Omega-3 polyunsaturated fatty acids/vitamin e Disease Interactions

Vitamin E is fat soluble and many oral formulations require bile for adequate intestinal absorption. Hepatic and/or biliary dysfunction decrease the absorption of vitamin E. Water- miscible vitamin E formulations may be better absorbed from the GI tract under these conditions. Vitamin E is metabolized by the liver and primarily excreted in bile and feces. Hepatic and/or biliary impairment can alter the metabolic and therapeutic activity of vitamin E.

Cases of recurrent atrial fibrillation (AF) or flutter have been reported with the use of omega-3 fatty acids in patients with a symptomatic paroxysmal AF or persistent AF. This condition is more apparent within the first 2 to 3 months after the initiation of therapy. Therapy with these agents should be administered cautiously in patients with cardiac conduction disorders.

Increases in alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) levels have been observed in patients receiving omega-3 fatty acids. Therapy with omega-3 fatty acid preparations should be administered cautiously in patients with hepatic impairment. Serum liver enzyme levels should be monitored periodically.

Vitamin E is readily absorbed from the intestinal tract in the presence of bile. Prolonged fat malabsorption (cystic fibrosis, hepatic cirrhosis, sprue) or malabsorption syndromes (celiac disease, GI resection) can decrease the absorption of many oral formulations of vitamin E. A water- miscible formulation of vitamin E may be better absorbed in these conditions.