Fish oil capsules
Fish oil is a component of SMOFLIPID, which was FDA approved in July 2016.
Official documents, adverse reaction reporting, and safety monitoring
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Official medicine documents
Safety monitoring data
Yellow Card reports
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Data from the MHRA Yellow Card scheme. A reported reaction does not necessarily mean the medicine caused it. Contains public sector information licensed under the Open Government Licence v3.0.
EudraVigilance
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38 branded products available
Part of the Nutrigen brand family (generic: Fish oil)
MHRA licensed products
View all licensed products for Fish oil on the MHRA register
Therapeutically similar medicines
Similarity based on WHO Anatomical Therapeutic Chemical (ATC) classification and NHS BNF section grouping. Source data: NHS dm+d via TRUD (OGL v3.0), WHO ATC/DDD Index.
Clinical guidelines and formulary information
British National Formulary
Fish oil
Source: British National Formulary, NICE. Joint Formulary Committee. Contains public sector information licensed under the Open Government Licence v3.0.
NICE clinical guidance(8)
Icosapent ethyl with statin therapy for reducing the risk of cardiovascular events in people with raised triglycerides (TA805)
Neonatal parenteral nutrition (NG154)
Stable angina: management (CG126)
Pancreatic cancer in adults: diagnosis and management (NG85)
Type 2 diabetes: prevention in people at high risk (PH38)
Acute coronary syndromes (NG185)
Rheumatoid arthritis in adults: management (NG100)
Hypertension in pregnancy: diagnosis and management (NG133)
Source: National Institute for Health and Care Excellence (NICE). Contains public sector information licensed under the Open Government Licence v3.0.
Check stock at pharmacies and supply information
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Supply & product information
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Pharmacy links redirect to the retailer's own search and do not represent real-time stock levels. emc (electronic medicines compendium) is operated by Datapharm Ltd. Shortage information sourced from NHS Specialist Pharmacy Service (SPS), sps.nhs.uk.
Codes for healthcare professionals and prescribing systems
These codes are used by healthcare IT systems and prescribers to identify this medicine.
NHS UK identifiers
Browse tools
SNOMED CT and dm+d codes from NHS TRUD (Technology Reference data Update Distribution), licensed under the Open Government Licence v3.0. BNF codes from NHS Business Services Authority (NHSBSA). ATC codes from the WHO Collaborating Centre for Drug Statistics Methodology (whocc.no).
Active and completed clinical studies from ClinicalTrials.gov
Source: ClinicalTrials.gov, a database of the U.S. National Library of Medicine (NLM), National Institutes of Health (NIH). Data accessed via ClinicalTrials.gov API v2. Trial information is provided for research purposes and does not constitute medical advice.
Pharmacology and chemical data from DrugBank
Key facts
Drug status
Approved
Major interactions
None known
Half-life
37 hours
Mechanism
The specific mechanism of action by which the fish oil EPA and DHA acids are cap…
Food interactions
None known
Human targets
11 targets
Data: DrugBank · CC BY-NC 4.0
Pharmacokinetics at a glance
Absorption
95%
[L784]…
Half-life
37 hours
Protein binding
Volume of distribution
82 L
[A18890]
Metabolism
Elimination
Clearance
548 ml
Pharmacokinetic data: DrugBank · CC BY-NC 4.0
More commonly, fish oil refers to the omega-3-fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) [FDA Label]. In general, dietary or pharmaceutical intake of these acids is primarily the only way to increase their levels in the human body where they are overall an essential element to dietary health as they have demonstrated abilities in minimizing or preventing hypertriglyceridemia when taken as an adjunct to a healthy diet [FDA Label].
Such fish oils are available in both non-prescription and prescription-only varieties at different concentrations. For many individuals, taking non-prescription fish oils as part of their multivitamin regimen is an effective way to supplement their diets with the healthy fatty acids. However, prescription-only fish oil products are sometimes prescribed for individuals who demonstrate severe (>= 500 mg/dL) hypertriglyceridemia [FDA Label].
Furthermore, a variety of studies regarding additional potential actions of fish oil omega-3-fatty acids EPA and DHA are ongoing. Such experimental actions include inflammation modulation, cardioprotective effects, the attenuation of oxidative stress, and more. Regardless, the specific mechanisms of action for these effects have yet to be formally elucidated.
