Vitamin C [EPC]Vitamin D [EPC]Vitamin B12 [EPC]Calcium [EPC]Vitamin B6 Analog [EPC]Nicotinic Acid [EPC]Vitamin A [EPC]Folate Analog [EPC]Vitamin K [EPC]Warfarin Reversal Agent [EPC]
Key Facts
According to the FDA (2024), the Upper Tolerable Intake Level (UL) for Vitamin E in adults is 1,000 mg (1,500 IU) per day to prevent bleeding risks.
A meta-analysis published in the Annals of Internal Medicine (2005) found that Vitamin E supplementation exceeding 400 IU daily may increase all-cause mortality.
The SELECT trial (2011) demonstrated a 17% increased risk of prostate cancer in healthy men taking 400 IU of Vitamin E daily.
Data from the NIH (2023) indicates that Vitamin E deficiency is extremely rare in healthy individuals but occurs in nearly all patients with abetalipoproteinemia.
The PIVENS trial (2010) showed that 800 IU of Vitamin E daily improved liver inflammation in non-diabetic patients with NASH.
According to the American Heart Association (2022), Vitamin E supplements are not recommended for the prevention of cardiovascular disease.
The Cochrane Database of Systematic Reviews (2017) found no evidence that Vitamin E prevents or treats late-stage Alzheimer's disease effectively.
Research in JAMA (2014) suggested that Vitamin E might slow functional decline in patients with mild-to-moderate Alzheimer's, though risks must be weighed.
The World Health Organization (WHO) classifies Vitamin E as an essential nutrient for the protection of polyunsaturated fatty acids in cell membranes.
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Prenatal Plus Vitamins, you must consult a qualified healthcare professional.
Clinical Information
Detailed information about Prenatal Plus Vitamins
ℹ️Overview
.alpha.-tocopherol Acetate, Dl- is a synthetic form of Vitamin E, a fat-soluble antioxidant essential for protecting cell membranes from oxidative damage. It is used to treat deficiencies and support various physiological functions under medical supervision.
💊Usage & Dosage
Adult Dosage
The dosage of .alpha.-tocopherol Acetate, Dl- varies significantly based on whether it is being used for general nutritional support or for the treatment of a specific medical condition.
Recommended Dietary Allowance (RDA): For most healthy adults, the RDA is 15 mg (approximately 22.4 IU of the synthetic form) per day. This amount is typically obtained through a balanced diet.
Therapeutic Dosing for Deficiency: Healthcare providers may prescribe doses ranging from 100 IU to 400 IU daily. In cases of severe malabsorption (e.g., cystic fibrosis), doses may reach 1,000 IU or higher, though such high doses require frequent monitoring.
NASH Treatment (Off-Label): Clinical studies, such as the PIVENS trial, utilized doses of 800 IU daily, but this is only performed under strict hepatology supervision due to potential long-term risks.
Pediatric Dosage
Pediatric dosing is strictly based on age and the underlying cause of the deficiency. Parents must never give Vitamin E supplements to children without a direct recommendation from a pediatrician.
Infants (0-12 months): 4 mg to 5 mg (6-7.5 IU) daily, usually met through breast milk or formula.
Children (1-8 years): 6 mg to 7 mg (9-10.5 IU) daily.
Children (9-13 years): 11 mg (16.5 IU) daily.
Adolescents (14-18 years): 15 mg (22.4 IU) daily.
In cases of pediatric malabsorption, specialists may prescribe much higher doses (e.g., 15-25 IU/kg/day) to ensure adequate systemic levels.
Dosage Adjustments
Renal Impairment
For patients with mild to moderate kidney disease, standard doses of .alpha.-tocopherol Acetate, Dl- generally do not require adjustment. However, in end-stage renal disease (ESRD) or patients on dialysis, the risk-benefit ratio of high-dose antioxidant therapy is still being studied. Consult a nephrologist before starting supplementation.
Hepatic Impairment
Because the liver is the primary site for Vitamin E metabolism and the production of alpha-TTP, patients with liver cirrhosis or hepatic failure may have altered Vitamin E status. While adjustments are not standardized, healthcare providers will monitor liver function tests (LFTs) and serum tocopherol levels closely.
