Vitamin E (Monograph)
Brand name: Aquasol E
Drug class: Vitamin E
ATC class: A11HA03
VA class: VT600
CAS number: 1406-18-4
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
Related/similar drugs
Ingrezza, azithromycin, donepezil, Zithromax, memantine, acetylcysteine, gentamicin
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 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 |
|
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 Aa |
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
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 |
AHFS DI Essentials™. © Copyright 2024, Selected Revisions January 1, 2009. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.
† 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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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. http://www.ncbi.nlm.nih.gov/pubmed/3975131?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3930760?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6423951?dopt=AbstractPlus
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