The short answer
A blanket fish-oil avoidance or spacing rule with ticagrelor is not established. Review the exact EPA/DHA product and procedure plans with your treating team.
What this answer covers
Oral fish oil containing EPA and DHA with oral ticagrelor tablets. Purified EPA prescriptions, ALA and all omega-3 doses are not interchangeable.
- Supplement or preparation
- Fish Oil
- Medication ingredient
- ticagrelor
A large trial provides useful counterevidence
The OPERA bleeding analysis included 1,516 cardiac-surgery patients given EPA plus DHA fish oil or placebo. Major perioperative bleeding was not increased with that regimen. This challenges a blanket assumption that all fish oil necessarily increases bleeding, but does not resolve this exact drug combination.
Read the EPA and DHA amounts
Record the daily EPA and DHA dose and whether this is a prescription product or supplement. The trial used a particular preoperative loading and maintenance regimen. It cannot be extended to every omega-3 formulation, purified EPA or unlimited doses.
Plan procedures with your treating team
Ticagrelor reduces platelet activity and can cause serious bleeding. The label also warns that stopping it increases cardiovascular risk, including stent-related harm in relevant patients. Have your prescribing team review supplements and procedure plans; do not stop ticagrelor or assume that a few hours of spacing removes a possible bleeding concern. Tell the team about fish oil before a procedure; do not create your own stopping or spacing schedule.
Know when to get help
Seek urgent care for bleeding that will not stop, vomiting blood or black, tarry stools. Tell your prescriber about the full supplement and medicine list. Do not stop prescribed antiplatelet treatment on your own to accommodate a supplement; ask the treating team to make a plan.
Evidence and practical considerations
Timing & monitoring
A routine fish-oil avoidance rule or protective spacing interval with ticagrelor is not established.
- Exact scope
- Oral fish oil containing EPA and DHA with oral ticagrelor tablets. Purified EPA prescriptions, ALA and all omega-3 doses are not interchangeable. with Exact ticagrelor RxCUI1116632 IN. Oral parent drug and active metabolite have antiplatelet activity; other P2Y12 drugs are not interchangeable.
- Medication form and route
- Oral
What remains uncertain
- Large surgical trial tested a defined EPA/DHA regimen, not an exact prasugrel- or ticagrelor-specific interaction. Results do not establish safety for every formulation or high-dose purified EPA.
Factors that may matter: Exact preparation and dose; Fasting versus fed dosing; Bleeding and ulcer history; Other medicines.
Read the supporting source summaries
Source 1: Current prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Prescription oral oral ticagrelor tablets users; short human pharmacology studies where described.
Significant bleeding risk; stopping treatment raises cardiovascular risk. Strong CYP3A inducers lower exposure and efficacy and should be avoided.
How this applies: Exact current product label. Exact ticagrelor RxCUI1116632 IN. Oral parent drug and active metabolite have antiplatelet activity; other P2Y12 drugs are not interchangeable.
No exact botanical bleeding rate. Rifampin exposure changes are not an effect size for St. John’s wort.
Source 2: Original clinical research
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: 1516 cardiac-surgery patients in the randomized OPERA trial bleeding analysis.
Major perioperative bleeding was not increased versus placebo; odds ratio 0.81, 95% CI 0.53-1.24. Fewer transfusion units were used.
How this applies: Indirect for oral ticagrelor tablets co-use; exact preparation and endpoint retained.
Abstract-only for this capture. Not a trial of chronic oral ticagrelor tablets co-use. Cardiac surgery is a different setting; the exact antiplatelet co-use was not the randomized exposure. Does not represent purified EPA, ALA or all doses.
Source 3: Medication terminology
rxnav.nlm.nih.gov · Source check Sep 10, 2026
Population: Terminology.
ticagrelor is IN.
How this applies: Exact identity.
Not clinical evidence.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Sources checked and article drafted. | |
| Research summary published |
Article revision: d03493f68ea1d8b7
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.