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System Formulary Update
Fat emulsion 20% with fish oil (SMOFlipid) 1000 mL bag
September 11, 2025

Situation
The UNC Medical Center (UNCMC) Adult Total Parenteral Nutrition (TPN) Service has requested addition of lipid
injectable emulsion (SMOFlipid) 1000 mL bags to formulary to allow SMOFlipid to be placed on the compounder
and used to prepare 3-in-1 TPN for adult patients.

Background
SMOFlipid is one of 3 formulary intravenous lipid emulsion (ILE) products at UNC Health, with only the 100 mL
and 250 mL bags currently on formulary. Historically, UNCMC has not allowed use of SMOFlipid in 3-in-1 TPN
preparation, however a request is currently being evaluated to remove this local restriction and allow use of
SMOFlipid on the TPN compounder.

Assessment
Use of SMOFlipid in 3-in-1 TPN instead of separate administration with a 2-in-1 TPN will allow customization of
lipid dosing, easier administration for nursing, and a reduction in error potential at transitions of care for
patients receiving 3-in-1 TPN at home. The cost per gram of SMOFlipid 1000 mL is lower compared to the
smaller available bag sizes

Recommendation
ADD lipid injectable emulsion (SMOFlipid) 1000 mL bags to UNC Health System formulary