Based on NIH | Is it safe to eat fish or take fish oil supplements while taking omeprazole?

Eating fish and taking fish oil supplements are generally considered safe while you’re taking omeprazole, and there is no well‑documented harmful interaction between typical omega‑3 supplements and omeprazole. Most official omeprazole interaction lists do not include fish or fish oil as a concern, and they focus on specific prescription drugs (for example, certain HIV medicines, clopidogrel, methotrexate) and some herbal products like St. John’s wort. ^{[1] [2]} In a controlled study, a prescription omega‑3 product (icosapent ethyl, a purified EPA) did not meaningfully change omeprazole blood levels or safety, suggesting co‑use is acceptable. ^[3]

---

What omeprazole interacts with

• Omeprazole can affect how some medicines are absorbed because it reduces stomach acid. This matters for drugs that need an acidic environment (for example, ketoconazole or certain iron salts), not for omega‑3 fats. ^[2]
• Omeprazole can influence liver enzymes (notably CYP2C19), which is why interactions with medicines like clopidogrel are highlighted. These interactions are medication‑specific and are not known to apply to fish or fish oil. ^{[4] [5]}

---

Evidence on fish oil with omeprazole

• A clinical pharmacokinetic study tested omeprazole 40 mg/day with icosapent ethyl 4 g/day and found no significant change in omeprazole exposure (AUC or Cmax) and no safety signal. This supports that omega‑3 supplementation does not interfere in a clinically meaningful way with omeprazole. ^[3]

---

Practical guidance

• Eating fish: There is no known interaction between eating fish and omeprazole, so fish consumption is generally fine while on therapy. ^[1]
• Fish oil supplements: Standard omega‑3 supplements (EPA/DHA) can typically be taken with omeprazole without dose changes. ^[3]

---

When to be cautious

• Bleeding risk: Prescription‑strength omega‑3 products can interact with blood‑thinning medicines by modestly increasing bleeding tendency. While this is not specific to omeprazole, users on anticoagulants or antiplatelets should discuss fish oil with their clinician. ^[6]
• Other medicines: If you’re also taking drugs that are known to interact with omeprazole (for example, clopidogrel, methotrexate, St. John’s wort, rifampin), review your full regimen with your clinician or pharmacist. ^{[1] [7]}

---

Tips for use

• Dosing time: You may take fish oil at a different time of day than omeprazole for convenience; there’s no requirement to separate them for interaction reasons. ^[3]
• Take omeprazole correctly: For best effect, take omeprazole before meals as directed; antacids may be used if needed. ^[1]

---

Summary table

Topic	What to know	Why it matters
Fish intake	Generally safe with omeprazole	No known food interaction with fish. [1]
Fish oil supplements	Generally safe with omeprazole	Clinical data show no meaningful PK effect with EPA ethyl ester. [3]
Acid‑dependent drugs	May have reduced absorption on omeprazole	Applies to certain meds (e.g., ketoconazole, some iron salts), not omega‑3s. [2]
Blood thinners	Monitor if combined with omega‑3s	Omega‑3s can affect clotting; discuss if on anticoagulants/antiplatelets. [6]
Key omeprazole interactions	Clopidogrel, methotrexate, St. John’s wort, rifampin (examples)	Medication‑specific; review with your clinician. [1] [7]

---

If you’re taking other prescription blood thinners or have a bleeding disorder, would you like me to review those alongside your fish oil and omeprazole?