What Not to Take with Vascepa: A Guide to Key Drug Interactions

October 9, 2025 •

4 min read

Vascepa (icosapent ethyl) significantly reduces the risk of major cardiovascular events, but clinical trials show it also increases the risk of bleeding events, particularly when taken with other blood thinners. Understanding what not to take with Vascepa is crucial for patient safety and treatment effectiveness.

Quick Summary

Vascepa can interact with other drugs and supplements, most notably those that increase bleeding risk, like anticoagulants and NSAIDs. Some medications may also counteract its triglyceride-lowering effects. Precaution is needed for certain health conditions.

Key Points

Blood thinners increase bleeding risk: Taking Vascepa with anticoagulants like warfarin or antiplatelets like aspirin significantly raises the risk of bleeding.
Certain medications reduce Vascepa's effectiveness: Some drugs, including certain beta-blockers, thiazide diuretics, and estrogens, can increase triglyceride levels, undermining Vascepa's benefits.
Caution with specific supplements: Herbal products like garlic, ginkgo biloba, and ginseng, along with supplemental fish oil, should be discussed with a doctor due to potential bleeding risks.
Limit alcohol intake: Excessive alcohol consumption can raise triglyceride levels and counteract the positive effects of Vascepa.
Monitor for allergies and health conditions: Individuals with fish/shellfish allergies, liver problems, or a history of atrial fibrillation should use Vascepa with caution and under medical supervision.
Report unusual bleeding: Seek immediate medical attention if you experience signs of serious bleeding, such as persistent nosebleeds, tarry stools, or excessive bruising.
Swallow capsules whole: Vascepa capsules should not be crushed, chewed, or opened, as this could affect drug absorption.

Critical drug interactions with Vascepa

When a physician prescribes a medication like Vascepa to lower very high triglyceride levels or reduce cardiovascular risk, it is essential to be aware of potential drug interactions. Vascepa, a high-purity form of eicosapentaenoic acid (EPA), can interact with other medications and supplements, primarily by increasing the risk of bleeding or interfering with its effectiveness. Always provide a complete list of your medications and supplements to your healthcare provider to ensure safe and effective treatment.

Increased bleeding risk with blood thinners

One of the most significant and well-documented interactions with Vascepa involves medications that affect blood clotting. Because high-dose omega-3 fatty acids can inhibit platelet aggregation, combining Vascepa with other blood-thinning agents can substantially increase the risk of bleeding. Patients should be closely monitored for signs of bleeding, including unusual bruising, nosebleeds, or blood in the stool.

Anticoagulants

These are prescription medications used to treat or prevent blood clots. Concurrent use with Vascepa can lead to a greater risk of serious bleeding events. Your doctor will determine if this combination is appropriate for you and will monitor your condition carefully. Common examples include:

Warfarin (Coumadin, Jantoven)
Apixaban (Eliquis)
Dabigatran (Pradaxa)
Rivaroxaban (Xarelto)
Enoxaparin (Lovenox)

Antiplatelet agents

These drugs help prevent blood clots by stopping platelets from sticking together. When combined with Vascepa, the risk of bleeding is heightened. Examples include:

Aspirin
Clopidogrel (Plavix)
Prasugrel (Effient)
Ticagrelor (Brilinta)

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Over-the-counter and prescription NSAIDs also have antiplatelet effects and can increase bleeding risk when taken with Vascepa. Examples include:

Ibuprofen (Advil, Motrin)
Naproxen (Aleve)

Medications that can reduce Vascepa's effectiveness

Certain medications may increase triglyceride levels, thereby counteracting the therapeutic effects of Vascepa. If these drugs are medically necessary, your doctor may need to adjust dosages or monitor you more frequently.

Beta-blockers: Some beta-blockers, like metoprolol and propranolol, can increase triglyceride levels. While this interaction is generally considered low-risk, doctors may prescribe a higher Vascepa dose if necessary.
Thiazide diuretics: Used to treat high blood pressure, these medications can increase triglycerides. An adjustment to your treatment plan may be needed.
Estrogens: Hormone therapies containing estrogen, such as those used for birth control or hormone replacement, can increase triglycerides and potentially reduce Vascepa's effect.

Supplements and substances to approach with caution

Herbal supplements

Some herbal supplements are known to have a blood-thinning effect. These should be used with caution, as combining them with Vascepa can further increase bleeding risk.

Garlic
Ginkgo biloba
Ginseng
Fish oil (supplemental forms)

Alcohol

While no direct interaction exists between alcohol and Vascepa, drinking alcohol can significantly raise triglyceride levels. Since Vascepa is prescribed to lower these levels, excessive alcohol consumption can undermine your treatment. Limiting alcohol is a crucial part of the recommended lifestyle changes for managing high triglycerides.

Conditions requiring precautionary measures

Fish or shellfish allergy

Vascepa contains icosapent ethyl derived from fish oil. While it is not known if those with fish or shellfish allergies are at a higher risk of an allergic reaction to Vascepa, caution is advised. Patients should be aware of potential allergic reaction symptoms like hives or swelling and seek medical attention if they occur.

Liver problems

Patients with liver impairment should be monitored, as Vascepa may affect liver enzymes. While the drug can be used in these patients, your doctor will likely perform periodic blood tests to monitor your liver function.

Atrial fibrillation/flutter

Vascepa has been linked to an increased risk of atrial fibrillation or flutter requiring hospitalization. The risk is higher for those with a pre-existing history of these conditions.

Vascepa vs. Other Interacting Medications


Medication/Substance Category	Examples	Interaction with Vascepa	Clinical Consideration
Anticoagulants	Warfarin, Apixaban	Increased bleeding risk	Close monitoring; potential dosage adjustment
Antiplatelet Agents	Aspirin, Clopidogrel	Increased bleeding risk	Careful risk-benefit assessment
NSAIDs	Ibuprofen, Naproxen	Increased bleeding risk	Use with caution and monitor for bleeding
Certain Beta-Blockers	Metoprolol, Propranolol	May reduce Vascepa's effectiveness	Higher Vascepa dose may be required
Thiazide Diuretics	Hydrochlorothiazide	May reduce Vascepa's effectiveness	Treatment adjustments may be necessary
Herbal Supplements	Garlic, Ginkgo Biloba	Potential increased bleeding risk	Consult with doctor before combining
Alcohol	Ethanol	Increases triglyceride levels	Limit consumption to not undermine treatment goals

How to safely manage medications with Vascepa

Managing your medications while on Vascepa is a collaborative effort with your healthcare team. Here are some steps you can take:

Keep an updated medication list: Share all prescription drugs, over-the-counter medicines, and supplements with your doctor and pharmacist.
Report any signs of bleeding: Immediately inform your doctor of any unusual bruising, nosebleeds, or blood in your stool or vomit.
Adhere to diet and exercise: Vascepa is part of a comprehensive treatment plan that includes lifestyle changes. These changes are vital for optimal results.
Do not alter capsules: Swallow Vascepa capsules whole. Crushing or chewing them is not recommended.
Don't double dose: If you miss a dose, take it as soon as you remember, but do not take a double dose to catch up.

Conclusion

Successfully managing your treatment with Vascepa requires an understanding of potential drug interactions and adherence to precautions. The primary concern is the increased risk of bleeding when taken alongside other blood-thinning agents, including anticoagulants, antiplatelets, and certain supplements. Additionally, some medications and alcohol can compromise the drug's effectiveness by raising triglyceride levels. By maintaining open communication with your healthcare provider about all substances you consume, you can navigate these risks effectively and ensure the safest possible course of treatment for your cardiovascular health.

Frequently Asked Questions

Combining aspirin with Vascepa increases the risk of bleeding. Your doctor will need to carefully weigh the risks and benefits. Do not start or stop taking aspirin without first discussing it with your healthcare provider.

Excessive alcohol consumption can increase your triglyceride levels, which can counteract the effects of Vascepa. While there is no known direct interaction, it is best to limit or avoid alcohol to ensure the medication works effectively.

Supplements that can increase bleeding risk, such as garlic, ginkgo biloba, and ginseng, should be approached with caution. You should also avoid taking supplemental fish oil, as Vascepa is a high-dose omega-3 and excess intake can be harmful.

Yes, Vascepa is often prescribed as an adjunct to maximally tolerated statin therapy to reduce cardiovascular risk. The combination is generally considered safe and effective under a doctor's supervision.

Signs of a bleeding problem include unusual bruising, nosebleeds, bleeding from gums, prolonged bleeding from cuts, or the presence of red or tarry stools. If you experience these, contact your doctor immediately.

Vascepa contains an omega-3 fatty acid derived from fish oil. While a direct allergic link is unconfirmed, caution is advised. If you have a fish or shellfish allergy, inform your doctor and watch for any signs of an allergic reaction.

Vascepa may cause an increase in liver enzyme levels, especially in patients with pre-existing liver problems. Your doctor will likely monitor your liver function periodically with blood tests during your treatment.