Smoflipid (0.2 g/mL) is indicated in adults as a source of calories and essential fatty acids for parenteral nutrition when oral or enteral nutrition is not possible, insufficient, or contraindicated. Smoflipid will compete with traditional lipids (Intralipid, Nutrilipid) for use in parenteral nutrition.
Smoflipid is a 20% emulsion (0.2 g/mL), like most lipid products and can be mixed with dextrose and amino acids, or hung separately. The difference is SMOFlipid contains four fats, Soybean oil (30%), Medium chain triglycerides (30%), Olive oil (25%), and Fish oil (15%). Intralipid and Nutrilipid just use soybean oil. Soybean oil contains the most essential fatty acids. But it may lead to inflammation and immunosuppression due to its omega-6 content. Plus its high phytosterol content is linked to liver dysfunction. Smoflipid is for central or peripheral intravenous infusion. Solutions with osmolarity of ≥ 900 mOsm/L must be infused through a central vein.
- The recommended dosage of Smoflipid for adult patients is 1 to 2 grams/kg per day and should not exceed 2.5 grams/kg per day. The initial rate of infusion should be 0.5 mL/min for the first 15 to 30 minutes of infusion. If tolerated, gradually increase until reaching the required rate after 30 minutes. Maximum infusion rate should not exceed 0.5 mL/kg/hour. The daily dose should also not exceed a maximum of 60% of total energy requirements.
The recommended duration of infusion for Smoflipid is between 12 and 24 hours, depending on the clinical situation. The administration flow rate is determined by dividing the volume of lipid by the duration of the infusion.
Smoflipid might be less inflammatory, since it has a lower amount of soybean oil and has added omega-3s from fish oil. Be aware that some evidence suggests Smoflipid decreases markers such as AST, ALT, bilirubin, or interleukin-6 and limited data show it might decrease length of stay after major abdominal surgery. Plus parenteral nutrition-associated liver disease may occur less often when using Smoflipid in neonates for up to a year. But it's too soon to say if Smoflipid leads to better outcomes in most patients with inflammatory states, including sepsis.
REFERENCES
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Mundi MS, Martindale RG, Hurt RT. Emergence of Mixed-Oil Fat Emulsions for Use in Parenteral Nutrition. JPEN J Parenter Enteral Nutr. 2017 Nov;41(1_suppl):3S-13S. Available at: https://pubmed.ncbi.nlm.nih.gov/29161196
Vanek VW, Seidner DL, Allen P, Bistrian B, Collier S, Gura K, Miles JM, Valentine CJ, Kochevar M; Novel Nutrient Task Force, Intravenous Fat Emulsions Workgroup; American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. A.S.P.E.N. position paper: Clinical role for alternative intravenous fat emulsions. Nutr Clin Pract. 2012 Apr;27(2):150-92. Available at: https://pubmed.ncbi.nlm.nih.gov/22378798
Calder PC, Adolph M, Deutz NE, Grau T, Innes JK, Klek S, Lev S, Mayer K, Michael-Titus AT, Pradelli L, Puder M, Vlaardingerbroek H, Singer P. Lipids in the intensive care unit: Recommendations from the ESPEN Expert Group. Clin Nutr. 2018 Feb;37(1):1-18. Available at: https://pubmed.ncbi.nlm.nih.gov/28935438
RxList. (2021). Smoflipid (Smoflipid): Uses, Dosage, Side Effects, Interactions, Warning. [online] Available at: https://www.rxlist.com/smoflipid-drug.htm#description