|
Adverse Reactions:
There have been no reports of serious
events, even in patients taking up to 15 grams daily for prolonged periods of
time.
Mild adverse reactions of fish oils
include:
|
mild
gastrointestinal upsets such as nausea, diarrhea, and flatulence |
|
halitosis |
|
eructation |
|
fishy smelling
breath, skin and even urine |
|
occasional
nosebleeds and easy bruising can occur due to blood thinning effects |
|
may exacerbate
asthma in aspirin-sensitive people |
|
avoid in early
pregnancy: fish oils contain vitamin A which may produce birth
defects |
|
fish oil metabolism
uses vitamin E, a powerful antioxidant, so increased vitamin E
intake is required if fish oil is being taken to avoid the lower of
vitamin E levels |
Side
Effects:
Ω-3 is relatively safe as a whole.
There have been concerns regarding increases in LDL, bleeding times, and
worsening of glycemic control in diabetics. In patients taking doses
higher than 3 g/day, clinicians may consider monitoring for clinical
bleeding and both LDL and glycemic response. In large amounts, Ω-3 has an
anti-inflammatory effect; therefore under certain circumstances the immune
system may become impaired, especially in the elderly if they are taking large
amounts for therapeutic reasons. Those with weakened immune systems should
probably avoid large doses of fish oil.
Contraindications:
None known.
Overdosage:
Not reported.
Drug
Interactions:
Favorable interactions include reduced
NSAID and chemotherapeutic drugs used in the treatment of RA. This would mean
fewer nephrotoxic and hypertensive effects of cyclosporine A, lessening the
chance of elevated homocysteine levels caused by methotrexate and sulfasalazine,
as well as ameliorating corticosteroid’s effects on bone density.
Interactions may occur between fish oil
and ASA or other NSAIDS, as well as herbs such as garlic and gingko. These
interactions are most often manifested by increases susceptibility to bruising,
nosebleeds, hemoptysis, hematemesis, hematuria, and blood in the stool.
Environmental Concerns:
Mercury contamination and
other environmental pollutants of fish have recently made the public weary of
ingesting high amounts of fish. To address this concern, a recent consumer
advisory on fish intake in March 2004 was recently updated by the FDA and the
Environmental Protection Agency (EPA). This advisory recommended that pregnant
women, nursing mothers, and children avoid eating fish high in mercury,
including shark, king mackerel, swordfish, and tile fish. Furthermore, the
importance of deity fish was stressed with recommendations of women to eat 2
meals per week (up to 12 oz) of low-risk fish.
|