Elderly Patients
Older adults may be at a higher risk for adverse effects from high-dose Vitamin E, particularly regarding bleeding risks and interactions with heart medications. Most geriatricians recommend sticking to the RDA unless a deficiency is clinically proven.
How to Take .alpha.-tocopherol Acetate, Dl-
To ensure maximum efficacy and safety, follow these administration guidelines:
Take with Food: Always take Vitamin E with a meal that contains some dietary fat (e.g., avocado, nuts, or olive oil). Without fat, the absorption of this vitamin is significantly reduced.
Swallow Whole: If taking softgels, swallow them whole with a full glass of water. Do not crush or chew the capsules unless they are specifically formulated as chewable tablets.
Time of Day: It can be taken at any time of day, but consistency is key. Many patients find it easiest to take with breakfast or dinner.
Storage: Store at room temperature (68°F to 77°F) away from direct sunlight and moisture. Heat and light can degrade the acetate ester, reducing the potency of the medication.
Missed Dose
If you miss a dose, take it as soon as you remember. If it is almost time for your next scheduled dose, skip the missed dose and resume your regular schedule. Do not double the dose to 'catch up,' as this increases the risk of GI side effects and potential bleeding issues.
Overdose
Acute overdose of Vitamin E is rarely life-threatening, but chronic 'over-supplementation' can lead to hypervitaminosis E.
Signs of Overdose: Blurred vision, severe headache, extreme fatigue, nausea, and unusual bruising or bleeding (such as nosebleeds or bleeding gums).
Emergency Measures: If someone has ingested a massive quantity, contact a Poison Control Center or seek emergency medical care immediately. Treatment is primarily supportive, focusing on the discontinuation of the supplement and monitoring coagulation parameters (PT/INR).
> Important: Follow your healthcare provider's dosing instructions exactly. Do not adjust your dose or start new supplements without medical guidance, as Vitamin E can accumulate in the body over time.
⚠️Side Effects
Common Side Effects (>1 in 10)
When taken at standard RDA levels, .alpha.-tocopherol Acetate, Dl- is generally well-tolerated. However, at higher supplemental doses (typically above 400 IU), patients may experience:
Gastrointestinal Distress: Nausea, stomach cramps, and diarrhea are the most frequently reported issues. These usually occur shortly after ingestion and may improve if the dose is taken with a larger meal.
Fatigue and Malaise: Some patients report a general feeling of tiredness or weakness when starting high-dose therapy.
Less Common Side Effects (1 in 100 to 1 in 10)
Headache: A persistent dull ache that may occur as the body adjusts to the supplement.
🔴Warnings
Important Safety Information
.alpha.-tocopherol Acetate, Dl- is a biologically active compound that can significantly impact blood coagulation and cellular signaling. It is not a 'simple' vitamin when taken in supplemental forms. Patients with a history of heart disease, diabetes, or bleeding disorders must exercise extreme caution. It is vital to disclose all other supplements, including fish oil or garlic, as these can compound the effects of Vitamin E.
Black Box Warnings
No FDA black box warnings for .alpha.-tocopherol Acetate, Dl-. This medication is generally recognized as safe (GRAS) when used within the established Upper Tolerable Intake Level (UL) of 1,000 mg (1,500 IU) per day for adults.
Major Precautions
Bleeding and Coagulation: The most significant precaution involves the inhibition of Vitamin K-dependent coagulation factors. Vitamin E can antagonize Vitamin K, leading to a prolonged prothrombin time (PT). Patients with Vitamin K deficiency or those taking anticoagulants are at the highest risk.
🔄Interactions
Contraindicated Combinations (Do Not Use Together)
While there are few absolute contraindications, .alpha.-tocopherol Acetate, Dl- should generally not be used in high doses alongside:
Tipranavir (Aptivus): This protease inhibitor used for HIV contains high amounts of Vitamin E in its formulation. Taking additional Vitamin E can lead to toxic levels and significantly increase the risk of intracranial hemorrhage (bleeding in the brain).
