Version July 2025
Dosage guidance:
Dosage form information: Not all available products may be represented in dosing; also refer to manufacturer’s labeling.
Dietary supplement/medical food:
MCT Oil: Oral: 15 to 20 mL per dose (maximum daily dose: 100 mL) (Ref).
Emulsion (KQuik, Liquigen): Oral: To be determined by the clinician or dietitian and is dependent on the age, body weight, and medical condition of the patient.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing.
(For additional information see "Medium chain triglycerides: Pediatric drug information")
Note: Dose to be individualized by clinician and/or dietitian based on patient age, caloric needs, tolerance, and clinical status. Initiate therapy using small amounts and gradually increasing based on patient tolerance to prevent and/or limit GI side effects (Ref).
Nutritional supplement: Limited data available: Infants: MCT oil: Oral: Initial: 0.5 mL every other feeding, then advance to every feeding, then increase in increments of 0.25 to 0.5 mL/feeding at intervals of 2 to 3 days as tolerated (Ref). For GI tolerability, maximum daily dose is 100 mL/day in divided doses (Ref).
Cystic fibrosis: Limited data available: Children and Adolescents: MCT oil: Oral: Individualize dose based on patient-specific needs and tolerance; 15 mL three times daily has been reported (Ref); it is recommended to initiate using small amounts and gradually increasing based on patient tolerance to prevent and/or limit GI side effects. For GI tolerability, maximum daily dose is 100 mL/day in divided doses (Ref).
Fatty acid oxidation disorders, nutritional supplementation:
Infants, Children, and Adolescents: Note: For GI tolerability, maximum daily dose is 100 mL/day in divided doses (Ref).
Long-chain hydroxyacyl-CoA dehydrogenase deficiency (LCHAD), Trifunctional protein (TFP) deficiency: Oral: 1 to 3 g/kg/day or 20% to 30% of energy (Ref).
Very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency: Oral: 1 to 3 g/kg/day or 10% to 30% of energy (Ref).
Ketogenic diet: Limited data available; optimal dose not established; consult institutional-specific protocols. For GI tolerability, maximum daily dose is 100 mL/day in divided doses (Ref).
Classic ketogenic diet: Infants, Children, and Adolescents: Oral: Added to meals as a supplement to boost ketosis and improved lipid abnormalities; may decrease amount per meal and increase the number of meals per day to improve tolerance (Ref). Infants usually tolerate ~10% to 25% of total calories from medium chain triglycerides (Ref).
Medium chain triglyceride (MCT) diet: Children and Adolescents: Oral: ~30% to 60% of total calories provided as MCTs; divide and administer with all meals; some patients may experience GI discomfort with the traditional MCT diet (60% of calories); to improve GI symptoms, some may utilize the modified MCT diet which provides ~30% of calories from MCTs and 30% from long chain triglycerides (Ref).
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Endocrine & metabolic: Decreased HDL cholesterol (>6 months daily use), increased serum triglycerides (>6 months daily use)
Gastrointestinal: Abdominal cramps, abdominal pain, bloating, diarrhea, nausea
Disease-related concerns:
• Diabetic ketoacidosis: Avoid use in patients with uncontrolled diabetic ketoacidosis.
• Hepatic impairment: Use with caution in patients with hepatic cirrhosis; large amounts of medium chain triglycerides (MCT) may elevate blood and spinal fluid levels of medium chain fatty acids (MCFA) due to impaired hepatic clearance of MCFA (Gracey 1970; Morgan 1974).
Special populations:
• Patients on a low-fat diet or with fat malabsorption syndrome: Use with a source of essential fatty acids in patients on a low-fat diet or with fat malabsorption syndrome to avoid deficiency (Limketkai 2017).
Other warnings/precautions:
• Appropriate use: These products are medical foods and should be used under medical supervision. MCTs are not intended as a sole source of nutrition; they do not provide the recommended daily dosage of essential fatty acids. Products may contain a different caloric content. Not for parenteral use.
Note: Not all available formulations may be represented in Dosage Forms. Additional products may be available from other manufacturers/suppliers.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Emulsion, Oral:
KQuik: (225 mL)
Liquigen: (250 mL)
Oil, Oral:
MCT Oil: (946 mL)
No
Oral: Possible GI side effects (diarrhea, nausea, or excess gas) may be minimized if therapy is introduced gradually and ingested slowly (Ref).
Product-specific information:
Emulsions (KQuik, Liquigen): Shake well before use. May administer orally or via feeding tube. May mix with beverages, enteral formula, or foods (recommendations may vary by product; refer to manufacturer's labeling).
MCT Oil: May administer orally or via feeding tube. May mix with beverages (eg, milk), sauces, salad dressings, or other foods (refer to manufacturer's labeling for detailed recommendations). For administration through a feeding tube, may administer undiluted; flush with 30 to 60 mL of water after administration.
Oral:
MCT oil: Dilute prior to administration; dilute with at least an equal volume of water or other beverage (eg, coffee, tea, hot chocolate, fruit/vegetable juices [including orange or tomato], smoothies, milk, cola) (should not be cold; flavoring may be added); solution should be sipped slowly. MCT oil may also be mixed into sauces, salad dressings, or other foods such as hot cereals, soups, and broth. If adding to hot substances, ensure temperature is <150°F (65.5°C) to avoid altering the flavor of the food (Ref). Administer no more than 15 to 20 mL of MCT oil per dose (Ref). Initiating with meals and gradually increasing to target dose may improve tolerability (Ref). MCT oil has been administered through feeding tubes in adult patients; feeding tube was flushed with water before and after administration (Ref).
Betaquik (liquid emulsion): Shake well prior to use. May be used similar to milk (ie, as a drink with or without added flavorings, added to hot tea or coffee, added to cereal, used in recipes). Best served chilled.
Liquigen (liquid emulsion): Shake well prior to use. May be used in drinks and food. Dilution may be required for children <5 years of age.
Dietary supplement: An alternative source of energy used to replace or supplement long chain fats in the nutritional management of patients who cannot efficiently digest and absorb fats (Limketkai 2017).
Medical food: Used to manage many metabolic and digestive abnormalities such as pancreatic insufficiency, fat malabsorption, impaired lymphocyte chylomicron transport, and severe hyperchylomicronemia; component of adult and preterm infant formulas (Łoś-Rycharska 2016).
May be taken with meals; may be mixed with beverages (eg, juice, milk), enteral formula, or foods (eg, sauces, salad dressings) (recommendations vary by product; refer to manufacturer’s labeling). Possible GI side effects from medication can be prevented if therapy is initiated with small supplements at meals and gradually increased according to patient's tolerance (Gracey 1970).
MCTs are saturated fatty acids in chains of 6-12 carbon atoms. They are water soluble and can pass directly through intestinal cell membranes into portal venous blood. Unlike long chain fats, MCTs do not require the presence of bile acids and pancreatic lipase for absorption. MCTs provide a source of calories while reducing the amount of malabsorbed fat remaining in stool (Gracey, 1970; Ruppin, 1980).
Onset of action: Octanoic acid appeared in each subject by 30 minutes following ingestion; effect on seizures in children: Within 6 weeks
Absorption: Up to 30% of dose can be absorbed unchanged as a triglyceride in the mucosal cell
Metabolism: Almost entirely oxidized by the liver to acetyl CoA fragments and to carbon dioxide; little deposited in adipose tissue or elsewhere
Excretion: As much as 20% of oral dose of MCT, recovered in expired CO2 in 50 minutes; <10% elimination of medium chain fatty acids in feces
