Identification

Summary

Medium-chain triglycerides is a source of essential fatty acids used as a source of calories in parenteral nutrition.

Generic Name
Medium-chain triglycerides
DrugBank Accession Number
DB13959
Background

Medium-chain triglycerides (MCTs) are triglycerides made up of a glycerol backbone and three fatty acids with an aliphatic tail of six to 12 carbon atoms. MCTs are found in natural foods, such as coconut oil, palm kernel oil, and raw coconut meat. In the body, MCTs are broken down into glycerol and free fatty acids, which are directly absorbed into the blood stream and transported to the target organs to exert a range of biological and metabolic effects.4 MCTs are used in parenteral nutrition therapy: they serve as a source of calories and essential fatty acids in conditions associated with malnutrition and malabsorption.10

Type
Small Molecule
Groups
Approved
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
External IDs
  • MIGLYOL 810 N
  • MIGLYOL 812 N

Pharmacology

Indication

Medium-chain triglycerides (MCTs), in combination with other compounds like fish oils, soya oil, and olive oil, is indicated in adult and pediatric patients, including term and preterm neonates, as a source of calories and essential fatty acids for parenteral nutrition when oral or enteral nutrition is not possible, insufficient, or contraindicated.10 MCTs are also available as over-the-counter natural products and health supplements.

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Associated Therapies
Contraindications & Blackbox Warnings
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Pharmacodynamics

Medium-chain triglycerides (MCTs) contained in injectable lipid emulsions serve as a source of calories and essential fatty acids, which are important substrate for energy production.10 MCTs exert several metabolic effects: they were shown to reduce weight, metabolic syndrome, abdominal obesity, and inflammation in animal studies. It is proposed that MCTs induces weight loss through increasing energy expenditure and fat oxidation, and altering body composition.4 However, it is unknown whether the effects of MCTs on energy expenditure and body weight are long-lasting and sustainable.9 MCTs can also play a role in food intake and satiety, as some studies showed that MCT consumption led to reduced food intake.4,6,7 While MCTs was shown to reduce energy intake, it was not shown to affect appetite.8 MCT may facilitate the absorption of calcium.2

Mechanism of action

Medium-chain triglycerides (MCTs) are broken down into glycerol and medium-chain fatty acids, which are directly absorbed into the blood stream and transported to the target organs,4 where they undergo β-oxidation to form acetyl-CoA. The β-oxidation is the most common mechanism of action for energy production derived from fatty acid metabolism.10 Because medium-chain fatty acids are rapidly oxidized, it leads to greater energy expenditure.9 Fatty acids are important substrates for energy production and also play a critical role in membrane structure and function. Additionally, fatty acids act as precursors for bioactive molecules (such as prostaglandins) and as regulators of gene expression.10

Fatty acids may mediate their effects on energy expenditure, food consumption, and fat deposition by upregulating the expression and protein levels of genes involved in mitochondrial biogenesis and metabolism via activating Akt and AMPK signaling pathways and inhibiting the TGF-β signaling pathway. It is proposed that the promotion of weight loss by MCTs may be due to sympathetic activation of brown fat thermogenesis.4

Absorption

Medium chain triglycerides are rapidly absorbed.2,11 They passively and directly diffuse across the gastrointestinal tract into the portal system then to liver, where they are oxidized.9,11

Volume of 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.1

Protein binding

Medium chain triglycerides bind weakly to serum albumin. They can readily cross the blood-brain barrier.11

Metabolism

Medium chain triglycerides are hydrolyzed by lipoprotein lipase to glycerol and medium-chain free fatty acids such as alpha-linolenic acid and linoleic acid.4,10,11 Free fatty acids then undergo β-oxidation in the organs such as the liver, kidneys, and heart. Alpha-linolenic acid and linoleic acid are metabolized within a common biochemical pathway through a series of desaturation and elongation steps. Downstream products of alpha-linolenic acid are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and linoleic acid is converted to arachidonic acid.10

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Route of elimination

There is limited information available regarding the main route of elimination.