Serious Interactions (Monitor Closely)
Warfarin (Coumadin): Vitamin E can enhance the effects of Warfarin by interfering with Vitamin K metabolism. This significantly increases the risk of life-threatening bleeding. If both must be used, the INR must be monitored extremely closely, and the Warfarin dose may need to be lowered.
Antiplatelet Drugs (Clopidogrel, Aspirin): Combining Vitamin E with these drugs can lead to an additive effect on platelet inhibition, increasing the risk of bruising and internal bleeding.
🚫Contraindications
Absolute Contraindications
.alpha.-tocopherol Acetate, Dl- must NEVER be used in the following circumstances:
Hypersensitivity: Any known severe allergy to synthetic Vitamin E or any of the inactive ingredients (such as bovine gelatin or soybean oil used in the capsules). Anaphylactic reactions, though rare, are life-threatening.
Active Internal Bleeding: Patients with active peptic ulcers, intracranial hemorrhage, or other major bleeding events should not take Vitamin E supplements, as they may worsen the condition by inhibiting clotting.
Relative Contraindications
Conditions requiring a careful risk-benefit analysis by a healthcare professional include:
Vitamin K Deficiency: Because Vitamin E antagonizes Vitamin K, patients who are already deficient are at an extremely high risk for coagulopathy (clotting disorders).
👥Special Populations
Pregnancy
FDA Pregnancy Category: Vitamin E is generally considered safe during pregnancy when consumed at the RDA level (15 mg/22.4 IU). It is often included in prenatal vitamins.
High-Dose Risks: High-dose supplementation (above the RDA) during pregnancy is not recommended unless a specific deficiency is identified. Some studies have suggested that excessive Vitamin E intake during pregnancy might be linked to an increased risk of premature rupture of membranes or congenital heart defects, though the evidence is not definitive.
Teratogenicity: There is no strong evidence that Vitamin E is teratogenic (causes birth defects) at normal doses.
Breastfeeding
Passage into Milk
🧬Pharmacology
Mechanism of Action
.alpha.-tocopherol Acetate, Dl- is a synthetic ester of alpha-tocopherol. Once the acetate group is cleaved by intestinal esterases, the free alpha-tocopherol acts as a primary antioxidant. It specifically targets the lipid peroxidation cycle. When a lipid radical (L•) or a lipid peroxyl radical (LOO•) is formed in the cell membrane, alpha-tocopherol (TOH) reacts with it faster than the radical can react with an adjacent fatty acid. This results in a stable lipid hydroperoxide and a tocopheroxyl radical (TO•). The tocopheroxyl radical is relatively unreactive and can be 'recycled' back into active tocopherol by other antioxidants like Vitamin C (ascorbic acid) or glutathione.
Pharmacodynamics
Dose-Response: Serum levels of Vitamin E increase with oral intake, but the relationship is non-linear. The liver's alpha-TTP protein is saturable, meaning that after a certain point, increasing the dose does not lead to a proportional increase in blood levels.
Onset of Effect: Antioxidant effects at the cellular level begin within hours of absorption, but clinical improvement in deficiency symptoms (like neurological issues) may take weeks or months of consistent dosing.
Frequently Asked Questions
Common questions about Prenatal Plus Vitamins
What is .alpha.-tocopherol Acetate, Dl- used for?
.alpha.-tocopherol Acetate, Dl- is primarily used to treat or prevent Vitamin E deficiency, particularly in individuals with fat malabsorption disorders like cystic fibrosis or certain genetic conditions. It acts as a powerful antioxidant that protects cells from oxidative stress and damage caused by free radicals. Healthcare providers also use it as a supplement for patients receiving long-term intravenous nutrition. In some specialized cases, it is used off-label to support liver health in patients with non-alcoholic steatohepatitis (NASH). It is essential to use this medication only under medical supervision to ensure the correct dosage for your specific health needs.
What are the most common side effects of .alpha.-tocopherol Acetate, Dl-?
