Vitamin E (Systemic)

(VYE ta min ee)

• Alph-E [OTC]
• Alph-E-Mixed 1000 [OTC]
• Alph-E-Mixed [OTC]
• Aquasol E [OTC] [DSC]
• Aquavit-E [OTC] [DSC]
• 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]

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

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).

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

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.