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.1

Clearance

The clearance of medium chain triglycerides in healthy control subjects was measured to be about 1.93 +/- 0.34 mL.kg-1.min-1.3

Adverse Effects
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Toxicity

There is limited information regarding the LD50 of medium-chain triglycerides; however, MCTs at doses up to levels of 1g/kg have been safely consumed by humans in several clinical trials.5

Fat overload syndrome is a condition rarely reported with the use of intravenous lipid emulsions that is most frequently observed when the recommended lipid dose or infusion rate was exceeded. However, some cases still occurred when the lipid formulation was administered according to instructions. Fat overload syndrome results from a reduced or limited ability to metabolize lipids, accompanied by prolonged plasma clearance, leading to a sudden deterioration in the patient's condition.10

If signs or symptoms of fat overload syndrome occur, stop the infusion of medium chain triglyceride-containing emulsions until triglyceride levels have normalized and symptoms have abated. The effects are usually reversible by stopping the lipid infusion. If medically appropriate, further intervention may be indicated. Lipids are not dialyzable from plasma.10

Pathways
Not Available
Pharmacogenomic Effects/ADRs
Not Available

Interactions

Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
Not Available
Food Interactions
No interactions found.

Products

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Mixture Products
NameIngredientsDosageRouteLabellerMarketing StartMarketing EndRegionImage
CELEPID MCT-LCT 20% W/VMedium-chain triglycerides (10 g) + Soybean oil (10 g)EmulsionIntravenousFARMALOGICA S.A2007-03-14Not applicableColombia flag
Colip 20%Medium-chain triglycerides (15 g / 100 mL) + Soybean oil (5 g / 100 mL)EmulsionIntravenousBaxter Corporation Clintec Nutrition Division1998-10-072007-08-02Canada flag
DeNino Diaper RashMedium-chain triglycerides (18.21 mL/60mL) + Avena sativa flowering top (.6 mL/60mL) + Lanolin (2.4 mL/60mL) + Zinc oxide (7.8 mL/60mL)CreamTopicalCorpsain Sa De Cv2010-04-01Not applicableUS flag
