Fish Oil

• Overview
• Uses
• Side Effects
• Precautions
• Interactions
• Dosing

Fish oil can be obtained from eating fish or by taking supplements. Fish that are especially rich in the beneficial oils known as omega-3 fatty acids include mackerel, herring, tuna, salmon, cod liver, whale blubber, and seal blubber. Two of the most important omega-3 fatty acids contained in fish oil are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Make sure to see separate listings on EPA and DHA, as well as Cod Liver Oil, and Shark Liver Oil.

Fish oil is FDA approved to lower triglycerides levels, but it is also used for many other conditions. It is most often used for conditions related to the heart and blood system. Some people use fish oil to lower blood pressure, triglycerides and cholesterol levels. Fish oil has also been used for preventing heart disease or stroke, as well as for clogged arteries, chest pain, irregular heartbeat, bypass surgery, heart failure, rapid heartbeat, preventing blood clots, and high blood pressure after a heart transplant.

Fish oil is also used to for many kidney-related problems including kidney disease, kidney failure, and kidney complications related to diabetes, cirrhosis, Berger's disease (IgA nephropathy), heart transplantation, or using the drug called cyclosporine.

Fish may have earned its reputation as "brain food" because some people eat fish to help with depression, bipolar disorder, psychosis, attention deficit-hyperactivity disorder (ADHD), Alzheimer's disease, developmental coordination disorder, migraine headache, epilepsy, schizophrenia, post-traumatic stress disorder, and mental impairment.

Some people use fish oil for dry eyes, cataracts, glaucoma, and age-related macular degeneration (AMD), a very common condition in older people that can lead to serious sight problems.

Fish oil is taken by mouth for stomach ulcers caused by Helicobacter pylori (H. pylori), inflammatory bowel disease, pancreatitis, an inherited disorder called phenylketonuria, allergy to salicylate, Crohn's disease, Behcet's syndrome, and Raynaud's syndrome.

Women sometimes take fish oil to prevent painful periods; breast pain; and complications associated with pregnancy such as miscarriage (including that caused by a condition called antiphospholipid syndrome), high blood pressure late in pregnancy, early delivery, slow infant growth, and to promote infant development.

Fish oil is also taken by mouth for weight loss, exercise performance and muscle strength, muscle soreness after exercise, pneumonia, cancer, lung disease, seasonal allergies, chronic fatigue syndrome, and for preventing blood vessels from re-narrowing after surgery to widen them.

Fish oil is also used for diabetes, prediabetes, asthma, a movement and coordination disorder called dyspraxia, dyslexia, eczema, autism, obesity, weak bones (osteoporosis), rheumatoid arthritis (RA), osteoarthritis, psoriasis, an autoimmune disease called systemic lupus erythematosus (SLE), multiple sclerosis, HIV/AIDS, cystic fibrosis, gum disease, Lyme disease, sickle cell disease, and preventing weight loss caused by some cancer drugs.

Fish oil is used intravenously (by IV) for scaly and itchy skin (psoriasis), blood infection, cystic fibrosis, pressure ulcers, and rheumatoid arthritis (RA).

Fish oil is applied to the skin for psoriasis.

How does it work?

A lot of the benefit of fish oil seems to come from the omega-3 fatty acids that it contains. Interestingly, the body does not produce its own omega-3 fatty acids. Nor can the body make omega-3 fatty acids from omega-6 fatty acids, which are common in the Western diet. A lot of research has been done on EPA and DHA, two types of omega-3 acids that are often included in fish oil supplements.

Omega-3 fatty acids reduce pain and swelling. This may explain why fish oil is likely effective for psoriasis and dry eyes. These fatty acids also prevent the blood from clotting easily. This might explain why fish oil is helpful for some heart conditions.

Effective for...

• High triglycerides. Research suggests that fish oil from supplements and food sources can reduce triglyceride levels. The effects of fish oil appear to be the greatest in people who have very high triglyceride levels. Also the amount of fish oil consumed seems to directly affect how much triglyceride levels are reduced. One particular fish oil supplement called Lovaza has been approved by the FDA to lower triglycerides. A one-gram capsule of Lovaza contains 465 milligrams of EPA and 375 milligrams of DHA. But, a small study suggests that taking fish oil daily for 8 weeks might not reduce triglycerides in adolescents.

Likely Effective for...

