REVIEW - Safety considerations with omega-3 fatty acid therapy

November 21, 2008

Am J Cardiol. 2007 Mar 19;99(6A):35C-43C. Epub 2006 Nov 28. Links

Comment in:

Am J Cardiol. 2007 Mar 19;99(6A):44C-46C.

Safety considerations with omega-3 fatty acid therapy.

Bays HE.

Louisville Metabolic and Atherosclerosis Research Center, Louisville,

Kentucky 40213, USA.

It has been suggested that the potential antithrombotic effect of fish

oils may theoretically increase the risk for bleeding, which may be a

safety concern for individual patients. However, clinical trial

evidence has not supported increased bleeding with omega-3 fatty acid

intake, even when combined with other agents that might also increase

bleeding (such as aspirin and warfarin). Another potential safety

concern is the susceptibility of omega-3 fatty acid preparations to

undergo oxidation, which contributes to patient intolerance and

potential toxicity. Finally, large amounts of fish consumption may

result in adverse experiences due to the potential presence of

environmental toxins such as mercury, polychlorinated biphenyls,

dioxins, and other contaminants. The risks of exposure to

environmental toxins and hypervitaminosis with fish consumption are

substantially reduced through purification processes used to develop

selected concentrated fish oil supplements and prescription

preparations. Thus, in choosing which fish oil therapies to recommend,

clinicians should be aware of available information to best assess

their relative safety, which includes the US Food and Drug

Administration (FDA) and Environmental Protection Agency (EPA)

advisory statement regarding fish consumption, the meaning of certain

labeling (such as " verification " through the US Pharmacopeia) and the

differences in FDA regulatory requirements between nonprescription

fish oil supplements and prescription fish oil preparations, and how

all of this is important to the optimal treatment of patients.

PMID: 17368277

Not an MD

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