Finomel Emulsion zur InfusionMedium-chain triglycerides (10.3 g/1085ml) + Alanine (11.41 g/1085ml) + Arginine (6.34 g/1085ml) + Calcium chloride dihydrate (0.41 g/1085ml) + D-glucose monohydrate (151.5 g/1085ml) + Fish oil (8.24 g/1085ml) + Glycine (5.68 g/1085ml) + Histidine (2.64 g/1085ml) + Isoleucine (3.31 g/1085ml) + Leucine (4.02 g/1085ml) + Lysine hydrochloride (3.99 g/1085ml) + Magnesium sulfate heptahydrate (1.36 g/1085ml) + Methionine (2.2 g/1085ml) + Olive oil (10.3 g/1085ml) + Phenylalanine (3.09 g/1085ml) + Potassium chloride (2.47 g/1085ml) + Proline (3.75 g/1085ml) + Serine (2.76 g/1085ml) + Sodium acetate trihydrate (3.1 g/1085ml) + Sodium glycerophosphate hydrate (3.26 g/1085ml) + Soybean oil (12.36 g/1085ml) + Threonine (2.31 g/1085ml) + Tryptophan (0.99 g/1085ml) + Tyrosine (0.22 g/1085ml) + Valine (3.2 g/1085ml) + Zinc sulfate heptahydrate (0.013 g/1085ml)EmulsionParenteralBaxter Healthcare Gmb H2019-05-14Not applicableAustria flag
Finomel Peri Emulsion zur InfusionMedium-chain triglycerides (7.65 g/1085ml) + Alanine (7.08 g/1085ml) + Arginine (3.93 g/1085ml) + Calcium chloride dihydrate (0.25 g/1085ml) + D-glucose monohydrate (84.4 g/1085ml) + Fish oil (6.12 g/1085ml) + Glycine (3.52 g/1085ml) + Histidine (1.64 g/1085ml) + Isoleucine (2.05 g/1085ml) + Leucine (2.5 g/1085ml) + Lysine hydrochloride (2.48 g/1085ml) + Magnesium sulfate heptahydrate (0.84 g/1085ml) + Methionine (1.37 g/1085ml) + Olive oil (7.65 g/1085ml) + Phenylalanine (1.92 g/1085ml) + Potassium chloride (1.53 g/1085ml) + Proline (2.33 g/1085ml) + Serine (1.71 g/1085ml) + Sodium acetate trihydrate (1.92 g/1085ml) + Sodium glycerophosphate hydrate (2.03 g/1085ml) + Soybean oil (9.18 g/1085ml) + Threonine (1.44 g/1085ml) + Tryptophan (0.62 g/1085ml) + Tyrosine (0.14 g/1085ml) + Valine (1.98 g/1085ml) + Zinc sulfate heptahydrate (0.008 g/1085ml)EmulsionParenteralBaxter Healthcare Gmb H2019-05-14Not applicableAustria flag
Lipidem 20%, Emulsion for infusionMedium-chain triglycerides (100 g/L) + Omega-3 fatty acids (20 g/L) + Soybean oil (80 g/L)Injection, emulsionIntravenous dripB.BRAUN MEDICAL INDUSTRIES SDN BHD2020-09-08Not applicableMalaysia flag
Lipidem 200mg/ml Emulsion for InfusionMedium-chain triglycerides (100 g/1000ml) + Omega-3 fatty acids (20 g/1000ml) + Soybean oil (80 g/1000ml)EmulsionIntravenousB. BRAUN SINGAPORE PTE LTD2009-03-16Not applicable
Lipidem Emulsion zur InfusionMedium-chain triglycerides (100 g/l) + Omega-3 fatty acids (20 g/l) + Soybean oil (80 g/l)EmulsionParenteralB. Braun Melsungen Ag2005-04-20Not applicableAustria flag
LIPOFUNDIN %10 MCT/LCT VIT ELI 500 ML IV SOL.Medium-chain triglycerides (50 g/L) + Soybean oil (50 g/L)Injection, emulsionIntravenousB.BRAUN MEDİKAL DIŞ TİC. A.Ş.2020-08-142018-10-03Turkey flag
LIPOFUNDIN %20 MCT/LCT VIT E'LI 500 ML IV SOL.Medium-chain triglycerides (100 g/L) + Soybean oil (100 g/L)Injection, emulsionIntravenousB.BRAUN MEDİKAL DIŞ TİC. A.Ş.2020-08-142018-10-03Turkey flag