• Heart disease. Research suggests that eating fish can be effective for keeping people with healthy hearts free of heart disease. People who already have heart disease might also be able to lower their risk of dying from heart disease by eating fish. The picture is less clear for fish oil supplements. For people who already take heart medications such as a "statin" and those who already eat a decent amount of fish, adding on fish oil might not offer any additional benefit.

Possibly Effective for...

• Preventing re-blockage of blood vessels after angioplasty, a procedure to open a closed blood vessel. Research suggests that fish oil decreases the rate of blood vessel re-blockage by up to 45% when given for at least 3 weeks before an angioplasty and continued for one month thereafter. But, when given for 2 weeks or less before angioplasty, it doesn't seem to have any effect.
• Miscarriage in pregnant women with an autoimmune disorder called antiphospholipid syndrome. Taking fish oil by mouth seems to prevent miscarriages and increase live birth rates in pregnant women with antiphospholipid syndrome.
• Attention deficit-hyperactivity disorder (ADHD) in children. Early research shows that taking fish oil improves attention, mental function, and behavior in children 8-13 years-old with ADHD. Other research shows that taking a specific supplement containing fish oil and evening primrose oil (Eye Q, Novasel) improves mental function and behavior in children 7-12 years-old with ADHD.
• Bipolar disorder. Taking fish oil along with conventional treatments for bipolar disorder seems to improve symptoms of depression but not mania in people with bipolar disorder.
• Cancer-related weight loss. Taking a high dose of fish oil seems to slow weight loss in some cancer patients. Low doses of fish oil don't seem to have this effect. Some researchers believe fish oil slows cancer-related weight loss by fighting depression and improving the mood of people with cancer.
• Coronary artery bypass surgery. Taking fish oil seems to prevent coronary artery bypass grafts from re-closing following coronary artery bypass surgery.
• Dry eye. Some clinical research shows that eating more fish oil is linked to a lower risk of getting dry eye syndrome in women. Other research shows that taking a specific fish oil product (PRN Dry Eye Omega Benefits softgels) daily modestly improves symptoms of dry eye such as pain, blurred vision, and sensitivity. Other research using other forms of fish oil products suggests that taking these supplements for 4-12 weeks modest improves some dry eye symptoms. However, the sensation of eye dryness is not always improved. Other research also shows that taking a specific combination products containing fish oil and other ingredients might improve some dry eye symptoms; however, this research is conflicted and poor quality.
• High blood pressure caused by the drug cyclosporine. Cyclosporine is a medication that reduces the chance of organ rejection after an organ transplant. Taking fish oil seems to prevent high blood pressure caused by this drug.
• Damage to the kidneys caused the drug cyclosporine. Cyclosporine is a medication that reduces the chance of organ rejection after an organ transplant. Taking fish oil seems to prevent kidney damage in people taking this drug. Fish oil also seems to improve kidney function during the recovery phase following the rejection of a transplanted organ in people taking cyclosporine.
• Developmental coordination disorder (DCD). A combination of fish oil (80%) and evening primrose oil (20%) seems to improve reading, spelling, and behavior when given to children age 5-12 years with developmental coordination disorder. However, it does not seem to improve motor skills.
• Menstrual pain (dysmenorrhea). Research shows that taking fish oil, alone or with vitamin B12, can improve painful periods and reduce the need for pain medications in women with menstrual pain.
• Movement disorder in children (dyspraxia). Taking a fish oil product that also contains evening primrose oil, thyme oil, and vitamin E (Efalex, Efamol Ltd) seems to decrease movement disorders in children with dyspraxia.
• Endometrial cancer. There is some evidence that women who regularly eat about two servings of fatty fish weekly have a reduced risk of developing endometrial cancer.
• Heart failure. Research shows that a higher intake of fish oil from foods or supplements is linked with a reduced risk for heart failure.
• Heart transplant. Taking fish oil seems to preserve kidney function and reduce the long-term rise in blood pressure after heart transplantation.
• Abnormal cholesterol caused by HIV/AIDS treatment. Some research suggests that taking fish oil reduces triglyceride levels in people with abnormal cholesterol levels caused by HIV/AIDS treatment. Taking fish oil might also reduce total cholesterol levels in these people, although results are inconsistent.
• High blood pressure. Fish oil seems to slightly lower blood pressure in people with moderate to very high blood pressure. Some types of fish oil might also reduce blood pressure in people with slightly high blood pressure, but results are inconsistent. Fish oil seems to add to the effects of some, but not all, blood pressure-lowering medications. However, it doesn't seem to reduce blood pressure in people with uncontrolled blood pressure who are already taking blood pressure-lowering medications.
• A certain kidney disease called IgA nephropathy. Some research shows that long-term but not short-term use of fish oil can slow the loss of kidney function in high-risk patients with IgA nephropathy. Fish oil might have greater effects when taken at higher doses. Also, it might be most effective in people with IgA nephropathy who have higher levels of protein in the urine.
• Weak bones (osteoporosis). Research suggests that taking fish oil alone or together with calcium and evening primrose oil slows the rate of bone loss and increases bone density at the thigh bone (femur) and spine in elderly people with osteoporosis.
• Psoriasis. There is some evidence that administering fish oil intravenously (by IV) can decrease the severity of psoriasis symptoms. Also, applying fish oil to the skin also seems to improve some symptoms of psoriasis. But taking fish oil by mouth does not seem to have any effect on psoriasis.
• Psychosis. Some research shows that taking a fish oil supplement might help prevent full psychotic illness from developing in teenagers and young adults with mild symptoms. These effects of fish oil have not been tested in older people.
• Raynaud's syndrome. There is some evidence that taking fish oil can improve cold tolerance in some people with the usual form of Raynaud's syndrome. However, people with Raynaud's syndrome caused by a condition called progressive systemic sclerosis do not seem to benefit from fish oil supplements.
• Abnormal cholesterol following a kidney transplant. Early research suggests that taking fish oil alone or together with cholesterol-lowering drugs can improve cholesterol levels in people with abnormal cholesterol levels after a kidney transplant.
• Rheumatoid arthritis (RA). Taking fish oil by mouth, alone or together with the drug naproxen (Naprosyn), seems to help improve symptoms of RA. People who take fish oil can sometimes reduce their use of pain medications. Also, administering fish oil intravenously (by IV) reduces swollen and tender joints in people with RA.
• Stroke. Moderate fish consumption (once or twice weekly) seems to lower the risk of having a stroke by as much as 27%. However, very high fish consumption (more than 46 grams of fish per day) seems to increase stroke risk, perhaps even double it. Eating fish does not lower stroke risk in people who are already taking aspirin for prevention.

