Should You Be Taking Prescription-Strength Fish Oil?


Share on PinterestOne prescription-strength fish oil can be equal to 10 to 40 capsules of over-the-counter fish oil. Getty Images

  • An FDA advisory panel has recommended that more people be eligible for prescription-strength fish oil.
  • The prescription medicine has been shown to reduce triglyceride levels and heart attack risk.
  • There can be side effects, including irregular heartbeat and excessive bleeding.

Should you be taking prescription-strength fish oil?

If you have high triglycerides levels, you might be able to do so pretty soon.

An advisory panel of the Food and Drug Administration (FDA) has recommended changing the standards for prescription-strength fish oil to help more people reduce their risk of heart attack and stroke.

The panel’s unanimous recommendation was prompted by a recent clinical trial that showed taking prescription-strength fish oil could reduce the risk of heart attack, clogged arteries, and other cardiovascular health issues by about 25 percent.

The clinical trial was sponsored by Amarin, the makers of Vascepa (icosapent ethyl).

According to the company, Vascepa is the first and only FDA-approved prescription-strength fish oil on the market to reduce high triglycerides without raising levels of so-called bad cholesterol (LDL-C).

Triglycerides are a type of blood lipid associated with increased risks of heart disease, the leading cause of death in the United States.

Triglyceride levels can become elevated from excessive calorie consumption, alcohol use, and unmanaged diabetes.

Prescription-strength fish oil is currently only available to people with abnormally high triglyceride levels.

However, if the FDA approves its panel’s recommendation, the new rules would mean people with lower levels of fat in their blood would be eligible for prescription fish oil.

So, how does the prescription fish oil differ from the products you buy over the counter?

It’s mostly about omega-3 fatty acids.

“The primary difference has to do with the amount of omega-3 provided,” Andy De Santis, a registered dietitian and weight loss specialist, told Healthline.

“Prescription fish oil has more marine-based omega-3 fatty acids, namely DHA and EPA,” added Kristin Kirkpatrick, nutritionist and author of “Skinny Liver: A Proven Program to Prevent and Reverse the New Silent Epidemic-Fatty Liver Disease.”

“The concentration is also greater,” Kirkpatrick said.

Amarin’s advertisements state that 4 of their pure capsules contain the equivalent of 10 to 40 over-the-counter capsules of fish oil and omega-3 supplements.

The second difference is the amount of data supporting the efficacy and safety of prescription-strength fish oils as opposed to supplemental varieties.

“Prescription fish oil has been shown in studies to help with the management and reduction of triglycerides, and it may help in the prevention of cardiovascular events,” Kirkpatrick told Healthline.

In contrast, “supplemental, over-the-counter omega-3 has mixed data with some studies showing minimal impact on cardiovascular health, depression and anxiety, or cognitive health,” she said.

There’s one other difference.

Vascepa currently costs around $300 per month without insurance. Over-the-counter fish oils and omega-3 supplements are a fraction of that cost.

Supplemental fish oil labels recommend people take 1 gram per day. Vascepa amounts to 4 grams per day.

“This is considered a high dose and carries with it some risks,” said De Santis.

Irregular heartbeat, blood thinning, and excessive bleeding are among the most common issues.

“This is why it’s regulated as a prescription. If you are taking this much, you need to do so under some form of medical supervision,” explained De Santis.

The FDA’s advisory panel addressed the known side effects of prescription-strength fish oil, including internal bleeding.

The panel members concluded that the perceived health benefits outweigh potential risks.

According to the Centers for Disease Control and Prevention (CDC), approximately 25 percent of adults ages 20 and over had elevated triglyceride levels from 2009 to 2012.

Lifestyle factors that contribute include smoking, poor diet, and low physical activity.

“In those with elevated blood triglycerides, omega-3 supplementation may help lower them,” De Santis said.

However, whether you need to take prescription-strength fish oil is something you and your healthcare team should decide.

“Since both over-the-counter fish oil and prescription fish oil can thin the blood, it can be a contraindication for individuals that are on blood thinning medications or when taken before surgery,” Kirkpatrick noted.

“In the majority of cases, I recommend food as the first option for getting all the nutrients you need,” she added.

De Santis said people can naturally increase their omega-3 fatty acids by regularly consuming different types of fish as well as walnuts, chia seeds, flax seeds, and hemp seeds.

“In those who don’t consume omega-3 rich foods, however, a fish oil supplement may offer cardiovascular benefits as it fills in the omega-3 gap,” said De Santis.

If your doctor suggests an over-the-counter supplement fish oil, Kirkpatrick says to look for “marine-based options which don’t need any conversion and which include some combination of DHA and EPA.”

“Then, check for certification by third parties that ensure quality ingredients,” she said.

US Pharmacopeia and are two resources that report on dietary supplements.


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