Graded against 178,763 supplements and 757 reviewed supplement and medication pairs, sourced from PubMed, FDA CAERS, openFDA, NIH DSLD
Fish Oil Extended: See fish-oil.md
Fatty AcidLast updated
AVELOR SUMMARY
, epa.md, and dha.md for oil form, sourcing and quality screening notes, including IFOS certification.
Those notes are not sourced by the clinical citations below, and no citation in this file establishes that the triglyceride form is better absorbed than the ethyl ester form, so that comparison is not asserted here.
What the citations below do support: 2 to 4 g/day EPA plus DHA is the range where the biomarker signals are clearest, and the strongest of those signals is triglyceride support, roughly 15% lower in a dose-dependent way on high-certainty evidence (Abdelhamid 2020).
At 1 g/day in a general adult population, hard cardiovascular outcomes did not move (Manson 2019).
REDUCE-IT is the origin of the "25%" figure often quoted for fish oil: 4 g/day icosapent ethyl, a prescription purified EPA ethyl ester, in statin-treated high-risk patients, primary composite endpoint 17.2% versus 22.0%, HR 0.75 (Bhatt 2019).
That is a prescription drug result at a pharmaceutical dose, not a dietary fish oil softgel result.
Independently graded against 178,763 indexed supplements and 757 reviewed supplement and medication pairs, sourced from PubMed, FDA CAERS, openFDA, and NIH DSLD | Last updated:
Not medical advice. Based on published clinical research and systematic reviews.
Medication review
This source review is incomplete. It does not establish which combinations are safe or appropriate for you.
Warfarin (Coumadin)
Source review required
The reviewed sources do not establish one bleeding or INR effect for every fish-oil product. A warfarin case report and a small controlled study had different findings.
Have the prescribing team review the exact omega-3 product and decide on bleeding or INR monitoring. Warfarin dose changes require the prescriber's instructions. The linked LOVAZA label covers monitoring with prescription EPA/DHA ethyl esters. Other mechanism and risk statements in this entry still need source review.
Evidence for prescription EPA/DHA ethyl esters does not establish the same effect for every fish-oil supplement.
FDA label, DailyMed set ID 21cfa4ce-0b05-47ed-b268-339eb1b83b75
(LOVAZA, section 7.1; monitoring/action only; legacy mechanism and risk pending source review)
Official source snapshot reviewed; this does not establish all claims in this entry.
Clopidogrel (Plavix)
Source review required
The cited observational study included aspirin as well as clopidogrel and did not find a statistically significant bleeding difference. It does not establish the risk of every fish-oil and clopidogrel combination.
Review the exact omega-3 product with the prescribing team. The LOVAZA label calls for periodic monitoring when prescription EPA/DHA ethyl esters are used with antiplatelet medicines; it does not establish a monitoring plan for every fish-oil supplement.
The cited prescription products have different formulations. Their precautions do not establish a monitoring plan for every fish-oil supplement.
Official source snapshot reviewed; this does not establish all claims in this entry.
High-dose Aspirin
Source review required
The reviewed trials do not establish a high-dose aspirin interaction estimate or a fish-oil dose cutoff for this entry. ASCEND studied 100 mg aspirin and 1-g omega-3 capsules; those exposures do not validate this high-dose aspirin claim.
The prescribing team needs the aspirin dose and exact omega-3 formulation before giving monitoring or procedure instructions. This entry supplies no universal 3-g cutoff or stop-before-surgery instruction.
The available studies do not define a high-dose aspirin threshold for this interaction. Findings for low-dose aspirin or one prescription omega-3 product cannot establish the effect of other doses or formulations.
Archived abstract; full report access separately enumerated.
Blood pressure medications
Source review required
Blood-pressure effects vary by omega-3 preparation. The reviewed evidence does not establish a predictable benefit or hypotension risk for every blood-pressure medicine.
Have the prescribing team review the exact omega-3 product and blood-pressure medicine, including whether monitoring is needed.
General blood-pressure findings do not establish the effect of combining a particular omega-3 product with a named medicine.
Archived abstract; full report access separately enumerated.
Orlistat (Alli)
Source review required
Orlistat reduces fat absorption. The reviewed omega-3 study measured formulation-specific absorption, not clinical effectiveness or a validated two-hour schedule.
Review the exact omega-3 formulation and timing with the pharmacist or prescribing team. The two-hour XENICAL label instruction concerns fat-soluble vitamin supplements, not a validated fish-oil schedule.
The vitamin-spacing instruction in the XENICAL label is not a fish-oil timing rule. The exact product and formulation matter.
Archived abstract; full report access separately enumerated.
Other combinations awaiting review (9)
Fish Oil with Anticoagulants
Source review required
The risk, benefit, preparation and dose context for this recorded combination remain under review. This entry does not establish that the combination is safe.
Omega-3 fish oil high-dose with Warfarin
Source review required
The risk, benefit, preparation and dose context for this recorded combination remain under review. This entry does not establish that the combination is safe.
Omega-3 fish oil high-dose with Clopidogrel
Source review required
The risk, benefit, preparation and dose context for this recorded combination remain under review. This entry does not establish that the combination is safe.
Fish Oil with Aspirin
Source review required
The risk, benefit, preparation and dose context for this recorded combination remain under review. This entry does not establish that the combination is safe.
Omega-3 fish oil high-dose with Aspirin
Source review required
The risk, benefit, preparation and dose context for this recorded combination remain under review. This entry does not establish that the combination is safe.
Omega-3 (EPA/DHA) with Lisinopril
Source review required
The risk, benefit, preparation and dose context for this recorded combination remain under review. This entry does not establish that the combination is safe.
Omega-3 (EPA/DHA) with Losartan
Source review required
The risk, benefit, preparation and dose context for this recorded combination remain under review. This entry does not establish that the combination is safe.
Omega-3 (EPA/DHA) with Ramipril
Source review required
The risk, benefit, preparation and dose context for this recorded combination remain under review. This entry does not establish that the combination is safe.
Omega-3 (EPA/DHA) with Valsartan
Source review required
The risk, benefit, preparation and dose context for this recorded combination remain under review. This entry does not establish that the combination is safe.