Possibly Ineffective for...

• Chest pain (angina). Research suggests that taking fish oil supplements does not reduce the risk of death or improve heart health in people with chest pain. Some evidence even suggests that fish oil supplements might actually increase the risk of heart-related death in people with chest pain.
• Hardening of the arteries (atherosclerosis). Some research shows that taking fish oil supplements might slightly reduce the progression of atherosclerosis. But most research shows that fish oil doesn't slow the progression or improve symptoms of atherosclerosis.
• Irregular heartbeat (atrial fibrillation). Some research suggests that people who eat fish five or more times weekly have a reduced risk of irregular heartbeat. But most research suggests that eating fatty fish or taking fish oil supplements does not reduce the risk of irregular heartbeat.
• Brain disorder due to blood blow problems (cerebrovascular disease). Some early research suggests that eating fish reduces the risk of cerebrovascular disease. But higher quality research suggests that taking fish oil does not have this effect.
• Liver scarring (cirrhosis). Taking fish oil by mouth does not seem to improve kidney problems associated with liver scarring caused by advanced liver disease.
• Leg pain due to blood flow problems (claudication). Taking fish oil by mouth does not appear to improve walking distance in people with leg pain due to blow flow problems.
• Mental function. Some early research suggests that eating fish or consuming higher amounts of fish oil from dietary sources is linked to improved mental function and reduced mental decline in older people. But, most evidence shows no benefit on mental function in older people or young adults and children.
• Gum disease (gingivitis). Taking fish oil does not seem to improve gingivitis.
• Helicobacter pylori (H. pylori) infection. Taking fish oil by mouth does not seem to improve H. pylori infections when compared to standard medications.
• HIV/AIDS. Some evidence shows that eating food bars containing fish oil does not increase CD4 cell counts in people with human immunodeficiency virus (HIV). Also, taken formula containing fish oil doesn't seem to reduce the amount of HIV in the blood.
• Breast pain (mastalgia). Taking fish oil does not appear to reduce long-term breast pain.
• Migraine headaches. Taking fish oil by mouth does not appear to decrease the number or severity of migraine headaches.
• Osteoarthritis. Evidence suggests that taking fish oil along with glucosamine sulfate does not decrease osteoarthritis symptoms compared to glucosamine sulfate alone.
• Pneumonia. Population research shows no relationship between fish consumption and the risk of developing pneumonia.
• Blood infection (sepsis). Research suggests that administering fish oil intravenously (by IV) does not improve survival or reduce brain injury in people with sepsis.
• Abnormal rapid heart rhythms (ventricular arrhythmias). Population research suggests that eating a lot of fish has no effect on the risk for abnormal rapid heart rhythms. Clinical research is inconsistent. Some research shows that taking fish oil daily does not affect the risk for abnormal heart rhythms. But other research shows that taking fish oil for 11 months delays the development of the condition. However, overall, taking fish oil does not seem to reduce the risk of death in people with abnormal rapid heart rhythms.

