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Fish Oil

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Are there any interactions with medications?



Birth control pills (Contraceptive drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Birth control pills might interfere with the triglyceride-lowering effects of fish oil.

Some of these drugs include ethinyl estradiol and levonorgestrel (Triphasil), ethinyl estradiol and norethindrone (Ortho-Novum 1/35, Ortho-Novum 7/7/7), and others.



Medications for high blood pressure (Antihypertensive drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Using fish oil with drugs that lower blood pressure may increase the effects of these drugs and may lower blood pressure too much.

Some medications for high blood pressure include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), amlodipine (Norvasc), hydrochlorothiazide (HydroDIURIL), furosemide (Lasix), and many others.



Orlistat (Xenical, Alli)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Orlistat (Xenical, Alli) might keep the beneficial fatty acids in fish oil from being absorbed by the body. Taking fish oil and orlistat (Xenical, Alli) at least 2 hours apart may keep this from happening.



Medications for cancer (Chemotherapy)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Some fish oil products contain small amounts of a fatty acid that is believed to stop certain chemotherapy drugs from working. However, the amount of this fatty acid in most fish oil products is probably too low to be a concern. Until more is known, you do not need to stop taking fish oil if you are also taking medications for cancer.



Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Using fish oil with medications that slow clotting may increase the risk of bleeding. However, conflicting data exists. Until more is known, use cautiously in combination with medications that slow blood clotting.

Some of these drugs include aspirin, clopidogrel (Plavix), dalteparin (Fragmin), dipyridamole (Persantine), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), warfarin (Coumadin), and others.



Warfarin (Coumadin)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Warfarin (Coumadin) is used to slow blood clotting. Fish oil also might slow blood clotting. Taking fish oil with warfarin might slow blood clotting too much and increase the risk of bleeding. However, conflicting results suggests that fish oil does not increase the effects of warfarin. Until more is known, use cautiously in combination with warfarin. Have your blood checked regularly, as your dose of warfarin (Coumadin) might need to be changed.

Dosing considerations for Fish Oil.

The following doses have been studied in scientific research:

