Vitamin E may be expressed as alpha-tocopherol equivalents (ATE), which refer to the biologically-active (R) stereoisomer content.
Dietary supplement:
Oral (capsule, tablet): Varies by product. Dosages range from 100 to 400 units/day.
Oral (aqueous drops): 30 units/day.
Nonalcoholic steatohepatitis (off-label use):
Oral: 800 units once daily (AASLD [Chalasani 2018]; Sanyal 2010).
(For additional information see "Vitamin E (systemic): Pediatric drug information")
Note: 1 mg of alpha tocopherol (vitamin E) is equivalent to 2.22 units of synthetic form or 1.49 units of naturally-sourced form (NIH 2021).
Vitamin E deficiency, prevention/treatment, chronic cholestasis/liver disease:
Infants, Children, and Adolescents: Oral: Usual dose: 25 to 50 units/kg/day; monitor closely and adjust doses as needed to maintain target ratio of serum vitamin E to total serum lipid concentrations. Reported range: 10 to 50 units/kg/day. Doses up to 100 units/kg/day have been described in infants with biliary atresia (ASPEN [Corkins 2015]; Schneider 2012; Sokol 1987; Sokol 1993; Thébaut 2016). Note: Studies were performed with a water miscible preparation of vitamin E (alpha-tocopherol polyethylene glycol succinate [TPGS]).
Vitamin E dietary supplement: Aqueous Oral Drops (50 units/mL) (manufacturer's labeling):
Infants: Oral: 5 units daily (0.1 mL).
Children <4 years: Oral: 10 units daily (0.2 mL).
Children ≥4 years and Adolescents: Oral: 30 units daily (0.6 mL).
Vitamin E supplementation, cystic fibrosis (CFF [Borowitz 2002]):
Infants: Oral: 40 to 50 units/day.
Children ≤3 years: Oral: 80 to 150 units/day.
Children 4 to ≤8 years: Oral: 100 to 200 units/day.
Children >8 years and Adolescents: Oral: 200 to 400 units/day.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule, Oral:
Alph-E: 400 units [DSC]
Alph-E-Mixed 1000: 1000 units [DSC]
Alph-E-Mixed: 200 units [DSC]
Alph-E-Mixed: 400 units [DSC] [corn free, milk free, sugar free, wheat free, yeast free]
Generic: 450 mg, 100 units, 400 units, 1000 units, 180 MG (400 UNIT), 200 units
Capsule, Oral [preservative free]:
E-400: 400 units [DSC] [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: 450 mg, 100 units, 400 units, 180 MG (400 UNIT)
Liquid, Oral:
Nutr-E-Sol: 400 units/15 mL (473 mL) [color free, starch free, sugar free]
Solution, Oral:
Aqueous Vitamin E: 15 mg/0.67 mL (30 mL) [contains methylparaben, polysorbate 80, propylene glycol, saccharin sodium; anise-butterscotch flavor]
SoluVita E: 50 units/mL (30 mL) [dye free, gluten free, lactose free, sugar free; contains methylparaben, polysorbate 80, propylene glycol, saccharin sodium]
Generic: 15 units/0.3 mL (12 mL [DSC], 30 mL)
Tablet, Oral:
E-Pherol: 400 units [DSC]
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
May be product dependent
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Oil, Injection:
Generic: 100 units/mL ([DSC])
Swallow capsules whole; do not crush or chew.
Oral: May administer with or without food. Swallow capsules whole; do not crush or chew.
Dietary supplement:
Vitamin E 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 for prevention of these conditions (Moyer 2014).
Nonalcoholic steatohepatitis
Aquasol E may be confused with Anusol
There are no adverse reactions listed in the manufacturer’s labeling.
Hypersensitivity to vitamin E or any component of the formulation
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.
Excessive intake of vitamin E may be associated with adverse effects, including hemorrhagic effects; use caution when total daily intake from all sources exceeds the recommended age-based daily upper limit: 1 to 3 years: 200 mg; 4 to 8 years: 300 mg; 9 to 13 years: 600 mg; 14 to 18 years: 800 mg; ≥19 years: 1,000 mg; monitor serum concentrations (IOM 2000).
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.): Vitamin E (Systemic) may enhance the antiplatelet effect of Agents with Antiplatelet Properties. Risk C: Monitor therapy
Anticoagulants: Vitamin E (Systemic) may enhance the anticoagulant effect of Anticoagulants. Risk C: Monitor therapy
CycloSPORINE (Systemic): Vitamin E (Systemic) may decrease the serum concentration of CycloSPORINE (Systemic). Risk C: Monitor therapy
Ibrutinib: Vitamin E (Systemic) may enhance the antiplatelet effect of Ibrutinib. Risk C: Monitor therapy
Orlistat: May decrease the absorption of Vitamins (Fat Soluble). Management: Administer oral fat soluble vitamins at least 2 hours before or 2 hours after the administration of orlistat. Avoid concomitant administration due to the risk of impaired vitamin absorption. Risk D: Consider therapy modification
Selumetinib: May enhance the adverse/toxic effect of Vitamin E (Systemic). Management: If selumetinib is combined with additional vitamin E supplements, ensure that the total daily intake of vitamin E (including the amount of vitamin E in selumetinib and the supplement) does not exceed the recommended or safe limits. Risk D: 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. Risk D: Consider therapy modification
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).
Vitamin E is found in breast milk; concentrations decrease over time and are highest immediately postpartum. Breast milk concentrations may be affected by maternal intake; however, additional supplementation is not needed in nursing women (IOM 2000).
Adequate intake (AI) (IOM 2000):
1 to 6 months: 4 mg
7 to 12 months: 5 mg
Recommended daily allowance (RDA) (IOM 2000):
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
>18 years: 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
Plasma tocopherol concentrations
Adults: Therapeutic: 0.8 to 1.5 mg/dL (SI: 19 to 35 micromole/L), some method variation.
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
Capsules (Vitamin E Oral)
45 MG(100 UNIT) (per each): $0.03 - $0.04
90 MG(200 UNIT) (per each): $0.04 - $0.06
180 MG(400 UNIT) (per each): $0.07 - $0.29
450 MG(1000 UT) (per each): $0.10 - $0.18
Solution (SoluVita E Oral)
15.8 mg/0.7 mL (per mL): $1.17
Solution (Vitamin E Oral)
6.75 mg/0.3 mL (per mL): $1.35
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