At standard doses, .alpha.-tocopherol Acetate, Dl- is usually well-tolerated with few side effects. However, when taken in higher supplemental doses, the most common issues include gastrointestinal symptoms such as nausea, stomach cramps, and diarrhea. Some patients also report feeling unusually tired or experiencing mild headaches and blurred vision. These side effects often resolve if the dose is lowered or taken with a larger meal. If you experience persistent or severe digestive upset, you should contact your healthcare provider to discuss adjusting your intake.
Can I drink alcohol while taking .alpha.-tocopherol Acetate, Dl-?
While there is no direct chemical interaction that makes alcohol strictly prohibited, caution is advised. Chronic heavy alcohol consumption can damage the liver and interfere with the body's ability to absorb fat-soluble vitamins like Vitamin E, potentially making the supplement less effective. Furthermore, both high-dose Vitamin E and heavy alcohol use can increase the risk of internal bleeding and GI irritation. It is best to discuss your alcohol consumption habits with your doctor to ensure the supplement is safe and effective for you. Moderate drinking is generally not considered a major risk for those taking standard RDA doses.
Is .alpha.-tocopherol Acetate, Dl- safe during pregnancy?
.alpha.-tocopherol Acetate, Dl- is considered safe and is actually essential during pregnancy when taken at the Recommended Dietary Allowance (RDA) of 15 mg per day. It is a standard component of most prenatal vitamins and supports the development of the fetus. However, pregnant women should avoid taking high-dose Vitamin E supplements (above the RDA) unless specifically instructed by their obstetrician. Some research has suggested that excessive intake could potentially lead to complications, so it is vital to stick to the doses recommended by your healthcare professional. Always inform your doctor of all supplements you are taking during pregnancy.
How long does it take for .alpha.-tocopherol Acetate, Dl- to work?
The time it takes for .alpha.-tocopherol Acetate, Dl- to work depends on the condition being treated. As an antioxidant, it begins working at the molecular level within hours of being absorbed into the cell membranes. However, if you are taking it to correct a clinical deficiency that has caused neurological symptoms or muscle weakness, it may take several weeks or even months of consistent dosing to notice an improvement. Your doctor will likely monitor your blood levels to ensure the supplement is reaching the therapeutic range. Consistency in taking the medication with food is the best way to ensure it works as quickly as possible.
Can I stop taking .alpha.-tocopherol Acetate, Dl- suddenly?
For the majority of patients, .alpha.-tocopherol Acetate, Dl- can be stopped suddenly without experiencing withdrawal symptoms. Unlike some medications that affect the central nervous system, Vitamin E does not create a physical dependence. However, if you were taking it to treat a specific medical condition or a severe deficiency, stopping the supplement could cause your Vitamin E levels to drop, potentially leading to a return of symptoms over time. You should always consult with your healthcare provider before stopping any prescribed supplement to ensure it is safe for your specific health situation. They can advise if a gradual reduction is necessary for your particular case.
What should I do if I miss a dose of .alpha.-tocopherol Acetate, Dl-?
If you miss a dose of .alpha.-tocopherol Acetate, Dl-, you should take it as soon as you remember, provided it is not almost time for your next scheduled dose. If you are close to the time of your next dose, simply skip the missed one and continue with your regular schedule. Never take two doses at the same time to make up for a missed one, as this can increase the risk of stomach upset and other side effects. Because Vitamin E is stored in the body's fat tissues, missing a single dose is unlikely to have a significant impact on your overall health. If you frequently forget your doses, consider using a pill organizer or a reminder app.
Does .alpha.-tocopherol Acetate, Dl- cause weight gain?
There is no clinical evidence to suggest that .alpha.-tocopherol Acetate, Dl- causes weight gain. It is a micronutrient and does not contain a significant number of calories. However, because Vitamin E must be taken with dietary fat for proper absorption, some patients may inadvertently increase their caloric intake if they significantly change their diet to include more fatty foods. If you notice unexpected weight changes while taking this supplement, it is more likely related to other factors such as diet, activity level, or an underlying medical condition. Discuss any concerns about weight with your healthcare provider.
Can .alpha.-tocopherol Acetate, Dl- be taken with other medications?
