Drug & supplement interaction

Eicosapentaenoic Acid (epa) + Ketoconazole

Ketoconazole brand name: Nizoral.

No Known Interaction
Medically reviewed by · Updated July 2026 · Pair last verified Sep 13, 2026
The bottom line No known interaction

We found no known interaction between Eicosapentaenoic Acid (epa) and Ketoconazole in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first. Additionally, although there is no interaction, the two are separately associated with some of the same side effects, which would make a new symptom harder to attribute to one or the other.

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Interaction report

Eicosapentaenoic Acid (epa) and Ketoconazole

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Ketoconazole and Eicosapentaenoic Acid (epa) in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

Eicosapentaenoic Acid (epa) safety at a glance

Eicosapentaenoic A... overall Generally safe EPA is generally well tolerated for most adults at typical supplement doses.
Pregnancy Use caution Omega-3s are often used in pregnancy, but check with your doctor about the right product and dose.
Breastfeeding Use caution Likely acceptable from food and supplements, but confirm dosing with your healthcare provider.

Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Ketoconazole and Eicosapentaenoic Acid (epa)? Ask Dr. Brian Staiger, PharmD, BCPS directly ›
How we checked

Why No Interaction Is Listed for Ketoconazole

Interactions in our licensed database are recorded against drug classes, not just single drug names. Ketoconazole is filed under 8 classifications — including antifungals, cytochrome p450 2c19 (cyp2c19) inhibitors, cytochrome p450 2c9 (cyp2c9) inhibitors. Eicosapentaenoic Acid (epa) has documented interactions with 2 drug classes — the most serious being anticoagulant/antiplatelet drugs (moderate) and antihypertensive drugs (moderate) — and none of Ketoconazole’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

Eicosapentaenoic Acid (epa) Does Interact With Other Medications

Eicosapentaenoic Acid (epa) has 289 moderate known drug interactions in our database — Ketoconazole isn’t one of them. If you take anything else, check it against the full list below.

Moderate 289 No known interaction 2,541 (incl. Ketoconazole)
Taking anything else?

Check Another of Your Medications Against Eicosapentaenoic Acid (epa)

Covers the 2,830 medications we’ve checked against Eicosapentaenoic Acid (epa). Pick one to open its full report.

What to actually watch for

No Interaction Found — But Data Suggests Eicosapentaenoic Acid (epa) and Ketoconazole May Share Several of the Same Side Effects

This is not an interaction. Neither one changes how your body handles the other, and nothing here says they react together. What our sources do show is that each has separately been linked to the effects below — so taking both can make those effects more likely to turn up, and harder to pin on one or the other if they do. One of them is worth acting on rather than waiting out — marked below.

  • Bleeding or bruising Worth acting on Additional detail

    Eicosapentaenoic Acid (epa)

    “Orally, reported side effects of EPA, as well as fish oils containing EPA and docosahexaenoic acid (DHA), have included nosebleed. There is some concern that taking high doses of oils providing EPA along with DHA might decrease blood coagulation and increase the risk of bleeding.”

    Eicosapentaenoic Acid (epa) · Natural Medicines adverse-effect record, reported in bleeding.

    5 sources cited
    1. 10007. Kris-Ehterton PM, Harris WS, Appel LJ, et al. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 2002;106:2747-57. PubMed
    2. 15497. Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 2007;369:1090-8. PubMed
    3. 1313. FDA. Center for Food Safety and Applied Nutrition. Letter regarding dietary supplement health claim for omega-3 fatty acids and coronary heart disease. Available at: http://www.fda.gov/ohrms/dockets/dockets/95s0316/95s-0316-Rpt0272-38-Appendix-D-Reference
    4. 95739. FDA announces qualified health claims for omega-3 fatty acids. Available at: https://www.fda.gov/Food/LabelingNutrition/ucm072756.htm. Accessed April 15 2019.
    5. 101286. Prescribing information: Vascepa (icosapent ethyl). Amarin Pharma, Inc. Bridgewater, NJ, USA. Revised 12/2019. Available at: https://www.vascepa.com/assets/pdf/Vascepa_PI.pdf [Accessed 12/16/2019].

