Q: How can I integrate fish oil with the medicines (Coumadin® and Lipitor®) I currently take for my heart condition? Is this something I need to make my doctor aware of?

A: Coumadin® is a brand name of warfarin, an anticoagulant drug often prescribed for certain heart, vascular, and lung conditions. It decreases the blood’s clotting ability by inhibiting vitamin K-dependent coagulation factors. Lipitor®, a brand name of atorvastatin, is a statin drug belonging to a group of medicines called HMG-CoA reductase inhibitors. Lipitor® and other statin drugs work by blocking an enzyme that the body needs to make cholesterol, thereby reducing the amount of cholesterol in the blood.

The use of fish oil in conjunction with statin drugs like Lipitor® is not contraindicated in any way. In fact, using Lipitor® may even enhance fish oil’s ability to increase levels of high-density lipoprotein (HDL), a beneficial blood lipid, and lower levels of dangerous triglycerides. Having said that, I strongly recommend physician monitoring of patients who take such medications and want to incorporate fish oil in their diet to help regulate cholesterol or triglyceride levels.

Patients who take anticoagulant drugs like Coumadin® should be aware that some studies have shown that the omega-3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) found in fish oil can prolong bleeding times. However, the prolonged bleeding times reported in these studies did not exceed normal limits or produce clinically significant episodes that would warrant a restriction of fish oil to help regulate blood lipids. Patients who wish to take Coumadin® and fish oil should have their clotting times periodically monitored by a health care professional.

The use of fish oil in combination with other medications should always be discussed with your physician. Beta-blockers, such as Tenormin® (atenolol) and Lopressor® (metoprolol), are prescribed for high blood pressure (hypertension), angina (chest pain), and heart attacks. Some evidence suggests that combining fish oil containing EPA/DHA with beta-blockers may have an additive (albeit mild) antihypertensive effect, thus underscoring the need for physician monitoring when combining fish oil with prescription medications.

Diuretics, another class of medications that may fall into this same precautionary category, are used to treat high blood pressure and fluid retention caused by various conditions, including heart disease. Diuretics cause the kidneys to excrete unneeded water and salt from the body into the urine. Some common drugs in this class are HydroDiuril® (hydrochlorothiazide) and Lozol® (indapamide). When used in combination with fish oil, dosages of these medications may have to be adjusted at the direction of your physician.

A sensible diet plan should always be followed by all patients taking heart medications. This diet plan should include foods low in cholesterol and unhealthy fats (such as saturated and trans fats).