Overview

Eicosapentaenoic acid (EPA) is an omega-3 fatty acid. It's found in the flesh of cold-water fish, including mackerel, herring, tuna, halibut, salmon, cod liver, whale blubber, or seal blubber.

EPA is used as a prescription medicine to reduce triglyceride levels. As a supplement, EPA is most commonly used for heart disease, preventing adverse events after a heart attack, and depression. It is also used for chemotherapy-related side effects, recovery after surgery, and many other conditions, but there is no good scientific evidence to support many of these uses.

Don't confuse EPA with similar fatty acids, such as alpha-linolenic acid and docosahexaenoic acid (DHA), as well as with oils like algal, krill, or fish oils, which contain both EPA and DHA. Most available research involving EPA is from the use of fish oil products containing variable combinations of EPA and DHA. See the separate listings for algal oil, alpha-linolenic acid, DHA, fish oil, and krill oil.

How does it work ?

EPA can prevent the blood from clotting easily. These fatty acids also reduce pain and swelling.

Uses & Effectiveness ?

Effective for

  • High levels of fats called triglycerides in the blood (hypertriglyceridemia). Research shows that taking a prescription drug called Vascepa, which contains pure EPA, helps lowers triglycerides levels by 33% in people with very high levels. This prescription product also lowers triglyceride levels by about 22% and cholesterol levels by 6% in most people taking cholesterol-lowering drugs called "statins" who continue to have high triglyceride levels. Taking this prescription drug also reduces the risk of major heart-related adverse events by about 25% in people taking statins with persistent high triglyceride levels and other heart-related risk factors.

Likely Effective for

  • High levels of blood fats called triglycerides (hypertriglyceridemia). Research shows that taking a specific product containing eicosapentaenoic acid as ethyl eicosapentaenoic acid (Vascepa by Amarin) by mouth along with dieting and cholesterol-lowering drugs called "statins" reduces levels of triglycerides in people with very high levels. It might also improve cholesterol levels. This product is FDA-approved in adults with very high triglyceride levels.

Possibly Effective for

  • Heart disease (cardiovascular disease). In people with high triglycerides and heart disease or a high risk of heart disease, research shows that taking a prescription drug called Vascepa reduces complications such as heart attack and stroke.
  • Depression. Research suggests that taking pure EPA or fish oil containing at least 60% EPA reduces symptoms of depression. It might work best when used along with antidepressant drugs.
  • Heart attack. After a heart attack, people may undergo a procedure called percutaneous coronary intervention (PCI) to improve blood flow to the heart. Taking EPA by mouth along with a drug called a "statin" within 24 hours of PCI reduces the risk of heart-related adverse events such as an irregular heart beat (arrhythmia) or death after the procedure. Also, taking EPA by mouth along with "statins" before undergoing PCI for chest pain reduces the risk of having a heart attack after the procedure.

