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Vitamin E

Class: Vitamin E
ATC Class: A11HA03
VA Class: VT600
CAS Number: 1406-18-4
Brands: Aquasol E

Medically reviewed by Last updated on Dec 22, 2020.


Fat-soluble vitamin; an antioxidant.a

Uses for Vitamin E

Dietary Requirements

Adequate intake needed to prevent vitamin E deficiency and peripheral neuropathy associated with vitamin E deficiency.159

Adequate intake of vitamin E usually can be accomplished through consumption of foodstuffs containing fat.159 Vitamin E is principally obtained from vegetable oils, unprocessed cereal grains, nuts, fruits, vegetables, and meats (especially those high in fat).b

Recommended Dietary Allowance (RDA) in adults is based on induced vitamin E deficiency and the correlation between hydrogen peroxide-induced erythrocyte hemolysis and plasma α-tocopherol concentrations.159

Adequate Intake (AI) established for infants ≤6 months of age is based on observed mean vitamin E intake of infants fed principally human milk; AI for infants 7–12 months of age is based on the AI for younger infants.159

Vitamin E Deficiency

Treatment of vitamin E deficiency (e.g., patients with genetic abnormalities in α-tocopherol transfer protein, fat malabsorption syndromes, or protein-calorie malnutrition).159

Alzheimer’s Disease

Has been evaluated in a dosage of 2000 units daily for the palliative treatment of moderately severe dementia of the Alzheimer’s type (Alzheimer’s disease, presenile or senile dementia).146 147 148 149 Not recommended for the treatment of cognitive symptoms of dementia because of limited evidence of efficacy and safety concerns.f (See Mortality under Cautions.)

Cardiovascular Risk Reduction

Current data does not support use of vitamin E supplements to reduce the risk of cardiovascular disease.168 169 171 172

Macular Degeneration

Suggested as a component of high-dose antioxidant supplements with zinc to reduce risk of developing advanced age-related macular degeneration in high-risk patients (i.e., those with intermediate stage age-related macular degeneration or advanced stage macular degeneration in only one eye).164 165

Use in Neonates

Has been used to prevent vitamin E deficiency in premature neonates.108

Pharmacologic doses of vitamin E not recommended for prevention or treatment of retinopathy of prematurity, bronchopulmonary dysplasia, or intraventricular hemorrhage.108

Cancer Risk Reduction

Use of vitamin E alone in conjunction with selenium does not decrease the risk of prostate cancer.175

Current data does not support the use of vitamin E supplements to reduce the risk of cancer.168 169 172

Prophylaxis of Tardive Dyskinesia

Has been used to reduce the risk of tardive dyskinesia associated with use of antipsychotic agents.173

Vitamin E Dosage and Administration


Usually administered orally; may administer parenterally as a component of a multivitamin injection.a

Oral Administration

Consider water-miscible oral vitamin E preparations for patients with malabsorption syndromes.a


Dosage expressed in terms of USP or International Units (IU).a

Adequate Intake (AI) and Recommended Dietary Allowance (RDA) are expressed in mg in terms of the 2R-stereoisomeric forms of α-tocopherol.159

Pediatric Patients

Dietary and Replacement Requirements

Infants ≤6 months of age: Recommended AI is 4 mg (0.6 mg/kg) of α-tocopherol daily.159

Infants 7–12 months of age: Recommended AI is 5 mg (0.6 mg/kg) of α-tocopherol daily.159

Children 1–3 years of age: RDA is 6 mg of α-tocopherol daily.159

Children 4–8 years of age: RDA is 7 mg of α-tocopherol daily.159

Children 9–13 years of age: RDA is 11 mg of α-tocopherol daily.159

Children 14–18 years of age: RDA is 15 mg of α-tocopherol daily.159

Vitamin E Deficiency

1 unit/kg daily (given as a water-miscible preparation) has been used in children with malabsorption syndromes.a

Preterm, low-birthweight neonates weighing <1 kg at birth: 6–12 units/kg daily has been used to prevent vitamin E deficiency.108


