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Vitamin E (Fat-Soluble Vitamin)

Alpha Tocopherol

Brand names: Ephynal, various vitamin E preparations

Adult dose

Dose: Vitamin E deficiency: 50–200 mg daily; malabsorption: up to 200 mg/kg daily
Route: Oral
Frequency: Once or twice daily depending on indication

Clinical pearls

  • Deficiency occurs in fat malabsorption syndromes (cystic fibrosis, cholestatic liver disease, abetalipoproteinaemia)
  • Neurological manifestations of deficiency: ataxia, peripheral neuropathy, retinal degeneration
  • High-dose supplementation in healthy individuals not generally recommended — lack of benefit shown in trials
  • Abetalipoproteinaemia requires very high doses (100 mg/kg/day) — specialist supervision needed
  • Water-soluble preparations available for severe fat malabsorption

Contraindications

  • No absolute contraindications at therapeutic doses
  • High doses should be avoided in patients taking anticoagulants without monitoring

Side effects

  • Generally well tolerated at recommended doses
  • High doses (>1000 mg/day): increased bleeding risk (anti-platelet effect)
  • Fatigue, weakness (high doses)
  • Nausea (high doses)

Interactions

  • Anticoagulants (warfarin) — high-dose vitamin E may increase anticoagulant effect; monitor INR
  • Vitamin K — may antagonise vitamin K-dependent clotting factors at very high doses
  • Cyclosporin — may reduce absorption

Monitoring

  • Serum vitamin E level (normal range: 11.6–46.4 µmol/L)
  • INR if on anticoagulants and taking high-dose supplements
  • Neurological assessment in deficiency states

Reference: BNF; NICE CKS Vitamin deficiency; British Inherited Metabolic Diseases Group guidelines; https://bnf.nice.org.uk/drugs/alpha-tocopherol/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways