Does fish oil interact with any medications

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Fish Oil Interaction with Medications

Fish Oil and Warfarin Interaction

Elevated INR Levels

Fish oil can significantly interact with warfarin, a common anticoagulant. A case study reported a 67-year-old woman who experienced a substantial increase in her international normalized ratio (INR) after doubling her fish oil dose from 1000 mg to 2000 mg per day. Her INR rose from 2.8 to 4.3 within a month, indicating an increased risk of bleeding. The INR levels normalized after reducing the fish oil dose, suggesting that fish oil can enhance the anticoagulant effects of warfarin by affecting platelet aggregation and vitamin K-dependent coagulation factors .

Mechanism of Interaction

The interaction is likely due to the omega-3 fatty acids in fish oil, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which can lower thromboxane A2 levels in platelets and decrease factor VII levels. This additive anticoagulant effect necessitates careful monitoring of INR levels in patients taking both fish oil and warfarin .

Fish Oil and Paracetamol Interaction

Enhanced COX Inhibition

Fish oil also interacts with paracetamol (acetaminophen), particularly in patients with rheumatoid arthritis (RA). A study found that fish oil supplementation increased the cyclooxygenase (COX) inhibitory activity of paracetamol. Patients with higher blood levels of EPA experienced greater suppression of COX-1 and COX-2 activities, leading to enhanced inhibition of prostaglandin E2 (PGE2) synthesis. This interaction suggests that combining fish oil with paracetamol can provide additive symptomatic relief equivalent to that of maximum therapeutic doses of nonsteroidal anti-inflammatory drugs (NSAIDs) .

Clinical Implications

Given the cardiovascular risks associated with NSAIDs, fish oil offers a safer alternative for enhancing the analgesic effects of paracetamol in RA patients. This combination can reduce reliance on NSAIDs and their associated risks 24.

Conclusion

Fish oil can interact with various medications, notably warfarin and paracetamol. It can enhance the anticoagulant effects of warfarin, necessitating careful monitoring of INR levels to prevent bleeding complications. Additionally, fish oil can increase the COX inhibitory activity of paracetamol, providing enhanced symptomatic relief in RA patients. These interactions highlight the importance of healthcare providers educating patients about potential drug-herb interactions and monitoring their effects closely.

Sources and full results

Most relevant research papers on this topic

Fish Oil Interaction with Warfarin

Fish oil supplementation can provide additional anticoagulant effects when combined with warfarin therapy, highlighting the need for patients undergoing anticoagulation therapy to be aware of potential drug-herb interactions.

Case ReportHighly Cited

2004·

127citations

·M. Buckleyet al.

Annals of Pharmacotherapy

Fish oil supplementation increases the cyclooxygenase inhibitory activity of paracetamol in rheumatoid arthritis patients.

Fish oil supplementation combined with paracetamol effectively suppresses prostaglandin synthesis, providing additive symptom relief for rheumatoid arthritis patients.

Non-RCT

2010·

37citations

·G. Caugheyet al.

Complementary therapies in medicine

Fish oil supplementation during pregnancy and allergic respiratory disease in the adult offspring

Maternal fish oil supplementation during pregnancy may have prophylactic potential for long-term prevention of asthma in offspring.

RCTLarge Human TrialHighly Cited

2017·

85citations

·Susanne Hansenet al.

The Journal of Allergy and Clinical Immunology

Fish oil: what the prescriber needs to know

Fish oil may provide symptomatic relief and reduce cardiovascular risk in arthritis patients, offering a potential alternative to NSAIDs.

Literature ReviewHighly Cited

2005·

130citations

·L. Clelandet al.

Arthritis Research & Therapy

Efficacy of fish oil and its components in the management of psoriasis: a systematic review of 18 randomized controlled trials.

Fish oil and omega-3 PUFAs combined with conventional treatments may have beneficial effects on psoriasis and its comorbidities, including obesity, cardiovascular disease, and metabolic disease.

Systematic Review

2020·

31citations

·Xi Chenet al.

Nutrition reviews

Effects of fish oil supplementation in rheumatoid arthritis.

Fish oil supplementation effectively suppresses clinical symptoms of rheumatoid arthritis, particularly joint swelling and early morning stiffness.

RCTHighly Cited

1990·

181citations

·H. V. D. Tempelet al.

Annals of the Rheumatic Diseases

Fish oils produce anti-inflammatory effects and improve body weight in severe heart failure.

Fish oils decrease TNF-alpha production in heart failure and improve body weight, potentially offering a novel therapeutic approach for late-stage heart failure with cardiac cachexia.

RCTHighly Cited

2006·

124citations

·M. Mehraet al.

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

Fish oil fatty acid supplementation in active ulcerative colitis: a double-blind, placebo-controlled, crossover study.

Fish oil supplementation improves clinical symptoms of active mild to moderate ulcerative colitis without significantly reducing mucosal leukotriene B4 production compared to placebo.

RCTHighly Cited

1992·

260citations

·A. Aslanet al.

The American journal of gastroenterology

Randomized study of the safety and efficacy of fish oil (omega-3 fatty acid) supplementation with dietary and exercise counseling for the treatment of antiretroviral therapy-associated hypertriglyceridemia.

Fish oil supplementation combined with dietary and exercise counseling effectively reduces fasting triglyceride levels in HIV patients with antiretroviral therapy-associated hypertriglyceridemia.

RCTHighly Cited

2005·

123citations

·D. Wohlet al.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

Fish oil LC-PUFAs do not affect blood coagulation parameters and bleeding manifestations: Analysis of 8 clinical studies with selected patient groups on omega-3-enriched medical nutrition.

Fish oil enriched medical nutrition is safe for consumption in vulnerable populations without increasing bleeding risk, including those with gastrointestinal cancer or in an ICU.

Meta-AnalysisVery Rigorous Journal

2017·

39citations

·Stephanie Jeansenet al.

Clinical nutrition

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