What is it?

DHA is an essential fatty acid that comes from fish oil. DHA is used to treat aggression, cancer, dementia, atopic dermatitis (itchy skin), gingivitis (swollen gums), high cholesterol and high triglycerides (blood fats), inflammatory bowel disease, lupus, rheumatoid arthritis, inflammation (pain and swelling), multiple sclerosis, psoriasis, brain development in infants, and high blood pressure.

Other names for DHA include: docosahexaenoic acid, omega-3 fatty acid, and fish oil.

Ask your doctor, nurse, or pharmacist if you need more information about this medicine or if any information in this leaflet concerns you.

Before Using:

Tell your doctor if you

• are taking medicine or are allergic to any medicine (prescription or over-the-counter (OTC) or dietary supplement)
• are pregnant or plan to become pregnant while using this medicine
• are breastfeeding
• have a bleeding disorder (hemophilia, thrombocytopenia) or diabetes
• have any other health problems, such as high blood pressure or heart or blood vessel disease

Dosage:

Talk with your caregiver about how much DHA you should take. The amount depends on the strength of the medicine and the reason you are taking DHA. If you are using this medicine without instructions from your caregiver, follow the directions on the medicine bottle. Do not take more medicine or take it more often than the directions tell you to.

To store this medicine:

Keep all medicine locked up and away from children. Store medicine away from heat and direct light. Do not store your medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down and not work the way it should work. Throw away medicine that is out of date or that you do not need. Never share your medicine with others.

Drug and Food Interactions:

Do not take omega-3 fish oils such as DHA without talking to your doctor first if you are taking:

• Blood thinning medicines (examples: warfarin (Coumadin(R)); dicumarol (Dicumarol(R))) (19)

Warnings:

• Before taking DHA, tell your doctor if you are pregnant or breast feeding
• Fish oils, a source of DHA, can be high in vitamin A and vitamin D. Taking more than 25000 IU of vitamin A per day, or 800 IU of vitamin D per day is not recommended (8)
• If you have a bleeding disorder (hemophilia, thrombocytopenia), you should not DHA without first asking your health care professional (12)
• Olive oil may decrease the ability of DHA to decrease inflammation (pain swelling, redness) (13,14)
• If you have diabetes (blood sugar disease), you should not take DHA without first asking your health care professional (15)

Side Effects:

Call your doctor right away if you have any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hand, swelling or tingling in your mouth or throat, chest tightness, trouble breathing, or rash.

Other Side Effects:

You may have the following side effects, but this medicine may also cause other side effects. Tell your doctor if you have side effects that you think are caused by this medicine.

• Bloating, diarrhea (17,18)
• Bruising and nosebleeds (12)
• Increased blood sugar and lower glucose tolerance in type II diabetic patients (15,20,21)
• Rash with topical use (18,22)
• Vitamin A and vitamin D poisoning (headache, nausea, vomiting, back pain) (16)

References:

1. Anti M, Marra G, Armelao F et al: Modulating effect of omega-3 fatty acids on the proliferative pattern of human colorectal mucosa. In: Hone et al: Eicosanoids and Other Bioactive Lipids in Cancer, Inflammation, and Radiation Injury. Plenum Press, New York, NY; 1997.

2. Marra G, Anti M, Armelao F et al: Rectal epithelial cell proliferation in subjects supplemented with fish oil: a randomized, double-blind trial. In: Drevon CA, Barksaas I & Krokan (eds.): Omega-3 Fatty Acids: Metabolism and Biologic Effects. Birkhauser Verlag, Basel, Switzerland; 1993.

3. Terano T, Fujishiro S, Ban T et al: Docosahexaenoic acid supplementation improves the moderately severe dementia from thrombic cerebrovascular disease. Lipids 1999; 34(suppl):S345-S346.

4. Bonaa KH, Bjerve KS & Nordoy A: Docosahexaenoic and eicosapentaenoic acids in plasma phospholipids are divergently associated with high density lipoprotein in humans. Arteriosclerosis Thrombosis 1992; 12:675-681.

5. Norris PG, Jones CHH & Weston MJ: Effect of dietary supplementation with fish oil on systolic blood pressure in mild essential hypertension. Br Med J 1986; 293:104.

6. Singer P, Jaeger W, Wirth M et al: Lipid and blood-pressure-lowering effect of mackerel diet in man. Atherosclerosis 1983; 49(1):99-108.

7. Lorenz R, Spengler U, Fischer S et al: Platelet function, thromboxane formation and blood pressure control during supplementation of the Western diet with cod liver oil. Circulation 1983; 67(3):504-511.

8. Lininger S (ed): The Natural Pharmacy. Prima Health Publishing, Rocklin, CA; 1998.

9. Sanders TAB & Hinds A: The influence of a fish oil high in docosahexaenoic acid on plasma lipoprotein and vitamin E concentrations and haemostatic function in healthy male volunteers. Br J Nutr 1992; 68:163-173.

10. Aslan A & Triadafilopoulus G: Fish oil fatty acid supplementation in active ulcerative colitis: A double-blind, placebo-controlled crossover study. Am J Gastroenterol 1992; 87:432-437.

11. Geusens P, Wouters C, Nijs J et al: Long-term effect of omega-3 fatty acid supplementation in active rheumatoid arthritis. Arthritis Rheum 1994; 37(6):824-829.

12. Goodnight SH Jr.: The vascular effects of omega-3 fatty acids. J Invest Dermatol 1989; 93:102-106.

13. James MJ, Cleland LG, Gibson RA et al: Interaction between fish and vegetable oils in relation to rat leukocyte leukotriene production. J Nutr 1991; 121(5):631-637.

14. Garg ML, Wierzbicki AA, Thomson ABR et al: Fish oil reduces cholesterol and arachidonic acid more efficiently in rats fed diets containing low linolenic acid to saturated fatty acid ratios. Biochim Biophys Acta 1988; 962:337-344.

15. Horrobin DF: Interactions between n-3 and n-6 fatty acids (EFAs) in the regulation of cardiovascular disorders and inflammation. Prostaglan Leukotr Ess Fatty Acids 1991; 44:127-131.

16. Baird MD & Hough JL: More on fish oils. N Engl J Med 1987; 316:626.

17. Anon: Fish oil for the heart. Med Lett Drug Ther 1987; 29:7-10.

18. Mehta VR: Side effects of eicosapentaenoic acid and docosahexaenoic acid (MaxEPA). JAPI 1992; 40(6):486.

19. Buckley MS, Goff AD & Knapp W: Fish oil interaction with warfarin. Ann Pharmacother 2004; 38:50-53.

20. Glauber H, Wallace P, Griver K et al: Adverse metabolic effect of omega-3 fatty acids in non-insulin dependent diabetes mellitus. Ann Intern Med 1988; 108:663-668.

21. Kasim SE, Stern B, Khilnani S et al: Effects of omega-3 fish oils on lipid metabolism, glycemic control, and blood pressure in type II diabetic patients. J Clin Endocrinol Metab 1988; 67:1-5.

22. Escobar SO, Achenbach R, Iannantuono R et al: Topical fish oil in psoriasis-a controlled and blind study. Clin Exp Dermatol 1992; 17:159-162.

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