Dietary and Replacement Requirements

Men and women ≥19 years of age: RDA is 15 mg of α-tocopherol daily.159

Vitamin E Deficiency

60–75 units daily.a

Macular Degeneration†

400 units in combination with ascorbic acid 500 mg, beta carotene 15 mg, and zinc (as zinc oxide) 80 mg, with copper (as cupric oxide) 2 mg (to prevent anemia) daily has been used.164 165

Tardive Dyskinesia†

400–800 units daily has been recommended.173

Prescribing Limits



≥400 units daily generally not recommended.166 (See Mortality under Cautions.)

Special Populations

Pregnant Women

RDA for pregnant women 14–50 years of age is 15 mg of α-tocopherol daily.159

Lactating Women

RDA for lactating women 14–50 years of age is 19 mg of α-tocopherol daily.159

Cautions for Vitamin E


No known contraindications.a




Long-term administration (>1 year) of high doses of vitamin E (≥400 units daily) may increase all-cause mortality.166 d

Specific Populations


Category A.c


Distributed into human milk.c

Common Adverse Effects

Usually nontoxic at therapeutic doses.a

Interactions for Vitamin E

Specific Drugs




Anticoagulants, oral

Risk of hemorrhage with large doses of vitamin Ea

Iron supplements

Vitamin E dosages ≥10 units/kg daily may delay response to iron therapy in children a

Mineral oil

Possible impaired absorption of vitamin Ea


Possible impaired absorption of fat-soluble vitamins, including vitamin E150

Administer orlistat ≥2 hours before or after vitamin E150 152 156 158

Vitamin A

Potential increase in absorption, utilization, and storage of vitamin Aa

Vitamin E Pharmacokinetics



Absorption from the GI tract depends on biliary and pancreatic secretions, micelle formation, uptake into erythrocytes, and chylomicron secretion.a b Not well absorbed; 20–60% absorbed from dietary sources.a Fraction absorbed decreases as dosage increases.a



Readily distributed into all tissues and stored in adipose tissue.a

Crosses the placenta.c Distributed into human milk.c

Secreted from the liver in very-low-density lipoproteins (VLDLs); only the R-stereoisomer of α-tocopherol is secreted by the liver.159



Extensively metabolized, principally in the liver, to glucuronides of tocopheronic acid and its γ-lactone.a

Elimination Route

Excreted principally in the feces via biliary excretion; also excreted in urine.a 159




Cool dry place.e


  • Chain-breaking antioxidant that prevents propagation of free-radical reactions (e.g., lipid peroxidation);159 scavenges peroxyl radicals;159 protects polyunsaturated fatty acids (PUFAs) and other oxygen-sensitive substances such as vitamin A and ascorbic acid from oxidation.a 159

  • Has been suggested that the antioxidant effects of the vitamin may have beneficial effects in delaying the onset or slowing the progress of Alzheimer’s changes.118 146 147 149

  • May enhance immune response in healthy geriatric individuals.142 143 159

Advice to Patients

  • Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as concomitant illnesses.a

  • Importance of proper dietary habits, including taking appropriate AI or RDA of vitamin E.a

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.a

  • Importance of informing patients of other important precautionary information. (See Cautions.)


Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Vitamin E


Dosage Forms


Brand Names





Capsules, liquid-filled

100 units*

200 units*

400 units*

600 units*

1000 units*

Capsules, water-miscible

100 units*

200 units*

400 units*

Liquid, dye-free

4600 units/5 mL*

Solution, water-miscible

50 units/mL

Solution, aqueous drops

15 units/0.3 mL

Aquasol E Drops (as dl-α-tocopheryl acetate; with propylene glycol)



100 units*

200 units*

400 units*

500 units*

600 units*

1000 units*

Vitamin E is also commercially available in combination with other vitamins, minerals, protein supplements, and infant formulas.

AHFS DI Essentials™. © Copyright 2021, Selected Revisions January 1, 2009. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.


Only references cited for selected revisions after 1984 are available electronically.