Insufficient Evidence for

  • An eye disease that leads to vision loss in older adults (age-related macular degeneration or AMD). Eating more EPA as part of the diet does not seem to prevent AMD.
  • Alzheimer disease. Early research suggests that increased intake of EPA in the diet doesn't help prevent Alzheimer disease.
  • Attention deficit-hyperactivity disorder (ADHD). Some research shows that low blood levels of EPA and other fatty acids are linked with ADHD in children. However, it's not known yet if taking EPA supplements can treat or prevent ADHD.
  • A mental disorder marked by unstable mood and behavior (borderline personality disorder). Early research shows that taking EPA seems to slightly lower aggressiveness and slightly relieve depression in women with this mood disorder.
  • Involuntary weight loss in people who are very ill (cachexia or wasting syndrome). Early research shows that taking a nutritional supplement containing EPA while undergoing chemotherapy to treat lung cancer helps prevent the loss of lean body mass better than a nutritional supplement without EPA. However, taking EPA along with a special diet doesn't seem to prevent the loss of lean body mass any more than the special diet alone in people with head and neck cancer when started before treatment.
  • Diarrhea caused by cancer drug treatment. Taking a nutritional supplement containing EPA doesn't seem to prevent diarrhea caused by cancer drug treatment for lung cancer.
  • Nausea and vomiting caused by cancer drug treatment. Taking a nutritional supplement containing EPA doesn't seem to prevent nausea or vomiting caused by cancer drug treatment for lung cancer.
  • Nerve damage in the hands and feet caused by cancer drug treatment. Taking a nutritional supplement containing EPA during cancer drug treatment for lung cancer prevents nerve pain by a small amount.
  • Tiredness in people treated with cancer drugs. Taking a nutritional supplement containing EPA during cancer drug treatment for lung cancer prevents tiredness by a small amount.
  • Non-cancerous growths in the large intestine and rectum (colorectal adenoma). Some research shows that taking EPA with aspirin daily for one year might reduce the number of these growths in people who are at high risk for colon cancer.
  • Heart disease (coronary heart disease). People with coronary artery disease who consume more EPA as part of their diet seem to have a slightly reduced risk of death. Early research shows that taking EPA daily reduces the risk of heart-related adverse events such as heart attacks in people with high cholesterol and coronary artery disease.
  • Diabetes. Early research shows that taking EPA by mouth does not seem to reduce blood sugar or cholesterol levels in people with type 2 diabetes.
  • An inherited brain disorder that affects movements, emotions, and thinking (Huntington disease). Research shows that taking EPA daily for 6 months doesn't improve symptoms of Huntington disease. But some early research shows that taking it for 12 months might improve some symptoms by a small amount.
  • High cholesterol. Taking EPA by mouth might lower levels of fats called triglycerides. But it probably doesn't lower levels of cholesterol.
  • High blood pressure. Taking EPA by mouth doesn't seem to reduce diastolic blood pressure (the bottom number) in people with high blood pressure. But it might reduce systolic blood pressure (the top number) in some people.
  • Infants with birth weight below the 10th percentile due to inadequate nutrition. Taking EPA by mouth does not seem to reduce the risk of an infant having delayed growth while still in the uterus.
  • Lung cancer. Early research shows that taking a nutritional supplement containing EPA (ProSure by Abbott Nutrition) by mouth while undergoing cancer drug treatment for lung cancer doesn't improve response rate or increase survival compared to taking a nutritional supplement without EPA.
  • Symptoms of menopause. Research shows that taking EPA reduces how often hot flashes occur. But EPA does not seem to reduce the intensity of the hot flashes or improve overall quality of life.
  • Infection after surgery. Early research shows that giving EPA, RNA, and L-arginine as part of "tube feeding" after surgery reduces the potential for infections and improves recovery time compared to standard "tube feeding."
  • Recovery after surgery. Weight loss and malnutrition are common after surgery to the esophagus. Early research shows that giving EPA as part of "tube feeds" after surgery to the esophagus doesn't prevent weight loss or loss of lean body mass compared to "tube feeds" without EPA.
  • High blood pressure during pregnancy. Early research shows that taking EPA by mouth does not seem to reduce high blood pressure in women with high-risk pregnancies.
  • Prostate cancer. It's unclear if taking EPA supplements, or eating more of this ingredient in the diet, can reduce the risk for prostate cancer. Some research shows that it might. But most research shows there's no link.
  • Scaly, itchy skin (psoriasis). Early research shows that taking EPA by mouth or giving EPA intravenously (by IV) along with a drug called etretinate improves psoriasis symptoms better than etretinate alone.
  • Schizophrenia. Research to date shows conflicting results about the effectiveness of EPA in treating schizophrenia.
  • A type of inflammatory bowel disease (ulcerative colitis). Some research shows that a higher intake of EPA and other fatty acids in the diet is associated with a reduced risk of having ulcerative colitis. Early research also shows that taking EPA for 6 months might reduce markers of bowel inflammation and the risk of worsening ulcerative colitis.
  • A condition that slowly leads to kidney disease (IgA nephropathy).
  • A rare condition that causes swelling (inflammation) of the blood vessels (Behcet disease).
  • A type of inflammatory bowel disease (Crohn disease).
  • An autoimmune disease that causes widespread swelling (systemic lupus erythematosus or SLE).
  • Asthma.
  • Cystic fibrosis.
  • Eczema (atopic dermatitis).
  • Hay fever.
  • Lung diseases.
  • Menstrual cramps (dysmenorrhea).
  • Migraine.
  • Painful response to cold especially in the fingers and toes (Raynaud syndrome).
  • Rheumatoid arthritis (RA).
  • Swelling (inflammation) of the kidneys in people with lupus.
  • Wound healing.
  • Other conditions.
More evidence is needed to rate EPA for these uses.