    Ketoconazole

    Listed in the ADVERSE REACTIONS section of the FDA label for Ketoconazole. Read the label on DailyMed ›

  • Bloating or gas / Stomach upset / Diarrhea / Nausea Additional detail

    Eicosapentaenoic Acid (epa)

    “Orally, reported side effects of EPA have included nausea, diarrhea, and epigastric discomfort. For fish oils containing EPA and docosahexaenoic acid, side effects can include fishy taste, belching, nausea, and loose stools.”

    Eicosapentaenoic Acid (epa) · Natural Medicines adverse-effect record, reported in diarrhea.

    5 sources cited
    1. 15497. Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 2007;369:1090-8. PubMed
    2. 103314. Rao A, Briskey D, Nalley JO, Ganuza E. Omega-3 eicosapentaenoic acid (EPA) rich extract from the microalga Nannochloropsis decreases cholesterol in healthy individuals: A double-blind, randomized, placebo-controlled, three-month supplementation study. Nut PubMed
    3. 110365. Mori T, Murasaki K, Yokoyama Y. Long-term safety and efficacy of MND-2119 (self-emulsifying formulation of highly purified eicosapentaenoic acid ethyl ester) in patients with hypertriglyceridemia: Results from a multicenter, 52-week, open-label study. J C PubMed
    4. 110366. Frangou S, Lewis M, McCrone P. Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: Randomized double-blind placebo-controlled study. Br J Psychiatry. 2006;188:46-50.
    5. 10007. Kris-Ehterton PM, Harris WS, Appel LJ, et al. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 2002;106:2747-57. PubMed

    Ketoconazole

    Listed in the ADVERSE REACTIONS section of the FDA label for Ketoconazole. Read the label on DailyMed ›

  • Joint pain / Muscle pain Additional detail

    Eicosapentaenoic Acid (epa)

    “Orally, EPA may cause musculoskeletal pain in some patients, although results from clinical research are conflicting. In one clinical study, a higher percentage of patients treated with ethyl-EPA 2 or 4 grams daily experienced joint pain compared to placebo (3.4% and 1.7% vs 0.4%, respectively).”

    Eicosapentaenoic Acid (epa) · Natural Medicines adverse-effect record, reported in pain.

    2 sources cited
    1. 91409. Ballantyne CM, Bays HE, Kastelein JJ, Stein E, Isaacsohn JL, Braeckman RA, Soni PN. Efficacy and safety of eicosapentaenoic acid ethyl ester (AMR101) therapy in statin-treated patients with persistent high triglycerides (from the ANCHOR study). Am J Cardi PubMed
    2. 15497. Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 2007;369:1090-8. PubMed

    Ketoconazole

    Listed in the ADVERSE REACTIONS section of the FDA label for Ketoconazole. Read the label on DailyMed ›

  • Itching / A skin rash Additional detail

    Eicosapentaenoic Acid (epa)

    “Orally, reported side effects of EPA have included skin rash and itching.”

    Eicosapentaenoic Acid (epa) · Natural Medicines adverse-effect record, reported in pruritus.

    1 source cited
    1. 15497. Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 2007;369:1090-8. PubMed

    Ketoconazole

    Listed in the ADVERSE REACTIONS section of the FDA label for Ketoconazole. Read the label on DailyMed ›

Reported for Eicosapentaenoic Acid (epa) but not commonly for Ketoconazole: an irregular heartbeat.

Effects for Ketoconazole come from the ADVERSE REACTIONS section of its FDA label; effects for Eicosapentaenoic Acid (epa) come from the Natural Medicines adverse-effect record, quoted above. Wording is matched across sources by our own clinical vocabulary, so treat this as a prompt to pay attention, not a diagnosis.

From our Q&A

Questions About Eicosapentaenoic Acid (epa) or Ketoconazole

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Eicosapentaenoic Acid (epa) or Ketoconazole, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Ketoconazole

This page covers Eicosapentaenoic Acid (epa) only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ketoconazole page lists 182 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Beer (major), Grapefruit (major), Siberian Cocklebur (major) and St. John's Wort (major).

By severity: 6 major · 135 moderate · 41 minor.

