Eicosapentaenoic Acid (EPA)
  Uses of this Supplement
Atherosclerosis
Chronic Obstructive Pulmonary Disease
Crohn's Disease
Diabetes Mellitus
Hypertension
Rheumatoid Arthritis
Ulcerative Colitis
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  Drugs that Interact
Summary
Aspirin
Aspirin-containing Medications
Cyclosporine
Etretinate
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
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  Supplements with Similar Warnings
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Nutrition
Look Up > Supplements > Eicosapentaenoic Acid (EPA) > Interactions
Interactions with Eicosapentaenoic Acid (EPA)
Aspirin

In a double-blind, randomized, crossover study, six healthy volunteers were given aspirin (40 mg/day) combined with omega-3 fatty acids (5.3 g) (Iacoviello et al. 1992). The combination lowered the fibrinolytic response to venous occlusion and could be helpful in the treatment of some forms of coronary artery disease.

Cyclosporine

In a double-blind, randomized, placebo-controlled study, 28 cardiac transplant patients received an immunosuppressive regimen consisting of cyclosporine (6 mg/kg body weight), azathioprine (2 mg/kg/day), and prednisolone (0.2 mg/kg/day) with either omega-3 fatty acids (4 g/day: 46.5% EPA and 37.8% DHA) or placebo (Andreassen et al. 1997). Both treatment groups also received alpha-tocopherol (3.7 mg). Treatment commenced 4 days postoperatively and continued for 6 months, with blood levels of cyclosporine remaining stable for both groups. After 6 months, systolic blood pressure decreased in the omega-3 group and increased in the control group. Diastolic blood pressure increased in both groups; this increase was statistically significant in the control group. An earlier study in 20 cardiac transplant patients receiving omega-3 fatty acids (3 g/day: EPA and DHA) in conjunction with cyclosporine and antihypertensive medications for 12 weeks supports these findings (Ventura et al. 1993). The mechanism of action may be due to decreasing systemic vascular resistance. The combination of omega-3 fatty acids with cyclosporine may show promise as effective hypertension prophylaxis in cardiac transplant patients.

Another placebo-controlled, prospective, double-blind, randomized study involving 26 patients was conducted to evaluate the effects of omega-3 fatty acids on cyclosporine-induced nephrotoxicity (Badalamenti et al. 1995). Liver transplant patients were given omega-3 fatty acids (12 g/day: 18% EPA and 12% DHA) or placebo while on cyclosporine therapy. After 2 months, renal plasma flow increased by 22%, the glomerular filtration rate (GFR) increased by 33%, renal blood flow increased by 17%, and renal vascular resistance decreased by 20% for patients receiving omega-3 fatty acids. No changes were noted in the control group.

Kidney transplant recipients also benefited from supplementation with omega-3 fatty acids (6 g: 30% EPA and 20% DHA) during cyclosporine therapy in a double-blind, placebo-controlled, prospective, randomized clinical trial involving 21 subjects (Homan van der Heide et al. 1990). After 3 months, blood pressure decreased in the omega-3 group, and GFR and renal plasma flow increased by 20.3% and 16.4%, respectively. However, another double-blind, randomized, controlled study with 25 renal transplant patients did not demonstrate any clinically significant benefits derived from one year of treatment with omega-3 fatty acids (6 g: 30% EPA, 20% DHA) (Kooijmans-Coutinho et al. 1996).

Etretinate

A randomized, open study was conducted to evaluate the effects of highly purified EPA (1800 mg/day) in combination with low-dose etretinate (0.3 to 0.5 mg/kg/day) for 12 weeks in patients with chronic, stable psoriasis vulgaris (Danno and Sugie 1998). Patients continued to be treated with a topical corticosteroid that previously had been ineffective. At the end of the study, clinical improvement was noted in 100% of the patients receiving etretinate with EPA as compared to 90% in the patients receiving etretinate monotherapy. The number of patients reporting adverse reactions was similar in both groups.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Omega-3 fatty acids (5 and 10 mL/kg body weight) significantly protected the gastric mucosa against ulcers induced by NSAIDs, reserpine, and necrotizing agents in rats (Al-Harbi et al. 1995).


References

Al-Harbi MM, Islam MW, Al-Shabanah OA, Al-Gharably NM. Effect of acute administration of fish oil (omega-3 marine triglyceride) on gastric ulceration and secretion induced by various ulcerogenic and necrotizing agents in rats. Food Chem Toxicol. 1995;33(7):555-558.

Andreassen AK, Hartmann A, Offstad J, Geiran O, Kvernebo K, Simonsen S. Hypertension prophylaxis with omega-3 fatty acids in heart transplant recipients. J Am Coll Cardiol. 1997;29(6):1324-1331.

Badalamenti S, Salerno F, Lorenzano E, et al. Renal effects of dietary supplementation with fish oil in cyclosporine-treated liver transplant recipients. Hepatol. 1995;22(6):1695-1701.

Danno K, Sugie N. Combination therapy with low-dose etretinate and eicosapentaenoic acid for psoriasis vulgaris. J Dermatol. 1998;25(11):703-705.

Homan van der Heide JJ, Bilo HJ, Tegzess AM, Donker AJ. The effects of dietary supplementation with fish oil on renal function in cyclosporine-treated renal transplant recipients. Transplantation. 1990;49(3):523-527.

Iacoviello K, Amore C, De Curtis A, et al. Modulation of fibrinolytic response to venous occlusion in humans by a combination of low-dose aspirin and n-3 polyunsaturated fatty acids. Arterioscler Thromb. 1992;12(10):1191-1197.

Kooijmans-Coutinho MF, Rischen-Vos J, Hermans J, Arndt JW, van der Woude FJ. Dietary fish oil in renal transplant recipients treated with cyclosporin-A: no beneficial effects shown. J Am Soc Nephrol. 1996;7(3):513-518.

Ventura HO, Milani RV, Lavie CJ, et al. Cyclosporine-induced hypertension. Efficacy of omega-3 fatty acids in patients after cardiac transplantation. Circ. 1993;88(5 pt 2):II281-II285.


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