Under EMA approval, such fish oil pharmaceuticals comprised of virtually the same fish and fish oil derived omega-3-fatty acids EPA and DHA are indicated specifically for (a) adjuvant treatment in secondary prevention after myocardial infarction, in addition to other standard therapy (ie. statins, antiplatelet medicinal products, beta blockers, ACE inhibitors), and (b) as a supplement to diet when dietary measures alone are insufficient to produce an adequate response, particularly with type IV hypertriglyceridemia in monotherapy or type IIb/III in combination with statins, when control of triglycerides is insufficient .
[L2661]
In addition, prescribing information for EMA approved fish oil pharmaceuticals are also indicated as an adjunct to diet to reduce very high (>=500 mg/dL) triglyceride levels in adult patients, much like similar FDA approved indications [F37, FDA Label].
Known interactions with other medications. Always consult a healthcare professional.
Showing 50 of 454 interactions
[L784]
However, according to the European Food Safety Authority, long-term consumption of EPA and DHA supplements at combined doses of up to about 5 g/day appears to be safe .
[L784]
Commonly reported side effects of omega-3 supplements are usually mild .
[L784]
These include unpleasant taste, bad breath, heartburn, nausea, gastrointestinal discomfort, diarrhea, headache, and odoriferous sweat .
[L784]
Moreover, new paradigms of how inflammation is contained and dissipated involve various newly discovered chemical mediators, resolvins, and protectins [A32933]. Such agents are believed to be directly involved in blocking neutrophil migration, infiltration, recruitment, as well as blocking T-cell migration and promoting T-cell apoptosis [A32933]. Additionally, such protectins can also reduce tumor necrosis factor and interferon secretion [A32933]. Of particular importance, however, is the fact that protectins and resolvins are exclusively derived from omega-3-fatty acids and that EPA is the substrate of the resolvins family and DHA can be converted to both resolvins and protectins [A32933]. It is believed that these effects of such fish oil acids underlie the actions that fish oil have demonstrated on eliciting stability for vulnerable inflammatory plaques [A32933].
Finally, fish oil acids have demonstrated certain direct electrophysiological effects on the myocardium [A32933]. In animal studies, it was shown that the ventricular fibrillation threshold could be increased in both animals fed or infused with omega-3-fatty acids [A32933]. Further studies subsequently revealed that such fatty acids could reduce both sodium currents and L-type calcium currents on a cellular and ion channel level [A32933]. It is consequently hypothesized that during ischemia, a reduction in the sodium ion current protects hyperexcitable tissue, and a reduction in the calcium ion current could reduce arrhythmogenic depolarizing currents - and that perhaps the use of EPA and DHA fish oil acids could facilitate such activity [A32933]. For the time being, however, omega-3-fatty acids in pharmaceutical supplement form have not been shown to elicit such protection against heart conditions [L2662].
Moreover, such fish oil acids can become important components of the phospholipids that form the structures of cell membranes [L784]. Specifically, DHA is particularly high in the retina, brain, and sperm [L784]. Additionally, these acids also provide energy for the body and are used to form eicosanoids - signaling molecules that have similar chemical structures to the fish oil fatty acids from which they are derived [L784]. Furthermore, such eicosanoids possess wide-ranging functions in the cardiovascular, pulmonary, immune, and endocrine systems [L784].
How the body processes this drug — absorption, distribution, metabolism, and elimination
[L784]
[A18890]
[L2661]
Furthermore, it also known that EPA can act as a precursor to DHA .
[A176741]
Proteins and enzymes this drug interacts with in the body
PMID:27184406
Probably plays a central role in cytosolic lipid accumulation. In liver, is primarily responsible for incorporating endogenously synthesized fatty acids into triglycerides (By similarity).
Also functions as an acyl-CoA retinol acyltransferase (ARAT) (By similarity). Also able to use 1-monoalkylglycerol (1-MAkG) as an acyl acceptor for the synthesis of monoalkyl-monoacylglycerol (MAMAG) PMID:28420705
PMID:11939906 PMID:16373578 PMID:19540099 PMID:22942274 PMID:26859324 PMID:27226593 PMID:7592599 PMID:7947975 PMID:9261177
The cyclooxygenase activity oxygenates AA to the hydroperoxy endoperoxide prostaglandin G2 (PGG2), and the peroxidase activity reduces PGG2 to the hydroxy endoperoxide prostaglandin H2 (PGH2), the precursor of all 2-series prostaglandins and thromboxanes .