From our pharmacist’s overview on the Ketoconazole page

“Ketoconazole (Nizoral) is already hard on the liver, so treat its 182 interacting supplements with genuine care, starting with the six rated major. Most of the list runs through CYP3A4, the liver enzyme ketoconazole strongly blocks, so it can raise levels of over a hundred herbal ingredients, while grapefruit pushes ketoconazole itself…”

Reviewed by 2 · Jul 18, 2026

Open the Ketoconazole interaction page

How much people look this up

Where Eicosapentaenoic Acid (epa) and Ketoconazole Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Eicosapentaenoic Acid (epa)
Steady interest

#1,129 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Ketoconazole
Steady interest

#1,865 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Where does our data come from?
  • Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
  • Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every Eicosapentaenoic Acid (epa) reference on this page ↓
  • Freshness: we automatically re-check this combination every week — this pair was last verified September 13, 2026. The Eicosapentaenoic Acid (epa) and Ketoconazole records this page draws on were last updated July 10, 2026.
  • What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.
Data structure & sourcing designed and verified by .
Supplement

About Eicosapentaenoic Acid (epa)

What is Eicosapentaenoic Acid (epa)?

  • Heart and triglyceride health
  • Inflammation
  • Mood and depression support
  • Joint comfort
  • General omega-3 supplementation

EPA is an omega-3 fatty acid found mostly in fatty fish and fish oil, and it is best known for lowering high triglycerides. It may also help with inflammation and mood in some people, but evidence varies by condition. Talk with your pharmacist or doctor before starting, especially if you take blood thinners or have a fish allergy.

Omega-3 fatty acid derived mainly from fatty fish and fish oil; also from algae · Softgel capsules, liquid fish oil, prescription-strength capsules, algae-based supplements

An interaction check asks whether these two react with each other — it does not ask whether Eicosapentaenoic Acid (epa) is a good idea for someone in your situation. Here is what our Eicosapentaenoic Acid (epa) record says about it on its own.

Eicosapentaenoic Acid (epa): dosing

There is no single standard dose of EPA for everyone, and the right amount depends on why you are taking it. Look at the actual amount of EPA listed on the label, since total fish oil is not the same as EPA content.

From our Eicosapentaenoic Acid (epa) monograph — the full record covers uses, side effects and every documented interaction.

Read the full Eicosapentaenoic Acid (epa) monograph & all interactions
Medication

About Ketoconazole

What Is Ketoconazole Used For?

Brand name: Nizoral

Ketoconazole 2% shampoo and foam are used to treat tinea versicolor (also called pityriasis versicolor) — a fungal infection caused by Pityrosporum orbiculare (also known as Malassezia furfur), a yeast that naturally lives on the skin.

This infection creates light or dark patches, most often on the trunk, neck, arms, and upper thighs. Even after the fungus is cleared, those skin patches may take months to return to their normal color — that's normal, and depends on your skin type and sun exposure. Tinea versicolor can also come back, since the fungus lives on healthy skin even when there's no active infection.

Most-Reported Side Effects for Ketoconazole

From FAERS, the FDA’s public side-effect reporting system (0 reports, all brands). Reports are voluntary and are not proof the drug caused the effect.

Pruritus 984 reports
Fatigue 975 reports
Nausea 873 reports
Rash 858 reports
Diarrhea 814 reports
See full Ketoconazole drug information
Keep checking

Other Drugs & Eicosapentaenoic Acid (epa)

Browse every other medication we’ve checked against Eicosapentaenoic Acid (epa) — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
289Moderate
0Minor
2,540No known interaction
289 Moderate 2,540 No interaction
Moderate

289 interactions

Showing 60 of 289 moderate interactions — see all 289 on the Eicosapentaenoic Acid (epa) page.

No interaction 2,540 drugs checked — show the list

We also checked Eicosapentaenoic Acid (epa) against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,540 medications checked with no known interaction — see the full Eicosapentaenoic Acid (epa) list.

See the full Eicosapentaenoic Acid (epa) interactions page
See every supplement checked against Ketoconazole, ranked by severity
Evidence & sources

