Hello, friends! In this article we will talk about analogues of the drug OMACOR, and what you should know to replace this drug, which is actively prescribed by doctors even for serious problems of the cardiovascular system. Is it possible to do this? We will also look at the role of Omega-3 polyunsaturated fatty acids (PUFAs) in the treatment of cardiovascular diseases. I highly recommend reading the article about fish oil and its great benefits. And this article was prompted by an incident that happened to me.
The doctor prescribed Omacor
My father is a heart patient. Once again, he went to the cardiologist - his blood pressure suddenly increased, and he received another prescription for medications.
One of the drugs for the cardiovascular system was Omacor. The medicine is not cheap. Hence all the fuss.
Having seen the already familiar designations of polyunsaturated fatty acids EPA and DHA - the main components, immediately assessing the composition, the price of this drug and seeing, in fact, ordinary fish oil, I without a doubt suggested that my father simply order fish oil, which I drink myself - benefits in cost, quantity these same PUFAs in the dose and time of administration (several months compared to Omacor), which is necessary for supplements, simply did not allow doubt.
However, not everything is so simple in the Danish kingdom. I was told that the doctor categorically stated: “This medicine is not the same as fish oil. And there is no need for amateur performances. If you are undergoing treatment, then you need to take medications prescribed by a doctor, but if not, then take all sorts of dietary supplements and other nonsense, but no one will vouch for your health.”
I had to shut up a little, especially since this drug is positioned as a medicine and it is indicated that it is dispensed with a doctor’s prescription. In addition, the cardiologist said so, and cardiovascular diseases are a serious thing. Telling my father that the doctor is wrong and I know better is simply impossible.
However, a natural feature in the search for truth, supported and strengthened recently by the blogging component, forced me to look into this issue.
So, if you are taking such a drug, but it is expensive for you, you would like to find an analogue that is cheaper and more profitable, but you are afraid to violate the doctor’s instructions, and also to understand what is unique about this drug, then read this article. It will be useful, at least in terms of interesting reading. And then it’s up to you to decide what to do.
Composition and purpose of Omakor
Omacor is a patented drug manufactured in Germany. Contains essential essential polyunsaturated fatty acids. Purpose: normalization of lipid metabolism and prevention of recurrent myocardial infarction . Omacor is registered as a medicine in the European Union, Russia, the USA and 40 other countries.
The cost is about 1500-1700 rubles for 28 capsules. You won’t find a package of 100 capsules, although it seems to be available. I'm just afraid to imagine its cost.
Dosages are prescribed by a doctor, depending on the condition and therapeutic effect and range from 1 to 4 capsules per day.
The drug is loved by cardiologists and is prescribed quite often. Although this is a medicine, you need to drink it for a long time to treat it, and considering the cost, the amount of treatment with such a drug, which is used in complex therapy (!), will not be small.
Compound:
For convenience and further comparative analysis, I will transform the indicators into more understandable ones. It turns out that Omacor contains 1000 mg (1 g):
- eicosapentaenoic acid – 460 mg
- docosahexaenoic acid – 380 mg
- vitamin E (tocopherol), as a preservative – 4 mg
In total, the preparation contains 840 mg of useful substances (let’s remove vitamin E), and the rest is unnecessary auxiliary and ballast substances (160 mg).
The intake rate is determined by the doctor, but more often 1 capsule (840 mg of a mixture of essential fatty acids) per day.
This drug is positioned as a medicine, not a supplement. It is available by prescription and has serious indications: hypertension, angina pectoris, high cholesterol, vascular atherosclerosis, cerebrovascular accidents, prevention of complications after myocardial infarction.
Omacor is a lipid-lowering drug.
A lipid-lowering drug is a drug designed to lower bad cholesterol levels. This means suppressing the increase in triglycerides and low-density lipids, which negatively affect the vascular walls and form cholesterol plaques that narrow or block blood vessels. Thus, due to the narrowing of blood vessels, increased pressure occurs in the circulatory system, which increases the risk of heart attacks and strokes. And this, in fact, is the rupture of the vessel due to pressure and the death of tissue due to lack of nutrients and oxygen.
Reducing plasma cholesterol reduces the risk of cardiovascular disease and mortality, heart attacks and strokes.
