<ownershipDocument>
    <schemaVersion>X0201</schemaVersion>

    <documentType>4</documentType>
<periodOfReport>2003-12-22</periodOfReport>
<notSubjectToSection16>0</notSubjectToSection16>
    <issuer>
        <issuerCik>0001027702</issuerCik>
        <issuerName>EPIX MEDICAL INC</issuerName>
        <issuerTradingSymbol>EPIX</issuerTradingSymbol>
</issuer>
<reportingOwner>
        <reportingOwnerId>
            <rptOwnerCik>0001240387</rptOwnerCik>
            <rptOwnerName>CARPENTER ALAN P JR</rptOwnerName>
        </reportingOwnerId>
        <reportingOwnerAddress>
            <rptOwnerStreet1>C/O EPIX MEDICAL, INC.</rptOwnerStreet1>
            <rptOwnerStreet2>71 ROGERS STREET</rptOwnerStreet2>
            <rptOwnerCity>CAMBRIDGE</rptOwnerCity>
            <rptOwnerState>MA</rptOwnerState>
            <rptOwnerZipCode>02138</rptOwnerZipCode>
            <rptOwnerStateDescription></rptOwnerStateDescription>
        </reportingOwnerAddress>
            <reportingOwnerRelationship>
<isDirector>0</isDirector>
<isOfficer>1</isOfficer>
<isTenPercentOwner>0</isTenPercentOwner>
<isOther>0</isOther>
<officerTitle>Exec. VP of Research &amp; Develop</officerTitle>
<otherText></otherText>
</reportingOwnerRelationship>
</reportingOwner>
<nonDerivativeTable><nonDerivativeTransaction><securityTitle><value>Common Stock (Sale Pursuant to a 10b5-1 Trading Plan)</value>
</securityTitle>
<transactionDate><value>2003-12-22</value>
</transactionDate>
<transactionCoding><transactionFormType>4</transactionFormType>
<transactionCode>S</transactionCode>
<equitySwapInvolved>0</equitySwapInvolved>
<footnoteId id="F1"></footnoteId>
</transactionCoding>
<transactionAmounts><transactionShares><value>1000</value>
</transactionShares>
<transactionPricePerShare><value>16.10</value>
</transactionPricePerShare>
<transactionAcquiredDisposedCode><value>D</value>
</transactionAcquiredDisposedCode>
</transactionAmounts>
<postTransactionAmounts><sharesOwnedFollowingTransaction><value>0</value>
</sharesOwnedFollowingTransaction>
</postTransactionAmounts>
<ownershipNature><directOrIndirectOwnership><value>D</value>
</directOrIndirectOwnership>
</ownershipNature>
</nonDerivativeTransaction>
<nonDerivativeTransaction><securityTitle><value>Common Stock (Sale Pursuant to a 10b5-1 Trading Plan)</value>
</securityTitle>
<transactionDate><value>2003-12-22</value>
</transactionDate>
<transactionCoding><transactionFormType>4</transactionFormType>
<transactionCode>S</transactionCode>
<equitySwapInvolved>0</equitySwapInvolved>
<footnoteId id="F1"></footnoteId>
</transactionCoding>
<transactionAmounts><transactionShares><value>300</value>
</transactionShares>
<transactionPricePerShare><value>16.11</value>
</transactionPricePerShare>
<transactionAcquiredDisposedCode><value>A</value>
</transactionAcquiredDisposedCode>
</transactionAmounts>
<postTransactionAmounts><sharesOwnedFollowingTransaction><value>0</value>
</sharesOwnedFollowingTransaction>
</postTransactionAmounts>
<ownershipNature><directOrIndirectOwnership><value>D</value>
</directOrIndirectOwnership>
</ownershipNature>
</nonDerivativeTransaction>
</nonDerivativeTable>
<derivativeTable></derivativeTable>
<footnotes><footnote id="F1">The sales reported in this Form 4 were effected pursuant to a Rule 10b5-1 Trading Plan adopted by the reporting person on November 26, 2003.</footnote>
</footnotes>
<ownerSignature><signatureName>Paula Valencia-Galbraith, Attorney-in-Fact</signatureName>
<signatureDate>2003-12-24</signatureDate>
</ownerSignature>
</ownershipDocument>