.alpha.-tocopherol Acetate, Dl- can interact with several types of medications, some of which can be serious. It is particularly dangerous when taken with blood thinners like Warfarin, as it can significantly increase the risk of bleeding. It may also interfere with the effectiveness of certain chemotherapy drugs and cholesterol medications like statins. Because of these potential interactions, it is crucial to provide your doctor with a complete list of all prescription drugs, over-the-counter medicines, and herbal supplements you are using. Your pharmacist can also perform a drug interaction check to ensure your combination of medications is safe.
Is .alpha.-tocopherol Acetate, Dl- available as a generic?
Yes, .alpha.-tocopherol Acetate, Dl- is widely available as a generic medication and as an over-the-counter supplement. The generic versions are biologically equivalent to brand-name versions and are typically much more cost-effective. When purchasing, you may see it labeled simply as 'Vitamin E' or 'Synthetic Vitamin E.' It is important to check the label to see if it is the 'dl' (synthetic) or 'd' (natural) form, as the natural form is more potent and may require a different dose. Always choose a reputable brand that follows Good Manufacturing Practices (GMP) to ensure the purity and accuracy of the dosage.
Similar Medications
Other drugs with the same active ingredient (.alpha.-tocopherol Acetate, Dl-)
Blurred Vision: Transient changes in vision have been reported at doses exceeding 800 IU daily.
Dizziness: A sensation of lightheadedness, particularly when rising quickly.
Emotional Changes: Some clinical reports suggest mild irritability or emotional lability in a small subset of patients.
Rare Side Effects (less than 1 in 100)
Necrotizing Enterocolitis (NEC): Historically, high doses of Vitamin E in premature infants were linked to NEC, a serious intestinal condition. This is why pediatric dosing is strictly controlled by neonatologists.
Creatinuria: An increase in creatine in the urine, which may indicate muscle metabolism changes, though the clinical significance is often low.
Gonadal Dysfunction: Very high doses over prolonged periods have been associated with alterations in hormone levels in rare case studies.
Serious Side Effects — Seek Immediate Medical Attention
> Warning: Stop taking .alpha.-tocopherol Acetate, Dl- and call your doctor immediately if you experience any of these serious symptoms.
Unexplained Bleeding: This includes frequent nosebleeds, blood in the stool (black or tarry stools), blood in the urine (pink or red urine), or heavy menstrual bleeding. Vitamin E has mild anti-platelet effects that can become dangerous at high doses.
Hemorrhagic Stroke Symptoms: Sudden, severe headache, weakness on one side of the body, or difficulty speaking. Large-scale meta-analyses have suggested a slight increase in the risk of bleeding in the brain with high-dose Vitamin E supplementation.
Severe Allergic Reaction (Anaphylaxis): While rare, symptoms include hives, swelling of the face or throat, and difficulty breathing.
Severe Hepatotoxicity: Though Vitamin E is often used for liver health, paradoxical liver enzyme elevations can occur in rare instances of hypersensitivity.
Long-Term Side Effects
Increased Mortality Risk: Several large-scale meta-analyses (notably Miller et al., 2005) have suggested that long-term supplementation of Vitamin E at doses of 400 IU or higher may be associated with a small but statistically significant increase in all-cause mortality. This finding remains a topic of intense debate in the medical community, but it has led many doctors to recommend against high-dose supplementation for general health.
Prostate Cancer Risk: The SELECT (Selenium and Vitamin E Cancer Prevention Trial) found that men taking 400 IU of Vitamin E daily had a 17% increased risk of developing prostate cancer compared to those taking a placebo. This effect persisted even after the men stopped taking the supplement.
Bone Mineral Density: Some animal studies suggest that very high levels of alpha-tocopherol might interfere with bone remodeling, though human data is currently inconclusive.
Black Box Warnings
There are currently no FDA black box warnings for .alpha.-tocopherol Acetate, Dl-. However, the lack of a black box warning does not imply absolute safety. The risks of bleeding and the potential for increased mortality at high doses are considered significant clinical concerns that require professional oversight.
Report any unusual symptoms, especially those related to bleeding or vision changes, to your healthcare provider immediately. Regular blood tests may be necessary if you are on long-term, high-dose therapy.
