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Vitamin E (Systemic)

Pronunciation

(VYE ta min ee)

Index Terms

  • d-Alpha Tocopherol
  • dl-Alpha Tocopherol

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Alph-E: 400 units

Alph-E-Mixed: 200 units

Alph-E-Mixed 1000: 1000 units

Alph-E-Mixed: 400 units [corn free, milk free, sugar free, wheat free, yeast free]

Formula E 400: 400 units

Vita-Plus E: 400 units

Vitamin E/D-Alpha Natural: 400 units [DSC]

Generic: 100 units, 200 units, 400 units, 1000 units

Capsule, Oral [preservative free]:

E-400: 400 units [corn free, gluten free, milk derivatives/products, no artificial color(s), no artificial flavor(s), sodium free, soy free, starch free, sugar free, yeast free]

E-400-Clear: 400 units [dye free]

E-400-Mixed: 400 units [dye free]

E-Max-1000: 1000 units [dye free]

Generic: 100 units, 400 units

Liquid, Oral:

Nutr-E-Sol: 400 units/15 mL (473 mL) [color free, starch free, sugar free]

Solution, Oral:

Aquasol E: 15 units/0.3 mL (12 mL, 30 mL) [contains polysorbate 80, propylene glycol, saccharin]

Aquavit-E: 15 units/0.3 mL (30 mL) [butterscotch flavor]

Aqueous Vitamin E: 15 units/0.3 mL (30 mL) [anise-butterscotch flavor]

Generic: 15 units/0.3 mL (12 mL)

Tablet, Oral:

E-Pherol: 400 units

Natural Vitamin E: 200 units, 400 units [animal products free, gelatin free, gluten free, kosher certified, lactose free, no artificial color(s), no artificial flavor(s), starch free, sugar free, yeast free]

Generic: 100 units, 200 units, 400 units

Brand Names: U.S.

  • Alph-E [OTC]
  • Alph-E-Mixed 1000 [OTC]
  • Alph-E-Mixed [OTC]
  • Aquasol E [OTC]
  • Aquavit-E [OTC]
  • Aqueous Vitamin E [OTC]
  • E-400 [OTC]
  • E-400-Clear [OTC]
  • E-400-Mixed [OTC]
  • E-Max-1000 [OTC]
  • E-Pherol [OTC]
  • Formula E 400 [OTC]
  • Natural Vitamin E [OTC]
  • Nutr-E-Sol [OTC]
  • Vita-Plus E [OTC]
  • Vitamin E/D-Alpha Natural [OTC] [DSC]

Pharmacologic Category

  • Vitamin, Fat Soluble

Pharmacology

Prevents oxidation of vitamin A and C; protects polyunsaturated fatty acids in membranes from attack by free radicals and protects red blood cells against hemolysis

Absorption

Depends on presence of bile; reduced in conditions of malabsorption, in low birth weight premature infants, and as dosage increases; water miscible preparations are better absorbed than oil preparations

Distribution

To all body tissues, especially adipose tissue, where it is stored

Metabolism

Hepatic to glucuronides

Excretion

Feces

Use: Labeled Indications

Dietary supplement

Note: According to the 2014 USPSTF recommendations for the primary prevention of cardiovascular disease and cancer, the use of vitamin E supplements are not recommended (Moyer 2014).

Contraindications

Hypersensitivity to vitamin E or any component of the formulation

Dosing: Adult

Vitamin E may be expressed as alpha-tocopherol equivalents (ATE), which refer to the biologically-active (R) stereoisomer content.

Recommended daily allowance (RDA) (IOM 2000): Oral: 15 mg; upper limit of intake should not exceed 1,000 mg/day

Pregnant female:

≤18 years: 15 mg; upper level of intake should not exceed 800 mg/day

19 to 50 years: 15 mg; upper level of intake should not exceed 1,000 mg/day

Lactating female:

≤18 years: 19 mg; upper level of intake should not exceed 800 mg/day

19 to 50 years: 19 mg; upper level of intake should not exceed 1,000 mg/day

Dietary supplement: Oral:

Capsule, tablet: Varies by product. Dosages range from 100 to 400 units/day

Aqueous Oral Drops: 30 units/day

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Vitamin E may be expressed as alpha-tocopherol equivalents (ATE), which refer to the biologically-active (R) stereoisomer content.

Adequate intake (AI): Oral (IOM 2000): Infants (RDA not established):

1 to 6 months: 4 mg

7 to 12 months: 5 mg

Recommended daily allowance (RDA): Oral (IOM, 2000): Children:

1 to 3 years: 6 mg; upper limit of intake should not exceed 200 mg/day

4 to 8 years: 7 mg; upper limit of intake should not exceed 300 mg/day

9 to 13 years: 11 mg; upper limit of intake should not exceed 600 mg/day

14 to 18 years: 15 mg; upper limit of intake should not exceed 800 mg/day

Vitamin E deficiency: Oral: Children (with malabsorption syndrome): 1 unit/kg/day of water miscible vitamin E (adjust dose based on serum concentrations) (Kleigman 2016)

Cystic fibrosis supplementation (Borowitz 2002): Oral:

1 to 12 months: 40 to 50 units/day

1 to 3 years: 80 to 150 units/day

4 to 8 years: 100 to 200 units/day

>8 years: 200 to 400 units/day

Dietary supplement: Oral: Aqueous Oral Drops:

Infants: 5 units/day

Children <4 years: 10 units/day

Children ≥4 years and Adolescents: 30 units/day

Administration

Swallow capsules whole; do not crush or chew.

Storage

Protect from light.

Drug Interactions

Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.): Vitamin E (Systemic) may enhance the antiplatelet effect of Agents with Antiplatelet Properties. Monitor therapy

Anticoagulants: Vitamin E (Systemic) may enhance the anticoagulant effect of Anticoagulants. Monitor therapy

CycloSPORINE (Systemic): Vitamin E (Systemic) may decrease the serum concentration of CycloSPORINE (Systemic). Monitor therapy

Ibrutinib: Vitamin E (Systemic) may enhance the antiplatelet effect of Ibrutinib. Monitor therapy

Orlistat: May decrease the serum concentration of Vitamins (Fat Soluble). Management: Administer oral fat soluble vitamins at least 2 hours before or after the administration of orlistat. Similar precautions do not apply to parenterally administered fat soluble vitamins. Consider therapy modification

Tipranavir: May enhance the adverse/toxic effect of Vitamin E (Systemic). Management: Patients taking tipranavir oral solution are advised to avoid taking additional vitamin E, beyond the amounts contained in a multivitamin product. This interaction does not apply to tipranavir capsules. Consider therapy modification

Adverse Reactions

There are no adverse reactions listed in the manufacturer’s labeling.

Warnings/Precautions

Concerns related to adverse effects:

• Vitamin K deficiency: May induce vitamin K deficiency (Corkins 2010).

Special populations:

• Low birth weight infants: Necrotizing enterocolitis has been associated with oral administration of large dosages (eg, >200 units/day) of a hyperosmolar vitamin E preparation in low birth weight infants.

Dosage form specific issues:

• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer’s labeling.

Monitoring Parameters

Plasma tocopherol concentrations

Pregnancy Considerations

Vitamin E crosses the placenta. Maternal serum concentrations of α tocopherol increase with lipid concentrations as pregnancy progresses; however, placental transfer remains constant. Additional supplementation is not needed in pregnant women without deficiency (IOM 2000).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience asthenia, dyspepsia, or diarrhea. Have patient report immediately to prescriber ecchymosis or hemorrhaging (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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