PMID:16373578 PMID:22942274 PMID:26859324 PMID:27226593 PMID:7592599 PMID:7947975 PMID:9261177
This complex transformation is initiated by abstraction of hydrogen at carbon 13 (with S-stereochemistry), followed by insertion of molecular O2 to form the endoperoxide bridge between carbon 9 and 11 that defines prostaglandins. The insertion of a second molecule of O2 (bis-oxygenase activity) yields a hydroperoxy group in PGG2 that is then reduced to PGH2 by two electrons .
PMID:16373578 PMID:22942274 PMID:26859324 PMID:27226593 PMID:7592599 PMID:7947975 PMID:9261177
Similarly catalyzes successive cyclooxygenation and peroxidation of dihomo-gamma-linoleate (DGLA, C20:3(n-6)) and eicosapentaenoate (EPA, C20:5(n-3)) to corresponding PGH1 and PGH3, the precursors of 1- and 3-series prostaglandins .
PMID:11939906 PMID:19540099
In an alternative pathway of prostanoid biosynthesis, converts 2-arachidonoyl lysophopholipids to prostanoid lysophopholipids, which are then hydrolyzed by intracellular phospholipases to release free prostanoids .
PMID:27642067
Metabolizes 2-arachidonoyl glycerol yielding the glyceryl ester of PGH2, a process that can contribute to pain response .
PMID:22942274
Generates lipid mediators from n-3 and n-6 polyunsaturated fatty acids (PUFAs) via a lipoxygenase-type mechanism. Oxygenates PUFAs to hydroperoxy compounds and then reduces them to corresponding alcohols .
PMID:11034610 PMID:11192938 PMID:9048568 PMID:9261177
Plays a role in the generation of resolution phase interaction products (resolvins) during both sterile and infectious inflammation .
PMID:12391014
Metabolizes docosahexaenoate (DHA, C22:6(n-3)) to 17R-HDHA, a precursor of the D-series resolvins (RvDs) .
PMID:12391014
As a component of the biosynthetic pathway of E-series resolvins (RvEs), converts eicosapentaenoate (EPA, C20:5(n-3)) primarily to 18S-HEPE that is further metabolized by ALOX5 and LTA4H to generate 18S-RvE1 and 18S-RvE2 .
PMID:21206090
In vascular endothelial cells, converts docosapentaenoate (DPA, C22:5(n-3)) to 13R-HDPA, a precursor for 13-series resolvins (RvTs) shown to activate macrophage phagocytosis during bacterial infection .
PMID:26236990
In activated leukocytes, contributes to oxygenation of hydroxyeicosatetraenoates (HETE) to diHETES (5,15-diHETE and 5,11-diHETE) .
PMID:22068350 PMID:26282205
Can also use linoleate (LA, (9Z,12Z)-octadecadienoate, C18:2(n-6)) as substrate and produce hydroxyoctadecadienoates (HODEs) in a regio- and stereospecific manner, being (9R)-HODE ((9R)-hydroxy-(10E,12Z)-octadecadienoate) and (13S)-HODE ((13S)-hydroxy-(9Z,11E)-octadecadienoate) its major products (By similarity).
During neuroinflammation, plays a role in neuronal secretion of specialized preresolving mediators (SPMs) 15R-lipoxin A4 that regulates phagocytic microglia (By similarity)
PMID:22282525 PMID:22343897 PMID:24742677 PMID:24817122 PMID:27852822
LCFAs sensing initiates activation of phosphoinositidase C-linked G proteins GNAQ and GNA11 (G(q)/G(11)), inducing a variety of cellular responses via second messenger pathways such as intracellular calcium mobilization, modulation of cyclic adenosine monophosphate (cAMP) production, and mitogen-activated protein kinases (MAPKs) .
PMID:22282525 PMID:22343897 PMID:24742677 PMID:27852822
After LCFAs binding, associates with beta-arrestin ARRB2 that acts as an adapter protein coupling the receptor to specific downstream signaling pathways, as well as mediating receptor endocytosis .
PMID:22282525 PMID:24817122
In response to dietary fats, plays an important role in the regulation of adipocyte proliferation and differentiation (By similarity). Acts as a receptor for omega-3 polyunsaturated fatty acids (PUFAs) at primary cilium of perivascular preadipocytes, initiating an adipogenic program via cAMP and CTCF-dependent chromatin remodeling that ultimately results in transcriptional activation of adipogenic genes and cell cycle entry (By similarity).
