Cod Liver Oil

• Nutritional Supplement: Prevention and treatment of vitamin A and vitamin D deficiencies.
• Bone Health: Supportive therapy in osteoporosis and rickets prevention due to its vitamin D content.
• Cardiovascular Health: Adjunct in managing hypertriglyceridemia and improving lipid profiles.
• Inflammatory Conditions: Used as a complementary therapy for inflammatory and autoimmune diseases such as rheumatoid arthritis, owing to its omega-3 fatty acids.
• General Health: Supplement to support immune function, skin health, and cognitive function.
• Off-label: May be used adjunctively in depression, ADHD, and other neuropsychiatric conditions due to EPA and DHA components.

• Adults: Typical oral dose ranges from 1 to 3 grams daily of oil, providing approximately 400–1000 IU vitamin D and 4500 IU vitamin A, depending on preparation.
• Pediatrics: Dose adjusted based on age and weight; typically 0.5–1 gram daily with lower vitamin A and D concentrations.
• Elderly: Same as adults, with careful monitoring of vitamin A to avoid toxicity.
• Special populations: Dose adjustment required in patients with liver disease or fat malabsorption disorders.
• Route: Oral administration, usually as capsules or liquid form.
• Duration: Long-term use is common for supplementation; monitoring of vitamin levels advised to prevent toxicity.

Cod liver oil contains high levels of omega-3 fatty acids (EPA and DHA), vitamin A, and vitamin D. Omega-3 fatty acids exert anti-inflammatory effects by modulating eicosanoid synthesis, reducing production of pro-inflammatory cytokines, and altering cell membrane composition. Vitamin D regulates calcium and phosphate metabolism, essential for bone mineralization, while vitamin A supports immune function, vision, and cellular growth. Together, these components improve bone health, reduce inflammation, and support multiple physiological systems.

• Absorption: Well absorbed orally; fat-soluble vitamins A and D require bile salts for optimal absorption.
• Distribution: Vitamins and fatty acids distribute into adipose tissue, liver, plasma lipoproteins, and cellular membranes.
• Metabolism: Vitamin A is stored in the liver; vitamin D undergoes hydroxylation in the liver (to 25-hydroxyvitamin D) and kidney (to active 1,25-dihydroxyvitamin D). Omega-3 fatty acids are metabolized via beta-oxidation.
• Excretion: Excess vitamins excreted primarily via bile into feces; omega-3 metabolites eliminated via oxidation and incorporation into phospholipids.
• Onset: Nutritional effects manifest over weeks to months; anti-inflammatory effects may begin earlier.

• Pregnancy: Generally regarded as safe when taken within recommended dietary allowances. Excessive vitamin A intake may cause teratogenicity; caution advised.
• Lactation: Safe at recommended doses; vitamin A and D pass into breast milk and support infant development. Avoid megadoses.

• Primary class: Nutritional Supplement
• Subclass: Omega-3 Fatty Acid Supplement; Fat-Soluble Vitamins (A and D)

• Known hypersensitivity to fish, cod liver oil, or any components.
• Hypervitaminosis A or D.
• Severe hepatic impairment or fat malabsorption syndromes without medical supervision.
• Caution in anticoagulant therapy due to bleeding risk from omega-3 fatty acids.

• Risk of vitamin A toxicity with excessive intake (symptoms: headache, nausea, dizziness, bone pain).
• Monitor vitamin D levels to prevent hypercalcemia.
• Omega-3 fatty acids may increase bleeding risk; use caution with antiplatelet or anticoagulant drugs.
• May cause gastrointestinal discomfort, fishy aftertaste, or burping.
• Use cautiously in patients with seafood allergies.

Common:

• Gastrointestinal upset (nausea, diarrhea, dyspepsia).
• Fishy taste or aftertaste.
• Mild headache or dizziness.

Rare/Serious:

• Hypervitaminosis A or D toxicity signs (headache, confusion, bone pain, hypercalcemia).
• Allergic reactions (rash, itching, anaphylaxis in sensitive individuals).
• Increased bleeding risk with high doses or concurrent anticoagulant use.

• Anticoagulants/antiplatelets: May enhance bleeding risk due to omega-3 effects on platelet aggregation.
• Vitamin A/D supplements: Concurrent use increases risk of hypervitaminosis.
• Orlistat and other fat absorption inhibitors: May reduce absorption of fat-soluble vitamins in cod liver oil.
• No significant CYP450 enzyme interactions reported.

• Recent guidelines emphasize safe dosing to avoid vitamin A toxicity, especially in pregnancy.
• Omega-3 fatty acids recognized for cardiovascular benefits; cod liver oil considered a source but newer purified fish oil preparations preferred for higher EPA/DHA content and lower vitamin A.
• Monitoring of vitamin D status recommended in supplementation regimens.
• Caution in combining supplements containing vitamin A or D to prevent overdose.

• Store in a cool, dry place at 15°C to 25°C (59°F to 77°F).
• Protect from light and heat to prevent oxidation of fatty acids.
• Keep container tightly closed to avoid rancidity.
• Refrigeration after opening recommended to prolong shelf life.
• Keep out of reach of children.