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101. Lorch V, Murphy MD, Hoersten LR et al. Unusual syndrome among premature infants: association with a new intravenous vitamin E product. Pediatrics. 1985; 75:598-602.

102. Bove KE, Kosmetatos N, Wedig KE et al. Vasculopathic hepatotoxicity associated with E-Ferol syndrome in low-birth-weight infants. JAMA. 1985; 254:2422-30.

103. Centers for Disease Control. Unusual syndrome with fatalities among premature infants: association with a new intravenous vitamin E product. MMWR Morb Mortal Wkly Rep. 1984; 33:198-9.

104. Butler J, Hutchison M, Sandlin M. Deaths in preterm infants associated with intravenous vitamin E supplement. Am J Hosp Pharm. 1984; 41:1514-6.

105. Bodenstein CJ. Intravenous vitamin E and deaths in the intensive care unit. Pediatrics. 1984; 73:733.

106. Phelps DL. E-Ferol: what happened and what now? Pediatrics. 1984; 74:1114-6. Editorial.

107. Lemons JA, Maisels MJ. Vitamin E—how much is too much? Pediatrics. 1985; 76:625-7. Editorial.

108. American Academy of Pediatrics Committee on Nutrition. Pediatric nutrition handbook. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2004:35.

109. Committee on Dietary Allowances, Food and Nutrition Board, National Research Council. Recommended dietary allowances. 9th rev ed. Washington, DC: National Academy of Sciences; 1980:63-9.

110. Finer NN, Peters KL, Hayek Z et al. Vitamin E and necrotizing enterocolitis. Pediatrics. 1984; 73:387-93.

111. Bhat R. Serum, retinal, choroidal vitreal vitamin E concentrations in human infants. Pediatrics. 1986; 78:866-70.

112. Conyers RAJ, Bais R, Rofe AM. Oxalosis and the E-Ferol toxicity syndrome. JAMA. 1986; 256:2677-8.

113. Brown RE, Alade SL, Krouse MA. Polysorbates and renal oxalate crystals in the E-Ferol syndrome. JAMA. 1986; 255:2445.

114. Alade SL, Brown RE, Paquet A Jr. Polysorbate 80 and E-Ferol toxicity. Pediatrics. 1986; 77:593-7.

115. Balistreri WF, Farrel MK, Bove KE. Lessons from the E-Ferol tragedy. Pediatrics. 1986; 78:503-6.

116. Phelps DL, Rosenbaum AL, Isenberg SJ et al. Tocopherol efficacy and safety for preventing retinopathy of prematurity: a randomized, controlled, double-masked trial. Pediatrics. 1987; 79:489-500.

117. National Research Council Food and Nutrition Board Subcommittee on the Tenth Edition of the RDAs. Recommended dietary allowances. 10th ed. Washington, DC: National Academy Press; 1989:99-107.

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125. Hennekens CH. Platelet inhibitors and antioxidant vitamins in cardiovascular disease. Am Heart J. 1994; 128:1333-6.

126. Mosca L, Rubenfire M, Mandel C et al. Antioxidant nutrient supplementation reduces the susceptibility of low density lipoprotein to oxidation in patients with coronary artery disease. J Am Coll Cardiol. 1997; 30:392-9.

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129. Tardif JC, Cote G, Lesperance J et al. Probucol and multivitamins in the prevention of restenosis after coronary angioplasty. N Engl J Med. 1997; 337:365-72.

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131. Stephens N. Anti-oxidant therapy for ischaemic heart disease: where do we stand? Lancet. 1997; 349:1710-1. Editorial.

132. Rapola JM, Virtamo J, Ripatti S et al. Randomised trial of α-tocopherol and β-carotene supplements on incidence of major coronary events in men with previous myocardial infarction. Lancet. 1997; 349:1715-20.