Eicosapentaenoic Acid (epa) References

The 14 references that drive our Eicosapentaenoic Acid (epa) monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. Prisco D, Paniccia R, Bandinelli B, et al. Effect of medium-term supplementation with a moderate dose of n-3 polyunsaturated fatty acids on blood pressure in mild hypertensive patients. Thromb Res 1998;1:105-12.
  2. Toft I, Bonaa KH, Ingebretsen OC, et al. Effects of n-3 polyunsaturated fatty acids on glucose homeostasis and blood pressure in essential hypertension. A randomized, controlled trial. Ann Intern Med 1995;123:911-8.
  3. Sacks FM, Hebert P, Appel LJ, et al. Short report: the effect of fish oil on blood pressure and high-density lipoprotein-cholesterol levels in phase I of the trials of hypertension prevention. J Hypertens 1994;12:209-13.
  4. Vandongen R, Mori TA, Burke V, et al. Effects on blood pressure of omega 3 fats in subjects at increased risk of cardiovascular disease. Hypertension 1993;22:371-9. PubMed
  5. FDA. Center for Food Safety and Applied Nutrition. Letter regarding dietary supplement health claim for omega-3 fatty acids and coronary heart disease. Available at: http://www.fda.gov/ohrms/dockets/dockets/95s0316/95s-0316-Rpt0272-38-Appendix-D-Reference
  6. Terano T, Hirai A, Hamazaki T, et al. Effect of oral administration of highly purified eicosapentaenoic acid on platelet function, blood viscosity and red cell deformability in healthy human subjects. Atherosclerosis 1983;46:321-31.. PubMed
  7. Kris-Ehterton PM, Harris WS, Appel LJ, et al. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 2002;106:2747-57. PubMed
  8. Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 2007;369:1090-8. PubMed
  9. Ballantyne CM, Bays HE, Kastelein JJ, Stein E, Isaacsohn JL, Braeckman RA, Soni PN. Efficacy and safety of eicosapentaenoic acid ethyl ester (AMR101) therapy in statin-treated patients with persistent high triglycerides (from the ANCHOR study). Am J Cardi PubMed
  10. FDA announces qualified health claims for omega-3 fatty acids. Available at: https://www.fda.gov/Food/LabelingNutrition/ucm072756.htm. Accessed April 15 2019.
  11. Prescribing information: Vascepa (icosapent ethyl). Amarin Pharma, Inc. Bridgewater, NJ, USA. Revised 12/2019. Available at: https://www.vascepa.com/assets/pdf/Vascepa_PI.pdf [Accessed 12/16/2019].
  12. Rao A, Briskey D, Nalley JO, Ganuza E. Omega-3 eicosapentaenoic acid (EPA) rich extract from the microalga Nannochloropsis decreases cholesterol in healthy individuals: A double-blind, randomized, placebo-controlled, three-month supplementation study. Nut PubMed
  13. Mori T, Murasaki K, Yokoyama Y. Long-term safety and efficacy of MND-2119 (self-emulsifying formulation of highly purified eicosapentaenoic acid ethyl ester) in patients with hypertriglyceridemia: Results from a multicenter, 52-week, open-label study. J C PubMed
  14. Frangou S, Lewis M, McCrone P. Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: Randomized double-blind placebo-controlled study. Br J Psychiatry. 2006;188:46-50.

Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Pharmacist Counseling Corner

Taking Eicosapentaenoic Acid (epa) and Ketoconazole Together: Common Questions

Is it safe to take Eicosapentaenoic Acid (epa) with Ketoconazole?
We do not list a known interaction between Eicosapentaenoic Acid (epa) and Ketoconazole. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.
Do Eicosapentaenoic Acid (epa) and Ketoconazole have any of the same side effects?
Yes — our sources link each of them separately to 9 of the same effects. That is not an interaction: neither changes how your body handles the other. It does mean that if one of those effects turns up, it can be harder to tell which one is behind it. They are listed on this page with the source behind each.
How was the Eicosapentaenoic Acid (epa) and Ketoconazole combination checked?
Interactions in our licensed database are recorded against drug classes. Ketoconazole is filed under 8 classifications, and Eicosapentaenoic Acid (epa) has documented interactions with 2 drug classes — none of Ketoconazole's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.
Does Eicosapentaenoic Acid (epa) interact with any other medications?
Yes. Eicosapentaenoic Acid (epa) has 289 documented drug interactions in our database — Ketoconazole is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.
Does Ketoconazole interact with any supplements?
Yes. Ketoconazole has documented interactions with 182 supplements in our database — Eicosapentaenoic Acid (epa) is not one of them. The Ketoconazole interaction page linked on this page lists every one, ranked by severity.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Where next

Keep Exploring

Eicosapentaenoic Acid (epa) monograph Uses, safety profile, and every drug interaction in one place Ketoconazole drug information The full plain-English guide to this medication Ketoconazole supplement interactions Every supplement checked against Ketoconazole, ranked by severity Supplement interaction checker Check any supplement or product against your medications Browse medications A–Z Every drug we’ve checked against herbs & supplements References The 14 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Ketoconazole and Eicosapentaenoic Acid (epa)?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.