There are several lipid-lowering drugs. This:
- Statins are substances that can inhibit enzymes responsible for the formation of bad cholesterol. They reduce the production of cholesterol by the liver and, accordingly, its amount in the blood plasma.
- Fibrates are drugs that affect the level of proteins that transport cholesterol and lipid metabolism, that is, they normalize the metabolism of fats and fat-like substances in the body.
- Omega-3 fatty acids . They affect lipid (fat metabolism) in the body. Fatty acids (PUFAs) are considered less effective in their lipid-lowering effects, but are effective and safe. In addition, such acids have many other useful and important functions. The benefits of these acids have been proven and have not been questioned for decades.
Omacor
Omacor is the trade name of a patented complex, including ethyl esters of fatty polyunsaturated Omega-3 acids (up to 90% of the total composition). The drug also contains eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are essential fatty acids. The EPA to DHA ratio is 1.2/1. The mechanism of action of Omacor is that eicosapentaenoic and docosahexaenoic acids are a poor substrate for enzymes responsible for the production of triglycerides (ultra-low density cholesterol) in the liver, thus increasing their concentration to a level characteristic of healthy people leads to the normalization of lipid metabolism by reducing the amount of triglycerides produced.
Figure 1 - Omacor is used for cholesterol
Omacor is used to reduce ultra-low-density cholesterol. The mechanism of action of Omacor is to improve lipid metabolism at three levels:
- Omega-3 fatty polyunsaturated acids are transported to the liver, where they form part of various types of lipoproteins, and are subsequently transported to peripheral fat depots;
- Phospholipids of cell membranes are replaced by phospholipids of lipoproteins - polyunsaturated fatty acids in this situation play the role of precursors of different types of eicosanoids;
- Fatty acids serve as a source of replenishing the energy balance in the body - its release occurs through their oxidation.
The concentration of Omega-3 fatty acids in Omacor corresponds to their natural level in the phospholipids of cell membranes.
Very low-density cholesterol is an endogenous lipid that is responsible for transporting fats from fat stores into the bloodstream in the form of fatty acids. When they are oxidized, energy is released. Dysfunction of VLDL (very low density lipids) leads to an increase in the proportion of endogenous triglycerides compared to individuals without such dysfunction. In turn, this can lead to the development of various cardiovascular diseases.
Figure 2 - Prepatha helps reduce cholesterol and weight loss
The drug is used to reduce cholesterol levels, in weight loss diets, to reduce the risk of recurrent myocardial infarction and stroke. Studies have shown that taking 1 milligram of the drug for 3-4 years significantly reduces the level of “bad” cholesterol. Taking Omacor reduces the production of endogenous lipids in the liver, which helps improve the condition of patients with impaired function of endogenous lipid metabolism.
A positive effect of the drug in normalizing blood pressure was noted.
Omacor is used as an adjuvant treatment of myocardial infarction, complementing other standard therapies - for example, the use of statins, antithrombocidal agents, beta blockers, angiotensin-modifying enzyme inhibitors.
In the treatment of endogenous hypertriglyceridemia, Omacor is prescribed if the desired effect cannot be achieved by maintaining a special diet. The drug is used both as monotherapy and in combination with statins.
The product is produced in the form of capsules filled with oils.
Take Omacor 1 capsule for breakfast and dinner orally in case of treatment of hypertriglyceridemia, 1 capsule per day for patients who have suffered a myocardial infarction. If necessary, the amount of the drug can be increased by the attending physician to the amount of daily Omacor intake to 4 capsules per day. It is especially recommended for patients with severe hypertriglyceridemia, for whom fibrates are contraindicated.
Data from clinical studies indicate that regular use of this drug for a long period, more than one year, significantly reduces the risk of developing coronary heart disease and other diseases of the cardiovascular system.
Capsules are taken whole, without opening or chewing, with the required amount of water. The effectiveness of the drug does not depend on food intake, however, if you experience discomfort in the stomach, it is better to combine taking Omacor with food.
Figure 3 — Before taking Omacor, you should consult your doctor
It is recommended to always take the drug at the same time to increase its effectiveness. You must strictly follow your doctor's instructions regarding dosage and frequency of administration. Before starting to take the drug, you should tell your doctor if the patient has or has had liver disease.
