vitamin E (alpha tocopherol)
Aquavit-E, d’ALPHA E 1000

Available forms
Available without a prescription, as appropriate
Capsules: 100 IU, 200 IU, 400 IU, 1,000 IU
Drops: 15 IU/0.3 ml
Oral solution: 50 IU/ml
Tablets: 100 IU, 200 IU, 400 IU, 500 IU, 800 IU, 1,000 IU

Indications and dosages
 Vitamin E deficiency in premature infants and in patients with impaired fat absorption (including patients with cystic fibrosis), biliary atresia. Adults: 60 to 75 IU P.O. daily, depending on severity. Maximum dose is 300 IU daily.
Children: 1 IU/kg P.O. daily.
Full-term neonates: 5 IU P.O. per liter of formula.
Premature neonates: 5 IU P.O. daily.
 RDA for vitamin E.  (α-TE is alpha tocopherol equivalent equal to 1 mg d-α-tocopherol or 1.49 IU).
Infants up to age 6 months: 3 α-TE or 4 IU.
Children ages 6 months to 1 year: 4 α-TE or 6 IU.
Children ages 1 to 3: 6 α-TE or 9 IU.
Children ages 4 to 10: 7 α-TE or 10 IU.
Boys and men older than age 11: 10 α-TE or 15 IU.
Girls and women older than age 11: 8 α-TE or 12 IU.
Pregnant women: 10 α-TE or 15 IU.
Breast-feeding women: First 6 months, 12 α-TE or 18 IU, over 6 months, 11 α-TE or 16 IU.

Pharmacodynamics
Nutritional action: As a dietary supplement, exact biochemical mechanism unclear, although it’s believed to act as an antioxidant. Vitamin E protects cell membranes, vitamin A, vitamin C (ascorbic acid), and polyunsaturated fatty acids from oxidation. It also may act as a cofactor in enzyme systems, and some evidence exists that it decreases platelet aggregation.

Pharmacokinetics
Absorption: GI absorption depends on presence of bile. Only 20% to 60% of vitamin obtained from dietary sources is absorbed. As dose increases, the fraction of vitamin E absorbed decreases.
Distribution: Distributed to all tissues; stored in adipose tissue.
Metabolism: Metabolized in liver by glucuronidation.
Excretion: Vitamin E excreted primarily in bile. Some enterohepatic circulation may occur. Small amounts of metabolites excreted in urine.

Contraindications and precautions
No known contraindications. Use cautiously in patients with liver or gallbladder disease.

Interactions
Drug-drug. Cholestyramine, colestipol, mineral oil, sucralfate: Increases vitamin E requirements. Give drugs at well-spaced intervals; monitor result.
Iron: Vitamin E may impair hematologic response to iron therapy in children with iron deficiency anemia. Monitor patient closely.
Oral anticoagulants: Causes risk of hemorrhage after large doses of vitamin E. Avoid use together.
Orlistat: May decrease GI absorption of vitamin E. Separate doses by at least 2 hours.
Vitamin K: May cause anti-vitamin K effects. Monitor therapeutic effect; adjust dosage as needed.

Adverse reactions
None reported with recommended doses. Hypervitaminosis E symptoms include fatigue, weakness, nausea, headache, blurred vision, flatulence, intestinal cramps, and diarrhea.

Effects on lab test results
None reported.

Overdose and treatment
Signs and symptoms of overdose include a possible increase in blood pressure.
 Treatment is generally supportive.

Special considerations
 ALERT Prescribing, dispensing, and dosing errors have been reported using the abbreviation IU. Take care to write clearly or spell out if possible.
• Give with bile salts if patient has malabsorption caused by lack of bile.
• Monitor patient for hypervitaminosis E.
• Vitamin E has been investigated to prevent retrolental fibroplasia and bronchopulmonary dysplasia in neonates and periventricular hemorrhage in premature infants, and to decrease the severity of hemolytic anemia in infants.

Patient education
• Inform patient about dietary sources of vitamin E.
• Instruct patient to swallow capsules whole and not to crush or chew them.
• Tell patient to store vitamin E in a tight, light-resistant container.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use