Likely Ineffective for...

• Diabetes. Taking fish oil does not lower blood sugar in people with type 2 diabetes. However, fish oil can provide some other benefits for people with diabetes, such as lowering blood fats called triglycerides.

Insufficient Evidence to Rate Effectiveness for...

• Age-related vision loss. There is some evidence that people who eat fish more than once weekly have a reduced risk of developing age-related vision loss. But, clinical research shows that taking fish oil by mouth for up to 5 years does not prevent vision loss.
• Seasonal allergies (hayfever). Early research suggests that mothers who take fish oil supplements during the late stages of pregnancy may lower the occurrence of allergies in their children. But other research suggests that fish oil does not reduce the development of allergies in children when taken by the mother during pregnancy.
• Alzheimer's disease. There is some early evidence that fish oil might help prevent Alzheimer's disease. However, it does not seem to help prevent a decline in thinking skills for most people who have already been diagnosed with Alzheimer's disease.
• Asthma. Some research suggests that fish oil supplements might help TREAT some asthma symptoms, but results are not consistent. Some research shows that taking fish oil improves breathing and reduces the need for medication, but other research suggests that fish oil does not reduce the severity of asthma is children.
  It is also not clear if fish oil can help PREVENT asthma. Some early research suggests that mothers who take fish oil supplements daily during pregnancy reduce the risk of asthma in their children by 35% to 63%. But, fish oil does not seem to provide any benefits when taken while breastfeeding.
• Scaly, itchy skin (eczema). Fish oil might help PREVENT eczema, but research is not consistent. Some early research suggests that mothers who take fish oil supplements during pregnancy reduce the risk of severe eczema in their infants. Also, population research suggests that children who eat fish at least once weekly from 1 to 2 years of age have a lower risk of developing eczema. But other research, including recent studies, suggests that neither supplementation during pregnancy nor supplementation during infancy reduces the risk of eczema. Overall, research suggests that fish oil does not help TREAT eczema once it has developed.
• Autism. Some early research suggests that taking fish oil might lower hyperactivity in children with autism. Other research suggests it does not.
• Cancer. Research on the effects of fish oil in preventing cancer has produced conflicting results. Some population research suggests that eating fish or having higher blood levels of omega-3 fatty acids from fish oil is linked to a lower risk of different cancers, including oral cancer, pharyngeal cancer, esophageal cancer, colon cancer, rectal cancer, breast cancer, ovarian cancer, and prostate cancer. But other research suggests that eating fish does not reduce the risk of cancer.
• Cataracts. There is some early evidence that eating fish three times weekly can slightly lower the risk of developing cataracts.
• Chronic fatigue syndrome (CFS). There is some conflicting evidence about the use of a specific product (Efamol Marine) that combines fish oil and evening primrose oil to reduce the symptoms CFS.
• Chronic kidney disease. Early evidence shows that fish oil might benefit some people with chronic kidney disease who are receiving dialysis treatments. But it's not clear if fish oil helps people with poor kidney function who are otherwise healthy.
• Abnormal cholesterol caused by clozapine. Clozapine is a drug used to treat schizophrenia. Early evidence suggests that taking fish oil reduces triglyceride levels, but increases total cholesterol and low-density lipoprotein (LDL or "bad") cholesterol, in people with abnormal cholesterol levels due to taking clozapine.
• Colorectal cancer. Some early research suggests that taking fish oil during chemotherapy might slow the progression of tumors in people with colorectal cancer.
• Thinking problems (cognitive impairment). Some research suggests that taking 3 specific fish oil capsules (EPAX 1050TG, EPAX AS, Lysaker, Norway) by mouth daily for 12 months might improve memory in people with some cognitive impairment.
• Crohn's disease. Research into the effects of fish oil on Crohn's disease has produced conflicting results. Some research shows that taking a specific fish oil product (Purepa, Tillotts Pharma) can reduce the relapse of Crohn's disease for people who have recovered. However, other research shows that fish oil does not have this effect.
• Cystic fibrosis. Early research suggests that taking fish oil by mouth can improve lung function in people with cystic fibrosis. However, administering fish oil intravenously (IV) does not have this effect.
• Memory loss (dementia). Some early research suggests that eating fish at least once per week reduces the risk of developing dementia. Other research suggests there is no link between fish consumption and the risk of dementia.
• Depression. There is inconsistent evidence on the effect of taking fish oil for depression. Some research shows that taking fish oil along with an antidepressant might help improve symptoms in some people. Other research shows that taking fish oil does not improve depression symptoms. The conflicting results may be due to the amount of EPA and DHA in the supplement or the severity of depression before treatment.