133. Greenberg ER. Antioxidant vitamins, cancer, and cardiovascular disease. N Engl J Med. 1996; 334:1189-90.

134. National Research Council, Committee on Diet and Health, Food and Nutrition Board, Commission on Life Sciences. Diet and health: implications for reducing chronic disease risk. Washington, D.C.: National Academy Press, 1989.

135. The Alpha-tocopherol, Beta Carotene Cancer Prevention Study Group. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med. 1994; 330:1029-35.

136. Greenberg ER, Baron JA, Tosteson TD et al. A clinical trial of antioxidant vitamins to prevent colorectal adenoma. N Engl J Med. 1994; 331:141-7.

137. Hunter DJ, Manson JE, Colditz GA et al. A prospective study of the intake of vitamins C, E, and A and the risk of breast cancer. N Engl J Med. 1993; 329:234-40.

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140. Hennekens CH, Buring JE, Peto R. Beta carotene, vitamin E, and lung cancer. N Engl J Med. 1994; 331:613-4.

141. Meydani SN, Meydani M, Verdon CP et al. Vitamin E supplementation suppresses prostaglandin E2 synthesis and enhances the immune response of aged mice. Mech Ageing Dev. 1986; 34:191-201.

142. Meydani SN, Meydani M, Blumberg J et al. Vitamin E supplementation and in vivo immune response in healthy elderly subjects: a randomized controlled trial. JAMA. 1997; 277:1380-6.

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146. Sano M, Ernesto C, Thomas RG et al. A controlled trial of selegiline, alpha- tocopherol, or both as treatment for Alzheimer’s disease. N Engl J Med. 1997; 336:1216-22.

147. Drachman DA, Leber P. Treatment of Alzheimer’s disease—searching or a breakthrough, settling for less. N Engl J Med. 1997; 336:1245-7.

148. Small GW, Rabins PV, Barry PP et al. Diagnosis and treatment of Alzheimer disease and related disorders: consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer’s Association, and the American Geriatric Society. JAMA. 1997; 278:1363-71.

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154. Melia AT, Koss-Twardy SG, Zhi J. The effect of orlistat, an inhibitor of dietary fat absorption, on the absorption of vitamins A and E in healthy volunteers. J Clin Pharmacol. 1996; 36:647-53.

155. Zhi J, Melia AT, Koss-Twardy SG et al. The effect of orlistat, an inhibitor of dietary fat absorption, on the pharmacokinetics of β-carotene in healthy volunteers. J Clin Pharmacol. 1996; 36:152-9.

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159. Committee on the Scientific Evaluation of Dietary Reference Intakes of the Food and Nutrition Board, Institute of Medicine, National Academy of Sciences. Dietary reference intakes for Vitamin C, Vitamin E, selenium, and carotenoids. Washington, DC: National Academy Press; 2000.

160. The Heart Prevention Evaluation Study Investigators. Vitamin E supplementation and cardiovascular events in high-risk patients. N Engl J Med. 2000; 342:154-60.

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164. Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss. Arch Ophthalmol. 2001; 119:1417-36.

165. Jampol LM. Antioxidants, zinc, and age-related macular degeneration. Arch Ophthalmol. 2001; 119:1533-4.

166. Miller ER, Pastor-Barriuso R, Dalal D, et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005:142. From Annals of Internal Medicine website ( Accessed 11 Nov 2004.

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168. Gualler E, Hanley DF, Miller ER. An editorial update: Annus horribilis for vitamin E. Ann Intern Med. 2005; 143:143-5.

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a. AHFS drug information 2007. McEvoy GK, ed. Vitamin E. Bethesda, MD: American Society of Health-System Pharmacists; 2007:3645-9.

b. Dietary reference intakes: the essential guide to nutrient requirements. Institute of Medicine of the National Academies. Washington, D.C.: National Academies Press, 2006: 235–43.

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e. Nature's Bounty 100% natural vitamin E 400 IU, softgels product information. From Walgreen's website. Accessed 24 Mar 2008.

f. American Psychiatric Association. Practice Guideline for the treatment of patients with Alzheimer's disease and other dementias. 2007 Oct. From the American Psychiatric Association website.