NutriStack
Fish Oil and Fluoxetine, a caution.
Fluoxetine depletes platelet serotonin and impairs aggregation, while high-dose fish oil adds modest antiplatelet activity. Observational data show SSRIs increase upper GI bleeding risk by roughly 55%; adding another antiplatelet substance compounds that risk.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Fish Oil and Fluoxetine
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Moderate evidence
Caution
What is happening. Fluoxetine depletes platelet serotonin and impairs aggregation, while high-dose fish oil adds modest antiplatelet activity. Observational data show SSRIs increase upper GI bleeding risk by roughly 55%; adding another antiplatelet substance compounds that risk.
Mechanism. Fluoxetine blocks the platelet 5-HT transporter, depleting platelet serotonin stores needed for full aggregation. EPA/DHA reduce thromboxane A2 synthesis and prolong bleeding time in a dose-dependent fashion.
Recommendation. Low-dose fish oil (≤1g/day) is generally compatible with fluoxetine. Avoid high-dose fish oil (>3g/day) unless your prescriber agrees, and watch for easy bruising, nosebleeds, or dark stools. Stop fish oil 7 days before surgery.
Sources (2)
- Andrade C, Sandarsh S, Chethan KB, Nagesh KS. Serotonin reuptake inhibitor antidepressants and abnormal bleeding: a review for clinicians and a reconsideration of mechanisms. J Clin Psychiatry. 2010;71(12):1565-75. PMID 21190637
- Jiang HY, Chen HZ, Hu XJ, et al. Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal bleeding: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2015;13(1):42-50. PMID 24993365
Stack Score
How this pair moves the number.
Effect on the composite score
If both Fish Oil and Fluoxetine are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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