• Kidney damage in people with diabetes (diabetic nephropathy). Evidence suggests that taking fish oil does not improve kidney function in people with diabetic nephropathy.
• Dyslexia. Taking fish oil by mouth seems to improve night vision in children with dyslexia.
• Abnormal cholesterol or fat levels in the blood (dyslipidemia). There is conflicting evidence about the effects of fish oil on cholesterol and fat levels in the blood. Some research shows that taking fish oil can lower triglyceride levels, low density lipoprotein (LDL or "bad") cholesterol, and increase high density lipoprotein (HDL or "good") cholesterol in people with abnormal cholesterol levels. However, other research shows that taking fish oil daily does not have this effect.
• Advanced kidney disease (end stage renal disease). Some evidence suggests that taking fish oil reduces markers of swelling (inflammation) in people with advanced kidney disease.
• Epilepsy. Research suggests that taking omega-3 fatty acids from fish oil by mouth daily for 10 weeks reduces seizures in people with epilepsy that is resistant to drugs.
• Muscle soreness due to exercise. Some research shows that taking fish oil by mouth daily for 1-6 months before and during exercise does not prevent muscle soreness in the elbow or the knee when contracted. But other research suggests that taking fish oil improves soreness from knee extension exercises.
• Exercise performance. Some evidence suggests that taking fish oil can improve lung function in athletes. But other evidence suggests that taking fish oil does not improve endurance, recovery, heart rate, or exercise duration.
• Preventing blockage of grafts used in kidney dialysis. Taking higher doses of fish oil short-term seems to help prevent blood clot formation in hemodialysis grafts. Taking lower doses long-term does not seem to have this effect.
• Prediabetes. Early studies suggest that fish oil may help prevent prediabetes from advancing to type 2 diabetes.
• Infant development. There is some evidence that mothers who eat fish or take fish oil supplements during pregnancy may improve some aspects of their baby's mental development. Taking fish oil during breast-feeding does not have this effect. However, feeding infants formula fortified with fish oil appears to improve some aspect of the baby's vision by the age of 2 months.
• Multiple sclerosis. Taking a specific fish oil product (MaxEPA) does not appear to improve the duration, frequency, or severity of relapses in patients with multiple sclerosis.
• Muscle strength. Some research suggests that taking fish oil daily for 90 to 150 days in addition to 90 days of resistance strength training might improve muscle growth and strength in healthy older women.
• Weight loss. Some research shows that eating fish improves weight loss and decreases blood sugar in people who are overweight with high blood pressure. Early research also shows that taking a specific fish oil supplement (Hi-DHA, NuMega) lowers body fat when combined with exercise. But other evidence suggests that taking another specific fish oil supplement (Lovaza) does not lower body weight in overweight people.
• Swelling of the pancreas (pancreatitis). Evidence suggests that feeding intravenously (IV) with nutrition that has been fortified with fish oil reduces the number of days of kidney replacement therapy needed by people with severe inflammation of the pancreas.
• Phenylketonuria (PKU). Some evidence suggests that taking fish oil supplements improves motor skills, coordination, and vision in children with a rare genetic disorder called phenylketonuria.
• Post-traumatic stress disorder (PTSD). Some early research shows that adding supplements containing omega-3 fatty acids from fish oil to psychoeducation does not provide any further benefits to people with PTSD.
• Pregnancy complications. There is some evidence that taking fish oil or eating seafood during pregnancy can help prevent premature delivery. However, fish oil does not seem to help prevent high blood pressure during pregnancy.
• Prematurity. Baby formula that has been fortified with fatty acids from fish oil and borage oil seems to improve growth and nervous system development in premature infants, especially boys.
• Bed sores (pressure ulcers). Early research suggests that supplementing either a feeding tube or IV with fish oil for 28 days might slow the progression of pressure ulcers.
• Salicylate intolerance. Some early research suggests that taking fish oil might improve symptoms of salicylate intolerance, such as asthma attacks and itching.
• Schizophrenia. There is one report of fish oil improving symptoms of schizophrenia in a pregnant woman.
• Sickle cell disease. Early research suggests that taking fish oil can reduce severe pain episodes in people with sickle cell disease.
• Systemic lupus erythematosus (SLE). Some early studies suggest that fish oil helps improve symptoms of SLE, while other studies show no effect.
• Inflammatory bowel disease (ulcerative colitis). Research studies into the effects of fish oil for treating ulcerative colitis show conflicting results.
• Glaucoma.
• Behcet's syndrome.
• Other conditions.
More evidence is needed to rate fish oil for these uses.

