Adequate intake of vitamin E usually can be accomplished through consumption of foodstuffs containing fat. Vitamin E is principally obtained from vegetable oils, unprocessed cereal grains, nuts, fruits, vegetables, and meats (especially those high in fat).
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.
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.
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). Not recommended for the treatment of cognitive symptoms of dementia because of limited evidence of efficacy and safety concerns. (See Mortality under Cautions.)
Cardiovascular Risk Reduction
Current data does not support use of vitamin E supplements to reduce the risk of cardiovascular disease†.
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).
Use in Neonates
Has been used to prevent vitamin E deficiency in premature neonates†.
Pharmacologic doses of vitamin E not recommended for prevention or treatment of retinopathy of prematurity†, bronchopulmonary dysplasia†, or intraventricular hemorrhage†.
Cancer Risk Reduction
Use of vitamin E alone in conjunction with selenium does not decrease the risk of prostate cancer†.
Current data does not support the use of vitamin E supplements to reduce the risk of cancer†.
Prophylaxis of Tardive Dyskinesia
Has been used to reduce the risk of tardive dyskinesia† associated with use of antipsychotic agents.
Dosage and Administration
Administration
Usually administered orally; may administer parenterally as a component of a multivitamin injection.
Oral Administration
Consider water-miscible oral vitamin E preparations for patients with malabsorption syndromes.
Dosage
Dosage expressed in terms of USP or International Units (IU).
Adequate Intake (AI) and Recommended Dietary Allowance (RDA) are expressed in mg in terms of the 2R-stereoisomeric forms of α-tocopherol.
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.
Infants 7–12 months of age: Recommended AI is 5 mg (0.6 mg/kg) of α-tocopherol daily.
Children 1–3 years of age: RDA is 6 mg of α-tocopherol daily.
Children 4–8 years of age: RDA is 7 mg of α-tocopherol daily.
Children 9–13 years of age: RDA is 11 mg of α-tocopherol daily.
Children 14–18 years of age: RDA is 15 mg of α-tocopherol daily.
Vitamin E Deficiency
Oral
1 unit/kg daily (given as a water-miscible preparation) has been used in children with malabsorption syndromes.
Preterm, low-birthweight neonates weighing <1 kg at birth: 6–12 units/kg daily has been used to prevent vitamin E deficiency.
Adults
Dietary and Replacement Requirements
Oral
Men and women ≥19 years of age: RDA is 15 mg of α-tocopherol daily.
Vitamin E Deficiency
Oral
60–75 units daily.
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.†
Tardive Dyskinesia
Oral
400–800 units daily has been recommended.†
Prescribing Limits
Adults
Oral
≥400 units daily generally not recommended. (See Mortality under Cautions.)
Special Populations
Pregnant Women
RDA for pregnant women 14–50 years of age is 15 mg of α-tocopherol daily.
Lactating Women
RDA for lactating women 14–50 years of age is 19 mg of α-tocopherol daily.
Cautions
Contraindications
No known contraindications.
Warnings/Precautions
Warnings
Mortality
Long-term administration (>1 year) of high doses of vitamin E (≥400 units daily) may increase all-cause mortality.
Potential increase in absorption, utilization, and storage of vitamin A
Pharmacokinetics
Absorption
Bioavailability
Absorption from the GI tract depends on biliary and pancreatic secretions, micelle formation, uptake into erythrocytes, and chylomicron secretion. Not well absorbed; 20–60% absorbed from dietary sources. Fraction absorbed decreases as dosage increases.
Distribution
Extent
Readily distributed into all tissues and stored in adipose tissue.
Crosses the placenta. Distributed into human milk.
Secreted from the liver in very-low-density lipoproteins (VLDLs); only the R-stereoisomer of α-tocopherol is secreted by the liver.
Elimination
Metabolism
Extensively metabolized, principally in the liver, to glucuronides of tocopheronic acid and its γ-lactone.
Elimination Route
Excreted principally in the feces via biliary excretion; also excreted in urine.
Stability
Storage
Oral
Cool dry place.
Actions
Chain-breaking antioxidant that prevents propagation of free-radical reactions (e.g., lipid peroxidation); scavenges peroxyl radicals; protects polyunsaturated fatty acids (PUFAs) and other oxygen-sensitive substances such as vitamin A and ascorbic acid from oxidation.
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.
May enhance immune response in healthy geriatric individuals.
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.
Importance of proper dietary habits, including taking appropriate AI or RDA of vitamin E.
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.
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.
Vitamin E
Routes
Dosage Forms
Strengths
Brand Names
Manufacturer
Oral
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*
Bulk
oil*
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)
Hospira
Tablets
100 units*
200 units*
400 units*
500 units*
600 units*
1000 units*
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Vitamin E is also commercially available in combination with other vitamins, minerals, protein supplements, and infant formulas.
† Use is not currently included in the labeling approved by the US Food and Drug Administration.
Remember, keep this and all other medicines out of the reach of children,
never share your medicines with others, and use this medication only for the indication prescribed.
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