Induces differentiation of brown adipocytes probably via autocrine and endocrine functions of FGF21 hormone (By similarity). Activates brown adipocytes by initiating intracellular calcium signaling that leads to mitochondrial depolarization and fission, and overall increased mitochondrial respiration (By similarity). Consequently stimulates fatty acid uptake and oxidation in mitochondria together with UCP1-mediated thermogenic respiration, eventually reducing fat mass (By similarity).
Regulates bi-potential differentiation of bone marrow mesenchymal stem cells toward osteoblasts or adipocytes likely by up-regulating distinct integrins (By similarity). In response to dietary fats regulates hormone secretion and appetite (By similarity). Stimulates GIP and GLP1 secretion from enteroendocrine cells as well as GCG secretion in pancreatic alpha cells, thereby playing a role in the regulation of blood glucose levels (By similarity).
Negatively regulates glucose-induced SST secretion in pancreatic delta cells (By similarity). Mediates LCFAs inhibition of GHRL secretion, an appetite-controlling hormone (By similarity). In taste buds, contributes to sensing of dietary fatty acids by the gustatory system (By similarity).
During the inflammatory response, promotes anti-inflammatory M2 macrophage differentiation in adipose tissue (By similarity). Mediates the anti-inflammatory effects of omega-3 PUFAs via inhibition of NLRP3 inflammasome activation .
PMID:23809162
In this pathway, interacts with adapter protein ARRB2 and inhibits the priming step triggered by Toll-like receptors (TLRs) at the level of TAK1 and TAB1 (By similarity). Further inhibits the activation step when ARRB2 directly associates with NLRP3, leading to inhibition of pro-inflammatory cytokine release .
PMID:23809162
Mediates LCFAs anti-apoptotic effects (By similarity)
The influx of Na+ ions provokes membrane depolarization, initiating the propagation of electrical signals throughout cells and tissues. The accessory beta subunits participate in localization and functional modulation of the Nav channels .
PMID:24297919
Modulates the activity of SCN1A/Nav1.1 .
PMID:33712547
Modulates the activity of SCN2A/Nav1.2 PMID:24297919
Enzymes involved in drug metabolism — important for understanding drug interactions
Chemical identifiers
CAS, UNII, InChI Key and database cross-references
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Chemical identifiers
CAS, UNII, InChI Key and database cross-references
Linked compound data from DrugBank Open Data (CC BY-NC 4.0)
Fish oil
Additional database identifiers
Drugs Product Database (DPD)
638
HUGO Gene Nomenclature Committee (HGNC)
HGNC:16940
GeneCards
DGAT2
Guide to Pharmacology
3211
UniProt Accession
DGAT2_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:9605
GenAtlas
PTGS2
GeneCards
PTGS2
GenBank Gene Database
L15326
GenBank Protein Database
291988
Guide to Pharmacology
1376
UniProt Accession
PGH2_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:19061
GenAtlas
GPR120
GeneCards
FFAR4
GenBank Gene Database
AY288417
Guide to Pharmacology
127
UniProt Accession
FFAR4_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:1390
GenAtlas
CACNA1C
GeneCards
CACNA1C
GenBank Gene Database
M92270
Guide to Pharmacology
529
UniProt Accession
CAC1C_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:1391
GenAtlas
CACNA1D
GeneCards
CACNA1D
GenBank Gene Database
M76558
GenBank Protein Database
179764
Guide to Pharmacology
530
UniProt Accession
CAC1D_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:1393
GenAtlas
CACNA1F
GeneCards
CACNA1F
GenBank Gene Database
AJ006216
GenBank Protein Database
3183953
Guide to Pharmacology
531
UniProt Accession
CAC1F_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:1397
GenAtlas
CACNA1S
GeneCards
CACNA1S
GenBank Gene Database
U30707
GenBank Protein Database
1698403
Guide to Pharmacology
528
UniProt Accession
CAC1S_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:1401
GenAtlas
CACNB1
GeneCards
CACNB1
GenBank Gene Database
M92303
GenBank Protein Database
179806
UniProt Accession
CACB1_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:1402
GenAtlas
CACNB2
GeneCards
CACNB2
GenBank Gene Database
S60415
GenBank Protein Database
300417
UniProt Accession
CACB2_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:1403
GenAtlas
CACNB3