This medicine changes the way other medicines work, and you should not take other medicines without first consulting your doctor or pharmacist. Omacor may enhance the effect of oral anticoagulants. Your doctor may recommend a special diet that you should follow to increase the effectiveness of this medication.
If a patient taking Omacor is pregnant or thinks she may become pregnant during treatment, she should tell her doctor. You should also inform about breastfeeding your baby during the course of treatment.
The medicine may cause heartburn and nausea. If you experience any other symptoms that a person taking Omacor believes may be caused by the drug, you should report this to your doctor.
The drug is prescribed with caution to persons with hypersensitivity or allergies to fish.
Since taking Omacor in higher dosages (4 capsules per day) can increase blood clotting time, this factor is taken into account when treating individuals at risk of bleeding, for example, during surgery, bleeding injuries, etc.
When treating with high doses of the drug, the need to control blood pressure in patients, especially in those suffering from any form of liver failure, should be taken into account.
The drug is not prescribed to patients with elevated levels of exogenous triglycerides, i.e. lipids from food. It is not used to treat patients with uncompensated diabetes.
Omacor can be replaced with medications containing Omega-3 fatty acids, but it should be taken into account that the content of eicosapentaenoic and docosahexaenoic acids gives the drug great value.
Omacor, 1000 mg, capsules, 28 pcs.
Abbott, Netherlands
Price from 1432₽
There are contraindications. Specialist consultation is required.
Omega-3 acids and fish oil
I wrote a large and comprehensive article about fish oil and its main essential acids needed by our body. Examples of drugs and other important features of selection and administration are also given and analyzed there. Read it. It is important.
Here I will just remind you that fish oil contains three most important components, the rest is not important:
- alpha-linolenic acid (ALA)
- eicosapentaenoic acid (EPA)
- docosahexaenoic acid (DHA)
Alpha-linolenic acid , in addition to fish oil, is found in various vegetable oils. In the body, it is capable, if necessary, of being converted into two other acids, but in a very limited amount, literally a few percent. This is so small that it is basically impossible and unreasonable to consider it a source of EPA and DHA acids.
EPA and DHA are essential fatty acids (NEFA), but we can only get them from fish products and from some algae extracts (vegetarian version).
These acids must be supplied with food.
Scientific and official recommendations for taking Omega-3 polyunsaturated acids
To be more convincing, let’s turn to scientific data. What do doctors start or should start from when prescribing Omega-3 acids (EPA and DHA) for cardiovascular diseases?
Multi-purpose scientific studies have proven the effectiveness of Omega-3 PUFAs for the prevention and treatment of cardiovascular diseases. In this regard, Omega-3 PUFA preparations are included in the recommendations of the World Health Organization (WHO), the All-Russian Scientific Society of Cardiology (VNOK, 2005), the American Heart Association (AHA, 2003) and others in the following dosages:
- For primary prevention of cardiovascular disease, 500 mg/day of EPA and DHA
- For secondary prevention of cardiovascular diseases, 1000 mg/day of EPA and DHA
- For arterial hypertension, it is necessary to take up to 3 g/day of EPA and DHA
- For hypertriglyceridemia (high levels of bad cholesterol), take 2-4 g/day EPA and DHA
pharmachologic effect
Omacor 1000 mg is a German drug in capsules that belongs to the group of lipid-lowering drugs. Its properties are associated with the polyunsaturated fatty acids contained in Omega-3, in particular EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Tocopherol or vitamin E is used as an additional means of protecting against oxidation and loss of the therapeutic effect of omega-3.
The drug has the following effects:
- normalizes lipid metabolism;
- lowers total cholesterol levels, affects the ratio of low-density and high-density cholesterol (good and bad);
- prevents the appearance of cholesterol plaques;
- improves the quality of life of patients with heart and vascular diseases.
Triglycerides and Omega-3 fatty acid esters: which is better and more effective?
Another important point that is worth paying attention to is that the Omacor packaging indicates the content of ethyl esters of Omega-3 polyunsaturated fatty acids . What is this? Some advanced medicinal form of fatty acids or the same thing? We must somehow justify the doctor’s words that “fish oil is completely different from this drug.” Maybe this is exactly the problem? And this is what I managed to find out.
