5 Supplements and Medications Not to Mix With Fish Oil

One in five adults over the age of 60 take fish oil, a supplement extracted from the tissues of fatty fish and rich in omega-3 fatty acids, which support heart, brain, eye and joint health. But even though omega-3s have benefits, some medications and supplements can interact with fish oil in potentially harmful ways. Here are five.

Omega-3 supplements can inhibit blood clotting, which is usually not a problem when taken alone, said Aaron Emmel, PharmD, pharmacist and founder and director of educational programs at Pharmacy Tech Scholar. Health.

However, mixing omega-3s with medications with similar effects, such as blood thinners like warfarin or antiplatelet drugs like aspirin, could increase the risk of bleeding, he said.

If you are taking these medications, talk to your doctor before adding fish oil. They may want to monitor your international normalized ratio, which measures the time it takes for your blood to clot, noted Amy Goldsmith, RDN, LDN, registered dietitian and owner of Kindred Nutrition & Kinetics in Frederick, Maryland.

Ginkgo biloba, an herbal supplement often taken for brain health and conditions like anxiety or PMS, also has antiplatelet properties that make it harder for blood to clot, says Brynna Connor, MD, ABFM, a board-certified family medicine physician and health care ambassador at NorthWestPharmacy.com.

That’s why combining it with fish oil increases the risk of bruising or bleeding, she explained. Health.

Vitamin E, an antioxidant linked to immune, heart and eye health, also thins the blood. When taken with fish oil, it may further increase the risk of bleeding or bruising.

Most adults can get the recommended 15 milligrams (mg) per day of vitamin E from foods like vegetable oils, nuts, seeds, spinach, and broccoli. Supplements often provide more than you need, which can make your risk worse when combined with fish oil.

NSAIDs such as ibuprofen and naproxen reduce pain and inflammation, but may increase the risk of internal bleeding, especially in the gastrointestinal tract. Since omega-3 has anticoagulant properties, taking both at the same time can be risky.

“NSAIDs have an increased bleeding risk with high doses of fish oil,” Goldsmith said, so the combination should be supervised by your provider.

Omega-3s may slightly lower blood pressure. When combined with blood pressure-lowering medications such as ACE inhibitors, beta blockers and calcium channel blockers, their effects can cause blood pressure to drop too far, Emmel said.

“That doesn’t mean you absolutely can’t take fish oil with these supplements,” he noted. “However, if you combine them, do so with caution.”

Adverse effects of fish oil usually occur with higher doses, more than 3,000 mg of EPA and DHA combined per day. “In general, the standard over-the-counter dose is 1,000 to 2,000 mg of total fish oil per day, and it should be safe as long as it is monitored and guided by your doctor,” Emmel said.

That said, many people may not need to take fish oil at all. All three experts recommended getting omega-3s in your diet before turning to supplements. You can probably meet the recommended intake by eating two to three servings of fish per week (a 3-ounce serving of salmon, for example, contains about 2,000 mg of DHA and EPA).

“Supplements are best for people who don’t eat fish or those who need therapeutic supplementation for conditions such as high triglycerides, cardiovascular disease risk and rheumatoid arthritis,” Connor said. Health.

For those who need supplements, Connor suggested choosing those in triglyceride or reesterified triglyceride form, which are more bioavailable than the ethyl ester form. Take them with a meal containing dietary fat to improve absorption, she said.