State of the Art Review: Intravenous Fat Emulsions: Current Applications, Safety Profile, and Clinical Implications

Ann Pharmacother. 2010 Apr;44(4):688-700. doi: 10.1345/aph.1M626.


Objective: To review the current state of the science regarding intravenous fat emulsions (IVFEs), with an emphasis on their safety profile.

Data sources: Articles were identified via a search of the MEDLINE database, including publications from 1979 to December 2009, using a search string that included the terms parenteral nutrition, lipid emulsion, fat emulsion, IVFE, safety, adverse effect, neonate intralipid, and terms describing a range of specific adverse events (AEs) such as pancreatitis.

Study selection and data extraction: We selected articles that allowed us to compare the results of clinical trials involving delivery of medications via IVFEs with the historical use and effects of IVFEs in parenteral nutrition, with an emphasis on AEs. We focused on 2 drugs in current use that are administered intravenously in lipid emulsions: propofol and clevidipine.

Data synthesis: Clearance of the fat particles in IVFEs is mediated by the enzyme lipoprotein lipase. AEs are more likely if the rate or duration of IVFE administration exceeds the enzyme's clearance capacity. AEs are also more likely after administration of a 10% IVFE formulation than a 20% formulation, because the higher concentration of free phospholipid in the 10% formulation interferes with lipoprotein lipase activity. AEs can be reduced by administering IVFEs at a dosage < or = 2.5 g/kg/day and at a rate < or = 0.11 g/kg/h. The anesthetic agent propofol, which is formulated in a 10% IVFE, has been used clinically for 25 years. Typical AEs associated with propofol use include infection, high plasma triglyceride concentrations, and pancreatitis. Recent clinical trials involving clevidipine, which is formulated in a 20% IVFE, have demonstrated a low rate of lipid-related AEs.

Conclusions: The results of this review demonstrate that IVFEs are well tolerated when administered in accordance with guideline recommendations.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anticoagulants / adverse effects
  • Antidotes / therapeutic use
  • Bacteria / drug effects
  • Bacteria / growth & development
  • Drug Delivery Systems
  • Drug Interactions
  • Drug Overdose
  • Fat Emulsions, Intravenous / adverse effects
  • Fat Emulsions, Intravenous / chemistry
  • Fat Emulsions, Intravenous / therapeutic use*
  • Humans
  • Hypertriglyceridemia / etiology
  • Immune System / drug effects
  • Infant, Newborn
  • Infant, Premature
  • Infant, Small for Gestational Age
  • Liver Function Tests
  • Pancreatitis / etiology
  • Parenteral Nutrition*
  • Respiratory Function Tests
  • Vitamin K / antagonists & inhibitors


  • Anticoagulants
  • Antidotes
  • Fat Emulsions, Intravenous
  • Vitamin K