ADULTS

BY MOUTH:
  • For high triglycerides: 1-15 grams of fish oil daily for up to 6 months, or fish oil providing 1.45 to 2.70 grams of EPA and 1.05 to 1.80 grams of DHA daily for 2 to 12 weeks, has been used.
  • For heart disease: Fish oil containing 0.6-10 grams of DHA and/or EPA daily has been taken for one month to 9 years.
  • For preventing and reversing the progression of hardening of the arteries after angioplasty: 6 grams of fish oil daily starting one month before angioplasty and continuing for one months after, followed by 3 grams daily for 6 months thereafter has been used. Also, 15 grams of fish oil has been taken daily for 3 weeks before angioplasty and for 6 months thereafter.
  • For preventing miscarriage in women with antiphospholipid antibody syndrome and a history of past miscarriage: 5.1 grams of fish oil with a 1.5 EPA:DHA ratio taken daily for 3 years has been used.
  • For attention deficit-hyperactivity disorder (ADHD): A specific supplement containing 400 mg of fish oil and 100 mg of evening primrose oil (Eye Q, Novasel) six capsules daily for 15 weeks has been used. Also, 250 mg of a omega-3 fatty acids that have been complexed with phosphatidylserine have been used daily for 3 months.
  • For bipolar disorder: Fish oil providing 6.2 grams of EPA and 3.4 grams of DHA taken daily for 4 months has been used. Also, 1-6 grams of EPA for 12-16 weeks or omega-3 fatty acids containing 4.4-6.2 grams of EPA plus 2.4-3.4 grams of DHA for 4-16 weeks have been used.
  • For colorectal cancer: Fish oil (Omega-3, Phytomare, Governador Celso Ramos, SC, Brazil) 2 grams daily containing 360 mg of EPA and 240 mg of DHA for 9 weeks has been used alongside chemotherapy.
  • For slowing weight loss in patients with cancer: 30 mL of a specific fish oil product (ACO Omega-3, Pharmacia, Stockholm, Sweden) providing 4.9 grams of EPA and 3.2 grams of DHA daily for 4 weeks has been used. 7.5 grams of fish oil daily providing EPA 4.7 grams and DHA 2.8 grams has been used for about 6 weeks. In addition, two cans of a fish oil nutritional supplement containing 1.09 grams of EPA and 0.96 grams of DHA per can have been used daily for up to 7 weeks.
  • For keeping veins open after coronary bypass surgery: 4 grams of fish oil containing 2.04 grams of EPA and 1.3 grams of DHA has been used daily for one year.
  • For dry eye: Fish oil supplements providing EPA 360-1680 mg and DHA 240-560 mg have been used for 4-12 weeks. Some people used the specific product (PRN Dry Eye Omega Benefits softgels). A specific combination product containing EPA 450 mg, DHA 300 mg, and flaxseed oil 1000 mg (TheraTears Nutrition, Advanced Nutrition Research) has been used once daily for 90 days.
  • For high blood pressure caused by the drug cyclosporine: 3 to 4 grams of omega-3 fatty acids daily for 6 months after a heart transplant has been used. 2-18 grams of fish oil daily for 1 to 12 months after a kidney transplant has also been used.
  • For kidney problems related to using cyclosporine to prevent organ transplant rejection: 12 grams of fish oil daily for 2 months has been used after liver transplant. Also, 6 grams of fish oil daily for up to 3 months after kidney transplant has been used.
  • For painful menstrual periods: A daily dose of 1080 mg of EPA and 720 mg DHA along with 1.5 mg of vitamin E daily for 2 months has been used. Also, 500-2500 mg of fish oil has been used daily for 2-4 months.
  • For heart failure: 600 to 4300 mg of omega-3 fatty acids daily for up to 12 months has been used. Also, 1 gram of fish oil daily for about 2.9 years has been used.
  • Heart transplant: 4 grams of fish oil containing 46.5% EPA and 37.8% of DHA daily for one year has been used.
  • For abnormal cholesterol caused by HIV/AIDS treatment: Two capsules of a specific fish oil supplement (Omacor, Pronova BioPharma, Norway) containing 460 mg of EPA plus 380 mg of DHA twice daily for 12 weeks has been used.
  • For high blood pressure: 4 to 15 grams of fish oil daily, taken in single or divided doses, for up to 36 weeks has been used. Also, 3-15 grams of omega-3 fatty acids daily for 4 weeks has been used.
  • For preserving kidney function in patients with severe IgA nephropathy: 1-12 grams of fish oil daily for 2-4 years has been used. Also, 3 grams of fish oil in combination with a drug called renin-angiotensin system blocker (RASB) daily for 6 months has been used.
  • For weak bones (osteoporosis): Four 500 mg capsules of a mixture of evening primrose and fish oil, taken three times daily with meals along with 600 mg of calcium carbonate for 18 months, has been used.
  • For psoriasis: Fish oil capsules containing 3.6 grams of EPA and 2.4 grams of DHA daily for 15 weeks along with UVB therapy have been used.
  • For psychosis: Fish oil capsules containing 700 mg of EPA and 480 mg of DHA mixed with tocopherols and other omega-3 fatty acids daily for 12 weeks has been used.
  • For Raynaud's syndrome: A daily dose of 3.96 grams of EPA and 2.64 grams of DHA for 12 weeks has been used.
  • For abnormal cholesterol levels following a kidney transplant: 6 grams of fish oil daily for 3 months has been used.
  • For rheumatoid arthritis (RA): 10 grams of fish oil daily for 6 months, or fish oil containing 0.5-4.6 grams of EPA and 0.2-3.0 grams of DHA, sometimes along with vitamin E 15 IU, daily for up to 15 months has been used.
BY IV:
  • For psoriasis: 100-200 mL of a specific fish oil solution containing 2.1 to 4.2 grams of EPA and 2.1 to 4.2 grams of DHA (Omegavenous, Fresenius, Oberursel, Germany), given daily for 10 to 14 days, has been used.
  • For rheumatoid arthritis (RA): 0.1-0.2 mg/kg of omega-3 fatty acids from fish oil daily for 7 days has been used. Also, 0.2 grams/kg of a specific fish oil solution (Omegaven, Fresenius-Kabi) daily for 14 consecutive days, followed by 0.05 grams of fish oil by mouth daily for 20 weeks, have been used.
APPLIED TO THE SKIN:
  • For psoriasis: Applying fish oil under a dressing for 6 hours daily for 4 weeks has been used.
CHILDREN

BY MOUTH:
  • For developmental coordination disorder in children: Fish oil providing 558 mg of EPA and 174 mg of DHA in three divided doses daily for 3 months has been used in children aged 5-12 years.
  • For improving movement disorders in children with poor coordination (dyspraxia): A specific supplement containing fish oil in combination with evening primrose oil, thyme oil, and vitamin E (Efalex, Efamol Ltd), taken daily for 4 months, has been used.

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