In fish oil, that is, in its natural form, essential fatty acids are in the form of triglycerides ( TG ). In many medications (eg Omacor), PUFAs are in the form of esters ( EE ).
The fact is that in fish oil itself the amount of necessary acids is about 20-30% by weight. To achieve higher concentrations of the two important acids EPA and DHA, it is necessary to convert triglycerides into esters.
The advantages are that in this way we can get up to 90% of EPA and DHA acids in a small amount of the mixture. To obtain a preventive or therapeutic norm, you need to drink less fish oil or capsules per day. The amount of ballast substances is also reduced. In Omacor, the total amount of acids is 84% (see composition), the rest is vitamin E and ballast substances. It is not possible to completely get rid of them.
From 1999 to 2008, scientists conducted serious clinical studies of Omacor. Two comparative placebo-controlled studies demonstrated an effective reduction in mortality from arrhythmias and other cardiovascular diseases. The effective therapeutic effects of Omega-3 acid esters have been proven. Please note that only the effects of ethers were studied.
It would seem that everything is great! Omacor and essential acids won! However, nature cannot be fooled so easily. She has her own views on human activity and has developed a reaction of incomprehensibility.
A little later, in 2010, scientists carried out another serious evidence-based work comparing triglycerides and PUFA esters and found that the bioavailability and digestibility of natural triglycerides (TG) in concentrated form by the body is higher than that of regular fish oil, and the digestibility of esters (EE) is lower by 27% compared to regular fish oil and 70% lower than triglyceride concentrate.
It follows from this that for maximum therapeutic effect it is necessary to choose a concentrate of natural fish oil (TG triglycerides) with the maximum possible content of natural EPA and DHA in the form provided by nature.
Omacor lost to natural fish oil concentrate.
Which is better - Omacor or Omega 3 Solgar
An analogue of Omacor 1000 is Solgar Omega-3 fish oil concentrate, produced in capsules. It is most often sold to order in pharmacies and on the iherb website. The analogue contains 600 mg of Omega-3, which replenishes the daily adequate intake by 30%.
Used during meals to reduce unwanted effects on the stomach, 2 capsules once a day. Restrictions on the use of the analogue include pregnancy, lactation and intolerance to the components. The drug is available in capsules, so it may not be suitable if swallowing is impossible or difficult.
Solgar price 750 rub. for 60 capsules and 1300 for 120 capsules, and a small package is enough for a course. The body receives 1200 mg of Omega 3 per day, which is equal to the dosage of Omacor. In terms of cost per course, the analogue is 2 times cheaper.
The choice in favor of a substitute is best made with a doctor.
Omacor's analogues
Taking into account all of the above, let's see what analogues can be selected to replace Omakor. As the most profitable, we will consider preparations with fatty acid esters. And let's look at the options for fish oil concentrates with triglycerides. I will say right away that manufacturers do not always indicate what is contained in the drug: triglycerides or esters. I had to dig around. It’s even more difficult with drugs in our pharmacies.
Preparations with ethyl esters of Omega-3 fatty acids
the Vitrum cardio Omega-3 PUFA complex presented in our pharmacies.
The composition is similar - the same esters of Omega-3 acids, but there are fewer acids in 1 capsule (1000 mg). This speaks for some superiority of Omakor. More complex modern technologies were used in its production, which made it possible to better purify and concentrate the fatty acid esters of fish oil. This is probably why the opinions of cardiologists differ: some allow taking this drug instead of Omacor, others absolutely do not. The truth is somewhere in the middle.
According to the indications, the amount of Vitrum Cardio Omega-3 taken is similar - 1 capsule per day or as prescribed by a doctor, which means a less pronounced therapeutic effect. However, the composition of the drug corresponds to the recommended amount of acids per day.
But the drug is already cheaper: 60 capsules cost about 1,000 rubles. By increasing the dosage prescribed by your doctor by 1-2 capsules, you will receive no less amount of fatty acids than in Omacor.
The prescriptions, contraindications, and adverse reactions are the same.
The only thing is that Vitrum Cardio is available without a prescription. What's the matter? I'll talk about this below.
The next drug from our pharmacies is Doppelherz aktiv.
