Vitamin E (Monograph)

Brand name: Aquasol E
Drug class: Vitamin E
ATC class: A11HA03
VA class: VT600
CAS number: 1406-18-4

Medically reviewed by Drugs.com on Dec 23, 2024. Written by ASHP.

Introduction

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^{† [off-label]} (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^{† [off-label]}.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^{† [off-label]} 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^{† [off-label]}.¹⁰⁸

Pharmacologic doses of vitamin E not recommended for prevention or treatment of retinopathy of prematurity^{† [off-label]}, 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

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

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

Oral

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

Oral

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

Adults

Dietary and Replacement Requirements

Oral

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

Vitamin E Deficiency

Oral

60–75 units daily.^a

Macular Degeneration†

Oral

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†

Oral

400–800 units daily has been recommended.¹⁷³

Prescribing Limits

Adults

Oral

≥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

Contraindications

No known contraindications.^a

Warnings/Precautions

Warnings

Mortality

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

Specific Populations

Pregnancy

Category A.^c

Lactation

Distributed into human milk.^c

Common Adverse Effects

Usually nontoxic at therapeutic doses.^a

Drug Interactions

Specific Drugs

Drug	Interaction	Comments
Anticoagulants, oral	Risk of hemorrhage with large doses of vitamin E^a
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 E^a
Orlistat	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 A^a

Vitamin E Pharmacokinetics

Absorption

Bioavailability

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

Distribution

Extent

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

Elimination

Metabolism

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

Stability

Storage

Oral

Cool dry place.^e

Actions

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.)

Preparations

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
Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Bulk	Other*
Oral	Solution, aqueous drops	15 units/0.3 mL	Aquasol E Drops (as dl-α-tocopheryl acetate; with propylene glycol)	Hospira

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

References

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

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