Side Effects

When taken by mouth: EPA is LIKELY SAFE for most adults when taken as a prescription product or as fish oil. It has been used safely in studies for up to 7 years. Most side effects are mild and may include nausea, diarrhea, discomfort in the upper abdomen, or belching. Taking EPA with meals can often decrease these side effects. EPA is POSSIBLY SAFE when taken as part of an oil from algae (algal oil) for up to 12 weeks. But people should limit intake of EPA and other omega-3 fatty acids to 3 grams per day, with no more than 2 grams per day from a dietary supplement unless approved by a healthcare provider. Doses of EPA and other omega-3 fatty acids greater than 3 grams per day is POSSIBLY UNSAFE. Taking more than 3 grams per day of omega-3 fatty acids might slow blood clotting and may increase the chance of bleeding.

When given by IV: EPA is POSSIBLY SAFE for most people when given by IV under the supervision of a healthcare provider. It is usually well tolerated.

Special Precautions and Warnings

Pregnancy and breast-feeding: There isn't enough reliable information to know if EPA is safe to use when pregnant or breast-feeding. Stay on the safe side and avoid using more than food amounts.

Irregular heartbeat (arrhythmia): In people with a history of arrhythmias, EPA may further increase risk of irregular heartbeat. If you have had arrhythmias, talk with your healthcare provider before you start taking EPA.

Aspirin-sensitivity: If you are sensitive to aspirin, EPA might affect your breathing.

Interactions ?

    Moderate Interaction

    Be cautious with this combination

  • Medications for high blood pressure (Antihypertensive drugs) interacts with EICOSAPENTAENOIC ACID (EPA)

    EPA can decrease blood pressure. Taking EPA along with medications for high blood pressure might cause you blood pressure to go too low.

    Some medications for high blood pressure include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), Amlodipine (Norvasc), hydrochlorothiazide (HydroDiuril), furosemide (Lasix), and many others.

  • Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs) interacts with EICOSAPENTAENOIC ACID (EPA)

    EPA (eicosapentaenoic acid) might slow blood clotting. Taking EPA (eicosapentaenoic acid) along with medications that also slow clotting might increase the chances of bruising and bleeding.

    Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.

Dosing

The following doses have been studied in scientific research:

BY MOUTH:
  • For high levels of fats called triglycerides in the blood (hypertriglyceridemia): A specific prescription medicine containing pure EPA (Vascepa) has been taken in doses of 2 grams twice daily along with dieting, and sometimes with cholesterol-lowering drugs called "statins."
  • For heart disease (cardiovascular disease): A specific prescription medicine containing pure EPA (Vascepa) 4 grams daily has been used for about 4.9 years.
  • For depression: For treating depression, 0.5-1 gram of EPA (as ethyl-EPA) twice daily has been used along with antidepressant medication. In some cases, EPA is taken with docosahexaenoic acid. The combination formulas containing at least 60% EPA seem to work best. For preventing depression in people receiving interferon-alpha treatment, 3.5 grams of EPA per day has been used for 2 weeks.
  • For heart attack: 1.8 grams of EPA daily in combination with "statins" has been taken for one month or one year following a procedure called percutaneous coronary intervention (PCI). Taking 1.8 grams daily in combination with "statins" for one month before PCI has also been used.
Many fatty acid preparations such as EPA also contain small amounts of vitamin E as an antioxidant to prevent spoilage.

View References

CONDITIONS OF USE AND IMPORTANT INFORMATION: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

This copyrighted material is provided by Natural Medicines Comprehensive Database Consumer Version. Information from this source is evidence-based and objective, and without commercial influence. For professional medical information on natural medicines, see Natural Medicines Comprehensive Database Professional Version. © Therapeutic Research Faculty 2018.