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).

Fish oil is LIKELY SAFE for most people when taken by mouth in low doses (3 grams or less per day). There are some safety concerns when fish oil is taken in high doses. Taking more than 3 grams per day might keep blood from clotting and can increase the chance of bleeding.

High doses of fish oil might also reduce the immune system's activity, reducing the body's ability to fight infection. This is a special concern for people taking medications to reduce their immune system's activity (organ transplant patients, for example) and the elderly.

Only take high doses of fish oil while under medical supervision.

Fish oil can cause side effects including belching, bad breath, heartburn, nausea, loose stools, rash, and nosebleeds. Taking fish oil supplements with meals or freezing them can often decrease these side effects.

Fish oil is POSSIBLY SAFE when injected intravenously (by IV) in the short-term. Fish oil or omega-3 fatty acid solutions have been safely used for 1 to 4 weeks.

Consuming large amounts of fish oil from some DIETARY sources is POSSIBLY UNSAFE. Some fish meats (especially shark, king mackerel, and farm-raised salmon) can be contaminated with mercury and other industrial and environmental chemicals. Fish oil supplements typically do not contain these contaminants.

Children: Fish oil is POSSIBLY SAFE when taken by mouth appropriately. Fish oil has been used safely through feeding tubes in infants for up to 9 months. But young children should not eat more than two ounces of fish per week. Fish oil is POSSIBLY UNSAFE when consumed from dietary sources in large amounts. Fatty fish contain toxins such as mercury. Eating contaminated fish frequently can cause brain damage, mental retardation, blindness and seizures in children.

Pregnancy and breast-feeding: Fish oil is LIKELY SAFE when taken by mouth appropriately. Taking fish oil during pregnancy does not seem to affect the fetus or baby while breast-feeding. Women who are pregnant or who may become pregnant, and nursing mothers should avoid shark, swordfish, king mackerel, and tilefish (also called golden bass or golden snapper), as these may contain high levels of mercury. Limit consumption of other fish to 12 ounces/week (about 3 to 4 servings/week). Fish oil is POSSIBLY UNSAFE when dietary sources are consumed in large amounts. Fatty fish contain toxins such as mercury.

Bipolar disorder: Taking fish oil might increase some of the symptoms of this condition.

Liver disease: Fish oil might increase the risk of bleeding in people with liver scarring due to liver disease.

Depression: Taking fish oil might increase some of the symptoms of this condition.

Diabetes: There is some concern that taking high doses of fish oil might make the control of blood sugar more difficult.

Familial adenomatous polyposis: There is some concern that fish oil might further increase the risk of getting cancer in people with this condition.

High blood pressure: Fish oil can lower blood pressure and might cause blood pressure to drop too low in people who are being treated with blood pressure-lowering medications.

HIV/AIDS and other conditions in which the immune system response is lowered: Higher doses of fish oil can lower the body's immune system response. This could be a problem for people whose immune system is already weak.

An implanted defibrillator (a surgically placed device to prevent irregular heartbeat): Some, but not all, research suggests that fish oil might increase the risk of irregular heartbeat in patients with an implanted defibrillator. Stay on the safe side by avoiding fish oil supplements.

Fish or seafood allergy: Some people who are allergic to seafood such as fish might also be allergic to fish oil supplements. There is no reliable information showing how likely people with seafood allergy are to have an allergic reaction to fish oil. Until more is known, advise patients allergic to seafood to avoid or use fish oil supplements cautiously.

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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.

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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.

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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.

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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.

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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.

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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.

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.