Surgery: Due to the risk of increased bleeding, healthcare providers typically recommend discontinuing .alpha.-tocopherol Acetate, Dl- at least two weeks before any scheduled surgical or dental procedure.
Cardiovascular Health: While once thought to prevent heart disease, some studies suggest that high-dose Vitamin E may increase the risk of heart failure in patients with existing vascular disease or diabetes.
Retinitis Pigmentosa: Patients with this genetic eye disorder should avoid high doses of Vitamin E, as some research indicates it may accelerate the loss of retinal function.
Monitoring Requirements
If you are prescribed high-dose .alpha.-tocopherol Acetate, Dl- (e.g., for NASH or malabsorption), your doctor may require the following monitoring:
Serum Alpha-Tocopherol Levels: To ensure the dose is within a therapeutic, non-toxic range.
Prothrombin Time (PT/INR): To monitor blood clotting ability, especially if you are also taking blood thinners.
Liver Function Tests (LFTs): To ensure the liver is processing the supplement correctly.
Prostate-Specific Antigen (PSA): For male patients on long-term therapy, to monitor for potential prostate health changes.
Driving and Operating Machinery
.alpha.-tocopherol Acetate, Dl- generally does not cause sedation or cognitive impairment. However, if you experience rare side effects like blurred vision or dizziness, you should avoid driving or operating heavy machinery until these symptoms resolve and you have consulted your doctor.
Alcohol Use
There is no direct contraindication between moderate alcohol consumption and Vitamin E. However, chronic heavy alcohol use can damage the liver and interfere with the absorption of fat-soluble vitamins, potentially worsening a Vitamin E deficiency while also increasing the risk of GI bleeding.
Discontinuation
For most patients, Vitamin E can be stopped without a tapering schedule. However, if you have been taking very high doses for a long period, your doctor may suggest a gradual reduction to prevent any rebound oxidative stress, although this is more theoretical than clinically documented.
> Important: Discuss all your medical conditions, especially any history of stroke or bleeding problems, with your healthcare provider before starting .alpha.-tocopherol Acetate, Dl-.
Chemotherapy and Radiotherapy: There is significant concern among oncologists that the antioxidant properties of Vitamin E might protect cancer cells from the oxidative damage intended by chemotherapy or radiation. Most protocols advise patients to avoid Vitamin E supplements during active cancer treatment.
Moderate Interactions
Statins and Niacin: Some evidence suggests that a combination of antioxidants (including Vitamin E and Vitamin C) may blunt the rise in 'good' HDL cholesterol in patients taking simvastatin and niacin. This could potentially reduce the cardiovascular benefits of the statin therapy.
Cyclosporine: Vitamin E may increase the absorption and blood levels of this immunosuppressant, potentially increasing the risk of kidney toxicity.
Food Interactions
High-Fat Meals: While fat is necessary for absorption, an excessively high-fat meal may cause a surge in tocopherol levels. Consistency in diet is recommended.
Alcohol: As noted, chronic alcohol use impairs the absorption of fat-soluble vitamins and increases bleeding risks.
Iron Supplements: High doses of Vitamin E may interfere with the body's response to iron supplements in children with iron-deficiency anemia.
Herbal/Supplement Interactions
Ginkgo Biloba, Garlic, and Ginseng: These supplements also have mild blood-thinning properties. When combined with Vitamin E, the cumulative effect on bleeding risk can be significant.
St. John's Wort: May slightly alter the metabolism of fat-soluble vitamins through CYP3A4 induction, though the clinical impact on Vitamin E is usually minimal.
Fish Oil (Omega-3): High doses of fish oil combined with high-dose Vitamin E can significantly prolong bleeding time.
Lab Test Interactions
Prothrombin Time (PT): As mentioned, Vitamin E can increase PT, which is a measure of how long it takes blood to clot.
Thyroid Function Tests: In rare cases, very high doses of Vitamin E may interfere with the accuracy of certain thyroid hormone assays.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking. A complete medication review is the only way to prevent dangerous interactions.
Scheduled Surgery: As a general rule, Vitamin E should be avoided in the perioperative period (the time around a surgery).
