What is it?

EPA is an oil that comes from fish. It is used to treat asthma, cancer, arthritis, Lupus, blood clotting, gingivitis (gum disease), high cholesterol, hypertension (high blood pressure), colitis (inflammatory bowel disease), Crohn's disease, and psoriasis. EPA is also used as an antiinflammatory (help with pain and swelling), to stimulate the immune system, and for cardiovascular health, to help prevent heart disease and stroke. It may also be used to prevent Alzheimer's disease.

Other names for EPA include: Eicosapentaenoic Acid, Fish Oil, Omega-3 Fatty Acid, Essential Fatty Acid.

Ask your doctor, nurse, or pharmacist if you need more information about this medicine or if any information in this leaflet concerns you.

Before Using:

Tell your doctor if you

• are taking medicine or are allergic to any medicine (prescription or over-the-counter (OTC) or dietary supplement)
• are pregnant or plan to become pregnant while using this medicine
• are breast feeding
• have a bleeding problem (hemophilia, thrombocytopenia) or diabetes
• have any other health problems, such as high blood pressure or heart or blood vessel disease

Dosage:

Talk with your caregiver about how much EPA you should take. The amount depends on the strength of the medicine and the reason you are taking EPA. If you are using this medicine without instructions from your caregiver, follow the directions on the medicine bottle. Do not take more medicine or take it more often than the directions tell you to.

To store this medicine:

Keep all medicine locked up and away from children. Store medicine away from heat and direct light. Do not store your medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down and not work the way it should work. Throw away medicine that is out of date or that you do not need. Never share your medicine with others.

Drug and Food Interactions:

Do not take omega-3 fish oils such as EPA without talking to your doctor first if you are taking:

Blood thinning medicines (examples: warfarin (Coumadin(R); dicumarol (Dicumarol(R))

Warnings:

• Before taking EPA, tell your doctor if you are pregnant or breast feeding
• Fish oils, a source of EPA, can be high in vitamin A and vitamin D. Taking more than 25,000 IU of vitamin A per day, or 800 IU of vitamin D per day is not advised while you are taking EPA
• Use only with a doctor's advice if you have diabetes or a bleeding disorder

Side Effects:

Stop taking your medicine right away and talk to your doctor if you have any of the following side effects. Your medicine may be causing these symptoms which may mean you are allergic to it.

• Breathing problems or tightness in your throat or chest
• Chest pain
• Skin hives, rash, or itchy or swollen skin

Other Side Effects:

You may have the following side effects, but this medicine may also cause other side effects. Tell your doctor if you have side effects that you think are caused by this medicine.

• Increased blood sugar, bruising, and nosebleeds have been reported with use of large amounts of fish oils

References:

1. Lininger S (ed): The Natural Pharmacy. Prima Health Publishing, Rocklin, CA; 1998.

2. Anti M, Marra G, Armelao F et al: Modulating effect of omega-3 fatty acids on the proliferative pattern of human colorectal mucosa. In: Hone et al: Eicosanoids and Other Bioactive Lipids in Cancer, Inflammation, and Radiation Injury. Plenum Press, New York, NY; 1997.

3. Aslan A & Triadafilopoulus G: Fish oil fatty acid supplementation in active ulcerative colitis: A double-blind, placebo-controlled crossover study. Am J Gastroenterol 1992; 87:432-437.

4. Kremer JM, Bigauoette J, Michalek AV et al: Effect of manipulation of dietary fatty acids on clinical manifestations of rheumatoid arthritis. Lancet 1985; 1:184-187.

5. Norris PG, Jones CJ, & Weston MJ: Effect of dietary supplementation with fish oil on systolic blood pressure in mild essential hypertension. Br Med J 1986; 293:104.

6. Singer P, Jaeger W, Wirth M et al: Lipid and blood-pressure-lowering effect of mackerel diet in man. Atherosclerosis 1983; 49(1):99-108.

7. Lorenz R, Spengler U, Fischer S et al: Platelet function, thromboxane formation and blood pressure control during supplementation of the Western diet with cod liver oil. Circulation 1983; 67(3):504-511.

8. Cartwright IJ, Pockley AG, Galloway et al: The effects of dietary omega-3 polyunsaturated fatty acids on erythrocyte membrane phospholipids, erythrocyte deformability and blood viscosity in healthy volunteers. Atherosclerosis 1985; 55:267-281.

9. Woodcock BE, Smith E, Lambert WH et al: Beneficial effects of fish oil on blood viscosity in peripheral vascular disease. Brit Med J 1984; 288:592-594.

10. Phillipson BE, Rothrock DW, Connor WE et al: Reduction of plasma lipids, lipoproteins, and apoproteins by dietary fish oils in patients with hypertriglyceridemia. New Eng J Med 1985; 312:1210-1226.

11. Sanders TAB & Hochland MC: A comparison of the influence on plasma lipids and platelet function of supplements of w3 and w6 polyunsaturated fatty acids. Brit J Nutr 1983; 50:521-530.

12. Simons LA, Hickie JB & Balasugramaniam S: On the effects of dietary n-3 fatty acids (Max EPA) on plasma lipids and lipoproteins in patients with hyperlipidemia. Atherosclerosis 1985; 54:75-88.

13. Saynor R, Verel & Gillot T: The long-term effect of dietary supplementation with fish lipid concentrate on serum lipids, bleeding time, platelets and angina. Atherosclerosis 1984; 50:3-10.

14. McCarren T, Hitzemann R, Smith R et al: Amelioration of severe migraine by fish oil (omega-3) fatty acids. Am J Clin Nutr 1985; 41:874a.

15. Belluzzi A, Brignola C, Campieri M et al: Effect of an enteric-coated fish-oil preparation on relapses in Crohn's disease. N Engl J Med 1996; 334:1557-1560.

16. Bjorneboe A, Soyland E, Bjorneboe G-EA et al: Effect of dietary supplementaion with eicosapentaenoic acid in the treatment of atopic dermatitis. Brit J Dermatol 1987; 117:463-469.

17. Soyland E, Rajka G, Bjorneboe A et al: The effect of eicosapentaenoic acid in the treatment of atopic dermatitis. A clinical study. Arch Derm Venereol 1989; 144(suppl):139.

18. Goodnight SH Jr: The vascular effects of omega-3 fatty acids. J Invest Dermatol 1989; 93: 102-106.

19. Horrobin DF: Interactions between n-3 and n-6 fatty acids (EFAs) in the regulation of cardiovascular disorders and inflammation. Prostaglandins Leukotr Essent Fatty Acids 1991; 44: 127-131.

20. Buckley MS, Goff AD & Knapp W: Fish oil interaction with warfarin. Ann Pharmacother 2004; 38:50-53.