The capsule contains 800 mg of highly purified Omega-3 fish oil from the body of Arctic salmon + vitamin E. Composition: 1 capsule contains:
Active ingredients: fish oil from the body of Arctic salmon - 800 mg (18% eicosapentaenoic acid, 12% docosahexaenoic acid, the amount of Omega-3 PUFAs is not less than 30%), vitamin E - 16.22 mg.
Excipients: glycerin, gelatin, purified water. Packaging: 30 and 80 capsules.
Directions for use and dosage: adults, 1 capsule per day during meals with water.
As you can see, the Omega-3 PUFA content is low. This is far from the recommended prophylactic dose. If you believe in the high quality of this fish oil, then you need to drink much more than recommended. And this is about 70% of unknown things. I was not able to find out what exactly is contained in the capsules, but a fairly low acid level indicates the possible presence of PUFA triglycerides. This is a plus, but this fish oil cannot be an analogue of Omacor. In addition, we can say that this is more of a vitamin E preparation, where there is a lot of it.
If you increase your intake beyond the recommended doses, you can greatly exceed the intake of not only ballast substances into the body, but also an excess of the same vitamin E, which is fraught with problems. Be careful when performing such amateur activities.
Quite often, manufacturers indicate that the fish oil in the supplement is subjected to molecular distillation.
Molecular distillation is a method of removing toxic substances, harmful impurities, heavy metal salts (mercury, etc.) from fish oil while maintaining the integrity of the structure of Omega-3 fatty acids.
The situation is such that any fish oil must undergo a complex purification system. Otherwise it is fraught. Marine organisms tend to accumulate a lot of harmful things in their tissues, which has caused restrictions on the consumption of fish products and has become a mandatory step in the production of fish oil-based supplements and medications. Today's ecological situation is such that even in deep-sea fish of the Arctic seas and in the liver of penguins (South Pole, just a second!) Toxic chemical elements are found.
Fish oil is often marketed as a pharmaceutical grade supplement. What is meant by this is not very clear and it is probably written for the sake of words. However, these are all indicators of the purity of fish oil from anything harmful. However, there will always be accompanying substances. They are not necessarily harmful. Fish oil contains a lot of things. The main thing is how much necessary (according to the purpose of treatment) EPA and DHA acids are there. As already mentioned, taking acids (even prophylactically) less than 500 mg per day does not make sense.
Omega-3, obtained by molecular distillation, without cholesterol
I take this fish oil almost constantly. A good fish oil with sufficient amounts of EPA and DHA. According to the recommendation, you should take 4 capsules per day (total acids 1200 mg). The amount of vitamin E is not indicated, but it is present and according to the instructions it is presented as natural d-alpha tocopherol from soy. In any case, there is no excess vitamin at the indicated dosage. The jar is enough for 4 months of daily use.
It took me a lot of work to find that in this preparation the acids are presented in the form of ethyl ester. At the recommended dose, this drug can be an analogue of Omacor and even surpasses it in the content of EPA and DHA acid esters.
RxOmega-3 Factors, EPA 400 mg/DHA 200 mg
I also take this supplement sometimes. More often before the crisis. This is a pharmaceutical grade fish oil that has been stripped of all excess and contains the most effective acids EPA and DHA. This concentrate has a very high degree of purification. It does not have any undesirable consequences in the form of belching. Acids are presented in the form of ethyl esters, as specified by the manufacturer. Vitamin E is listed as natural. Recommended dosage is 1-3 capsules. When taking 2 capsules of the drug (1200 mg of acids), it will last for 4 months (pack of 240 capsules). This is the closest analogue of Omacor and may well replace it.
Solgar, Omega-3 EPA and DHA, Triple Strength, 950 mg
Well, this drug will not just be a replacement for Omacor, but will also surpass it many times over both in the amount of a mixture of EPA and DHA acids per capsule, and in the amount of unnecessary auxiliary substances (more than 2 times less). Even paying for a more modern processing technology, for the brand and packaging (dark glass), on iHerb such an analogue of Omakor will be more profitable.
Omega-3 triglyceride preparations
We have selected the closest analogue to Omakor. But do you remember what the latest research showed? The most absorbable form of Omega-3 acids EPA and DHA are triglycerides (TG). Overseas manufacturers immediately realized this and began to produce additives of the specified form, not forgetting to indicate this in the instructions. Either such information has not yet reached our doctors and manufacturers, or something else.
