avoidance and diabetes control remain the first step, and the drug delivers little without them. Gemfibrozil carries a feature fenofibrate lacks: it raises statin concentrations sharply, and the label prohibits combining it with simvastatin.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit