From the Guidelines
The highest dosed omega-3 product available is 4 grams per day of prescription-grade omega-3 fatty acids, including mixtures of EPA and DHA, as well as purified EPA, such as IPE 1.
Key Points
- Prescription omega-3 fatty acid preparations, including ethyl ester and carboxylic acid preparations of DHA and EPA mixtures, and pure EPA as IPE, are available at doses of up to 4 grams per day 1.
- The American Heart Association recommends 2 to 4 g of EPA plus DHA per day for patients who need to lower their triglyceride level 1.
- A dose-response relationship exists between marine-derived omega-3 PUFA and triglyceride lowering, with an approximate 5% to 10% reduction in triglycerides for every 1 g of EPA/DHA consumed 1.
- The REDUCE-IT trial demonstrated a 25% reduction in the primary composite endpoint of cardiovascular death, nonfatal MI, nonfatal stroke, coronary revascularization, or unstable angina with 4 g of EPA (in the form of IPE) daily versus mineral oil placebo 1.
Important Considerations
- Baseline triglyceride levels were not an inclusion criterion for some large randomized controlled trials of omega-3 fatty acids for cardiovascular risk reduction 1.
- The most frequent adverse effects of prescription omega-3 fatty acid preparations include eructation, dyspepsia, taste perversion, musculoskeletal pain, peripheral edema, constipation, gout, and atrial fibrillation 1.
From the Research
Omega-3 Products and Dosage
- The highest dosed omega-3 product is not explicitly stated in the provided studies, but it is mentioned that high-purity eicosapentaenoic acid (EPA) ethyl ester and EPA/docosahexaenoic acid (DHA) preparations have been developed for the treatment of hypertriglyceridemia 2.
- The American Heart Association recommends consumption of approximately 1 g per day of eicosapentaenoic acid plus docosahexaenoic acid for cardioprotection, while higher dosages of 2 to 4 g per day are required to reduce elevated triglyceride levels 3.
- A study suggests that consistent cardiovascular effects of omega-3 PUFA supplements could be expected only with daily doses above 2000 mg 4.
- The REDUCE-IT study used a high dose of high-purity EPA preparation and showed a relative reduction in cardiovascular events, while the STRENGTH study used a high dose of EPA/DHA preparation but did not support this benefit 2.
Comparison of Omega-3 Products
- A study analyzed nine commercially available omega-3 fatty acid supplements and found huge differences in their long-chain omega-3 fatty acid content, with some products failing to achieve the daily recommended dose of 1 g 5.
- The study found that the highest percentage of DHA and EPA was detected in Omacor (95.80 +/- 0.63%) and Percucor (76.8 +/- 7.109%) 5.
- It is advisable to use the most standardized and purified products available to ensure consistent intake of omega-3 fatty acids 5.