Categories

Drug Categories
Classification
Not classified
Affected organisms
  • Humans and other mammals

Chemical Identifiers

UNII
C9H2L21V7U
CAS number
438544-49-1
InChI Key
Not Available
InChI
Not Available
IUPAC Name
Not Available
SMILES
Not Available

References

General References
  1. Mingrone G, De Gaetano A, Greco AV, Capristo E, Castagneto M, Gasbarrini G: Medium-chain triglycerides for parenteral nutrition: kinetic profile in humans. Nutrition. 1995 Sep-Oct;11(5):418-22. [Article]
  2. Los-Rycharska E, Kieraszewicz Z, Czerwionka-Szaflarska M: Medium chain triglycerides (MCT) formulas in paediatric and allergological practice. Prz Gastroenterol. 2016;11(4):226-231. doi: 10.5114/pg.2016.61374. Epub 2016 Jul 20. [Article]
  3. Druml W, Fischer M, Pidlich J, Lenz K: Fat elimination in chronic hepatic failure: long-chain vs medium-chain triglycerides. Am J Clin Nutr. 1995 Apr;61(4):812-7. doi: 10.1093/ajcn/61.4.812. [Article]
  4. Wang Y, Liu Z, Han Y, Xu J, Huang W, Li Z: Medium Chain Triglycerides enhances exercise endurance through the increased mitochondrial biogenesis and metabolism. PLoS One. 2018 Feb 8;13(2):e0191182. doi: 10.1371/journal.pone.0191182. eCollection 2018. [Article]
  5. Traul KA, Driedger A, Ingle DL, Nakhasi D: Review of the toxicologic properties of medium-chain triglycerides. Food Chem Toxicol. 2000 Jan;38(1):79-98. doi: 10.1016/s0278-6915(99)00106-4. [Article]
  6. Clegg ME: Medium-chain triglycerides are advantageous in promoting weight loss although not beneficial to exercise performance. Int J Food Sci Nutr. 2010 Nov;61(7):653-79. doi: 10.3109/09637481003702114. [Article]
  7. St-Onge MP, Ross R, Parsons WD, Jones PJ: Medium-chain triglycerides increase energy expenditure and decrease adiposity in overweight men. Obes Res. 2003 Mar;11(3):395-402. doi: 10.1038/oby.2003.53. [Article]
  8. Maher T, Clegg ME: A systematic review and meta-analysis of medium-chain triglycerides effects on acute satiety and food intake. Crit Rev Food Sci Nutr. 2021;61(4):636-648. doi: 10.1080/10408398.2020.1742654. Epub 2020 Mar 26. [Article]
  9. St-Onge MP, Jones PJ: Physiological effects of medium-chain triglycerides: potential agents in the prevention of obesity. J Nutr. 2002 Mar;132(3):329-32. doi: 10.1093/jn/132.3.329. [Article]
  10. FDA Approved Drug Products: SMOFLIPID (lipid injectable emulsion), for intravenous use [Link]
  11. Australian Government Therapeutic Goods Administration: Australian Public Assessment Report for SMOFlipid [Link]
RxNav
1310578
Wikipedia
Medium-chain_triglyceride

Clinical Trials

Clinical Trials
PhaseStatusPurposeConditionsCount
4CompletedHealth Services ResearchSepsis Newborn1
4CompletedPreventionCholestasis / Psychomotor Disorders, Developmental1
4CompletedSupportive CareDietary and Nutritional Therapies1
4CompletedSupportive CareGastric Resection / Malnutrition1
4CompletedSupportive CareMalnutrition1
4CompletedTreatmentHepatic Function / Inflammatory Responses1
4CompletedTreatmentParenteral Nutrition1
4Not Yet RecruitingSupportive CarePreterm, Infant1
4RecruitingSupportive CareChildren - Malnutrition1
4RecruitingTreatmentPatients Requiring Home Parenteral Nutrition1

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage Forms
FormRouteStrength
CreamTopical
EmulsionIntravenous100 g/1000ml
Injection, emulsionIntravenous drip
InjectionIntravenous12 g/1000ml
EmulsionParenteral
EmulsionIntravenous
Injection, emulsionIntravenous4.656 g/1000ml
Injection, emulsionIntravenous6.792 g/1000ml
Injection, emulsionIntravenous14 g/1000ml
Injection, emulsionIntravenous4.3 g/1000ml
Injection, emulsionIntravenous
Injection, emulsionIntravenous60 g/1000ml
Injection, solutionIntravenous
EmulsionIntravenous0.74 g/L
SolutionParenteral
Prices
Not Available
Patents
Not Available

Properties

State
Solid
Experimental Properties
Not Available
Predicted Properties
Not Available
Predicted ADMET Features
Not Available

Spectra

Mass Spec (NIST)
Not Available
Spectra
Not Available

Carriers

Kind
Protein
Organism
Humans
Pharmacological action
Unknown
Actions
Binder
General Function
Toxic substance binding
Specific Function
Serum albumin, the main protein of plasma, has a good binding capacity for water, Ca(2+), Na(+), K(+), fatty acids, hormones, bilirubin and drugs. Its main function is the regulation of the colloid...
Gene Name
ALB
Uniprot ID
P02768
Uniprot Name
Serum albumin
Molecular Weight
69365.94 Da
References
  1. Australian Government Therapeutic Goods Administration: Australian Public Assessment Report for SMOFlipid [Link]

Drug created at January 17, 2018 16:57 / Updated at June 01, 2022 17:06