GeneCards
CACNB3
GenBank Gene Database
X76555
GenBank Protein Database
435135
UniProt Accession
CACB3_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:1404
GenAtlas
CACNB4
GeneCards
CACNB4
GenBank Gene Database
U95020
GenBank Protein Database
2058727
UniProt Accession
CACB4_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:10585
GenAtlas
SCN1A
GeneCards
SCN1A
GenBank Gene Database
AF225985
GenBank Protein Database
12642270
Guide to Pharmacology
578
UniProt Accession
SCN1A_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:10582
GenAtlas
SCN10A
GeneCards
SCN10A
GenBank Gene Database
AF117907
GenBank Protein Database
4838145
Guide to Pharmacology
585
UniProt Accession
SCNAA_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:10583
GenAtlas
SCN11A
GeneCards
SCN11A
GenBank Gene Database
AF188679
GenBank Protein Database
6572950
UniProt Accession
SCNBA_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:10588
GenAtlas
SCN2A
GeneCards
SCN2A
GenBank Gene Database
M94055
GenBank Protein Database
457879
Guide to Pharmacology
579
UniProt Accession
SCN2A_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:10590
GenAtlas
SCN3A
GeneCards
SCN3A
GenBank Gene Database
AJ251507
GenBank Protein Database
7414320
Guide to Pharmacology
580
UniProt Accession
SCN3A_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:10591
GenAtlas
SCN4A
GeneCards
SCN4A
GenBank Gene Database
M81758
GenBank Protein Database
338213
Guide to Pharmacology
581
UniProt Accession
SCN4A_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:10593
GenAtlas
SCN5A
GeneCards
SCN5A
GenBank Gene Database
M77235
GenBank Protein Database
184039
Guide to Pharmacology
582
UniProt Accession
SCN5A_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:10594
GeneCards
SCN7A
UniProt Accession
SCN7A_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:10596
GenAtlas
SCN8A
GeneCards
SCN8A
GenBank Gene Database
AF050736
GenBank Protein Database
4321647
Guide to Pharmacology
583
UniProt Accession
SCN8A_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:10597
GenAtlas
SCN9A
GeneCards
SCN9A
GenBank Gene Database
X82835
GenBank Protein Database
758110
Guide to Pharmacology
584
UniProt Accession
SCN9A_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:10586
GeneCards
SCN1B
GenBank Gene Database
L10338
GenBank Protein Database
307415
UniProt Accession
SCN1B_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:10589
GeneCards
SCN2B
GenBank Gene Database
AF007783
GenBank Protein Database
3309111
UniProt Accession
SCN2B_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:20665
GeneCards
SCN3B
GenBank Gene Database
AJ243396
GenBank Protein Database
7160975
UniProt Accession
SCN3B_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:10592
GeneCards
SCN4B
GenBank Gene Database
AY149967
GenBank Protein Database
27465047
UniProt Accession
SCN4B_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:7795
GenAtlas
NFKB2
GeneCards
NFKB2
GenBank Gene Database
X61498
UniProt Accession
NFKB2_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:7794
GenAtlas
NFKB1
GeneCards
NFKB1
GenBank Gene Database
M55643
GenBank Protein Database
189180
UniProt Accession
NFKB1_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:11289
GeneCards
SREBF1
UniProt Accession
SRBP1_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:9232
GenAtlas
PPARA
GeneCards
PPARA
GenBank Gene Database
L02932
GenBank Protein Database
307341
Guide to Pharmacology
593
UniProt Accession
PPARA_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:9236
GenAtlas
PPARG
GeneCards
PPARG
GenBank Gene Database
U79012
GenBank Protein Database
1711117
Guide to Pharmacology
595
UniProt Accession
PPARG_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:9235
GenAtlas
PPARD
GeneCards
PPARD
GenBank Gene Database
L07592
GenBank Protein Database
190230
Guide to Pharmacology
594
UniProt Accession
PPARD_HUMAN
HUGO Gene Nomenclature Committee (HGNC)
HGNC:2637
GenAtlas
CYP3A4
GeneCards
CYP3A4
GenBank Gene Database
M18907
Guide to Pharmacology
1337
UniProt Accession
CP3A4_HUMAN
Patent information
All patents expired, 3 expired
Source: DrugBank · CC BY-NC 4.0. Patent data sourced from national patent offices. Expiry dates may not reflect extensions, regulatory exclusivity periods, or legal challenges.
DrugBank citations
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