Solgar, Omega-3 Fish Oil Concentrate
Solgar fish oil supplement made from the meat of deep-sea and cold-sea fish. It is presented in our pharmacies for very decent money, not to say worse. According to the manufacturer, the fish oil in this composition is tested for optimal purity. It undergoes molecular distillation to remove mercury and other harmful impurities. Solgar is a very high-quality and responsible premium brand. I must say that the price for such a number of capsules on iHerb is quite acceptable. The manufacturer recommends taking 2 capsules 2-3 times a day. Taking even 2 capsules you will receive the recommended preventive dose (520 mg) of a mixture of EPA and DHA acids in the best digestible form of triglycerides (TG).
California Gold Nutrition, Omega 800, Pharmaceutical Grade Fish Oil, 80% EPA/DHA, Triglyceride Form, German Processed, Cholesterol Free, 1000 mg
Another very profitable drug at an attractive price with a huge content of EPA and DHA acids in the form of triglycerides (TG) in 1 capsule, as indicated by the manufacturer. It may well be a replacement for Omakor. The iHerb website and the manufacturer’s website even include certificates and other evidence of effectiveness and high quality.
Sports Research, Omega-3, Triple Strength, 1250 mg
An excellent preparation from the fat of wild Alaskan pollock, caught in the waters of Alaska. Created using the most advanced technologies, the maximum amount of PUFA acids in the form of triglycerides has been achieved and a bunch of other advantages according to the manufacturer. A little expensive, but you have to pay for all this best stuff.
Omacor - instructions for use
Omacor is a medicine, not a dietary supplement, and has positive reviews from cardiologists. It is used exclusively as prescribed by a doctor and is available in pharmacies with a prescription. The duration of the course is determined by the cardiologist, the daily dose is from 1 to 4 capsules per day, depending on the severity of the disease and the age of the patient.
It is recommended to take Omacor after meals to avoid unwanted reactions from the gastrointestinal tract. If this recommendation is not followed, nausea, vomiting, abdominal pain, belching, diarrhea and other side effects may occur.
The instructions for use do not answer the question of when to take Omacor - in the morning or in the evening. Statins, which have a similar effect, are used before bedtime. The choice of time of administration depends on the amount of medication in the evening and morning, and their compatibility.
Why do doctors deceive us?
Why are doctors deceiving us and persistently pushing the very expensive Omacor, which, in fact, is just a concentrate of fish oil, without allowing for anything else? Let's try to answer this question. Are there any reasons?
And here I will somewhat take the side of the doctors, which I don’t often allow myself to do. (Amitus Plato, sed magis amica veritas! Plato is my friend, but the truth is more precious!) If your attending physician does not have a direct interest, then it is not at all necessary that he is deceiving. Doctors, like all of us, are to some extent forced people. In medicine there are many restrictions, rules, instructions and guidelines. So why do they prescribe Omacor and are categorically opposed to dietary supplements?
- Omacor is now on the Russian market the only patented and registered drug based on Omega-3 acids that has undergone serious clinical trials and has an evidence base. Everything else, no matter how similar and beautiful, according to laws and regulations, is considered additives. Their effect has not been proven. Therefore, they cannot be prescribed by a doctor. They are available without a prescription and do not require mandatory certification in Russia. If such registration is carried out, at least in this way, then for the absence of harm, toxicity and safety. If a doctor prescribes a supplement, then this is his recommendation as part of the main comprehensive treatment. However, Omacor is prescribed for the same purpose (as indicated in the instructions for the drug).
- Most doctors simply do not know any analogues. They are superior to any additives there. If you take fish oil, then, as we found out, it is not the same. In addition, all these supplements on our market are often counterfeited and of low quality.
- Our medicine lags behind the global one in many indicators and is not aware of more modern research and development, as described in this article.
- Omacor contains few excipients compared to fish oil and analogues. Not 100%, which is impossible, but a little, which minimizes allergic reactions and individual intolerances. According to research, PUFAs are not allergens themselves and are very well tolerated by the body; moreover, they are necessary for cell growth and other metabolic processes. They are well tolerated even by people with seafood allergies. And even vegetarians allow taking these acids and drugs based on them.
