Warfarin Institute of America
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THE INTERACTION BETWEEN FISH OIL AND WARFARIN
Buckley et al report a case where a woman was taking warfarin and fish oil. Her INR was stable until she doubled the dose of the fish oil. The INR increased from 2.8 to 4.3. The warfarin dose was decreased. She then decreased her fish oil dose to the previous level and the INR went down to 1.6. When the fish oil dose was kept at the same level as before, the warfarin dose was returned to the same level.
This case illustrates how much we do not know yet about the things that affect warfarin. It is prudent to check the INR shortly after making any change to other medications, prescription or not, because they may affect the warfarin dosage.
Holbrook et al published a systematic review of things that interact with warfarin. They rate it as highly probable that the INR will increase, necessitating a lower warfarin dose when someone taking warfarin adds fish oil to their medications.
Reference:
Buckley MS et al. Fish oil interaction with warfarin. Ann Pharmacother. 2004;38:50-2.
Holbrook AM et al. Systematic Overview of warfarin and its drug and food interactions. Arch Intern Med 2005;165:1096-1106.
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Last updated May 25, 2005