History of Hemorrhagic Stroke: Individuals who have previously suffered a stroke caused by bleeding in the brain should avoid supplemental Vitamin E unless specifically directed by a neurologist.
Retinitis Pigmentosa: Due to data suggesting high doses may worsen the progression of this specific type of vision loss.
Diabetes and Heart Failure: Based on the HOPE-TOO trial data, patients with these conditions should avoid doses over 400 IU due to a potential increase in heart failure risk.
Cross-Sensitivity
Patients who are allergic to soybean products should be cautious, as many Vitamin E softgels use soybean oil as a carrier. While the tocopherol itself may be pure, the 'dl-alpha-tocopherol acetate' is often suspended in oils that could trigger a reaction in highly sensitive individuals. Always check the label for 'inactive ingredients' or 'contains' statements.
> Important: Your healthcare provider will evaluate your complete medical history, including any history of bleeding or upcoming surgeries, before prescribing .alpha.-tocopherol Acetate, Dl-.
: Vitamin E is a natural component of breast milk and is essential for infant health. The concentration in milk is generally reflective of the mother's intake.
Safety: Supplemental Vitamin E at RDA levels is considered safe for nursing mothers. However, extremely high doses should be avoided as they could theoretically affect the infant's coagulation system.
Pediatric Use
Approved Use: Vitamin E is used in children primarily to treat malabsorption syndromes (like cystic fibrosis) and to prevent deficiency in premature infants.
Growth Effects: Normal levels are essential for neurological development and muscle function. Deficiency in children can lead to spinocerebellar ataxia (loss of coordination) and muscle weakness.
Warning: High-dose Vitamin E in low-birth-weight infants must be managed by specialists due to the historical risk of sepsis and necrotizing enterocolitis.
Geriatric Use
Increased Risks: The elderly are more likely to be on polypharmacy (multiple medications), particularly anticoagulants like Warfarin or Apixaban. This makes the bleeding risk of Vitamin E much more significant in this population.
Cognitive Health: While often marketed for 'brain health,' the evidence for Vitamin E preventing dementia in the elderly is weak, and the potential for increased mortality at high doses often outweighs the perceived benefits.
Renal Impairment
Dosing: No specific dose adjustments are required for patients with renal impairment, but these patients are often at higher risk for cardiovascular complications. Monitoring by a nephrologist is recommended if doses exceed the RDA.
Dialysis: Vitamin E is not significantly removed by hemodialysis due to its high protein binding and fat solubility.
Hepatic Impairment
Malabsorption: Patients with cholestatic liver disease often require water-solubilized forms of Vitamin E because they cannot absorb standard fat-soluble 'dl-alpha-tocopherol acetate'.
Monitoring: Close monitoring of serum tocopherol levels and liver function is required in patients with significant cirrhosis.
> Important: Special populations require individualized medical assessment. Never start a supplement for a child, pregnant woman, or elderly person without professional consultation.
Duration: Because it is stored in adipose tissue, the effects of Vitamin E can persist for several weeks after discontinuation.
Pharmacokinetics
| Parameter | Value |
|---|---|
| Bioavailability | 20% to 50% (highly dependent on fat intake) |
| Protein Binding | 95% to 99% (bound to lipoproteins like LDL/VLDL) |
| Half-life | 48 to 72 hours (systemic circulation) |
| Tmax | 3 to 6 hours after oral ingestion |
| Metabolism | Hepatic; metabolized to alpha-CEHC |
| Excretion | Fecal (>70%), Renal (<30% as metabolites) |
Chemical Information
Molecular Formula: C31H52O3
Molecular Weight: 472.7 g/mol
Solubility: Practically insoluble in water; freely soluble in ethanol, oils, and organic solvents.
Structure: Consists of a chromanol ring with a long saturated phytyl side chain. The 'dl' form is a racemic mixture of 8 stereoisomers (2-ambo-alpha-tocopherol).
Drug Class
.alpha.-tocopherol Acetate, Dl- is classified as a Fat-Soluble Vitamin. It is often grouped with other essential vitamins like A, D, and K. Related compounds include tocotrienols, though alpha-tocopherol is the form with the highest biological activity in humans.