Side Effects, Safety, Interaction and Dosing of Vitamin E


Vitamin E plays the role of antioxidant, preventing free radical damage to specific fats in the body.

May 7, 2019

Side Effects, Safety, Interaction and Dosing of Vitamin E

Vitamin E plays the role of antioxidant, preventing free radical damage to specific fats in the body that are critical for your health and naturally slowing aging. The deficiency can occur in people with certain genetic disorders and in very low-weight premature infants. People with fat absorption problems, which is a common problem for those who struggle with inflammatory bowel disease, may also struggle with a vitamin E deficiency in some cases. Deficiency symptoms include loss of muscle coordination and impaired vision and speech. Vitamin E is safe for most healthy people when taken by mouth or applied to the skin in appropriate dose.

Side Effects & Safety:

  • Vitamin E is likely safe for most healthy people when taken by mouth or applied to the skin. Most people do not experience any side effects when taking the recommended daily dose, which is 15 mg.
  • Vitamin E is possibly unsafe if taken by mouth in high doses. If you have a condition such as heart disease or diabetes, do not take doses of 400 IU/day or more. High doses might increase the chance of death and possibly cause other serious side effects. The higher the dose, the greater the risk of serious side effects.
  • There is some concern that vitamin E might increase the chance of having a serious stroke called hemorrhagic stroke, which is bleeding into the brain. Taking vitamin E in doses of 300-800 IU each day might increase the chance of this kind of stroke. However, in contrast, vitamin E might decrease the chance of having a less severe stroke called an ischemic stroke.
  • There is contradictory information about the effect of vitamin E on the chance of developing prostate cancer. Taking large amounts of a multivitamin plus a separate vitamin E supplement might actually increase the chance of developing prostate cancer in some men.
  • High doses can also cause nausea, diarrhea, stomach cramps, fatigue, weakness, headache, blurred vision, rash, and bruising and bleeding.

Special Precautions & Warnings:

Special precautions should be taken for the below condition:

Pregnancy:

When used in the recommended daily amount, vitamin E is possibly safe for pregnant women. There has been some concern that taking vitamin E supplements might be harmful to the fetus when taken in early pregnancy. Therefore, do not take vitamin E supplements during early pregnancy without talking with your healthcare provider.

Breast-feeding:

Vitamin E is likely safe when taken by mouth in recommended daily amounts during breast-feeding.

Infants and children:

Vitamin E is likely safe when taken by mouth appropriately. The maximum amounts of vitamin E that are considered safe for children are based on age. Less than 200 mg daily is safe for children 1 to 3 years old. Less than 300 mg daily is safe for children 4 to 8 years old. Less than 600 mg daily is safe for children 9 to 13 years old. Less than 800 mg daily is safe for children ages 14 to 18 years old.
Vitamin E (alpha-tocopherol) is possibly unsafe when given intravenously (by IV) to premature infants in high doses.

Angioplasty:

Avoid taking supplements containing vitamin E or other antioxidant vitamins (beta-carotene, vitamin C) immediately before and following angioplasty without the supervision of a health care professional. These vitamins seem to interfere with proper healing.

Diabetes:

Vitamin E might increase the risk for heart failure in people with diabetes. People with diabetes should avoid high doses of vitamin E.

Heart attack:

Vitamin E might increase the risk for death in people with a history of heart attack. People with a history of heart attack should avoid high doses of vitamin E.

Stroke:

Vitamin E might increase the risk for death in people with a history of stroke. People with a history of stroke should avoid high doses of vitamin E.

Vitamin K deficiency:

Vitamin E might worsen clotting problems in people whose levels of vitamin K are too low.

Retinitis pigmentosa:

All-rac-alpha-tocopherol (synthetic vitamin E) 400 IU seems to speed vision loss in people with retinitis pigmentosa. However, much lower amounts (3 IU) do not seem to produce this effect. If you have this condition, it is best to avoid vitamin E.

Bleeding disorders:

Vitamin E might make bleeding disorders worse. If you have a bleeding disorder, avoid taking vitamin E supplements.

Prostate cancer:

There is concern that taking vitamin E might increase the chance of developing prostate cancer. The effect of vitamin E in men who currently have prostate cancer is not clear. However, taking vitamin E supplements might worsen prostate cancer in men who already have it.

Head and neck cancer:

Do not take vitamin E supplements in doses of 400 IU/day or more. Vitamin E might increase the chance that cancer will return.

Surgery:

Vitamin E might increase the risk of bleeding during and after surgery. Stop using vitamin E at least 2 weeks before a scheduled surgery.

Interactions:

Moderate Interaction:
Be cautious with the below combination:

Cyclosporine (Neoral, Sandimmune) interacts with Vitamin E:

Taking large amounts of vitamin E along with cyclosporine (Neoral, Sandimmune) might increase how much cyclosporine (Neoral, Sandimmune) the body absorbs. By increasing how much cyclosporine the body absorbs, vitamin E might increase the effects and side effects of cyclosporine (Neoral, Sandimmune).

Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates) interacts with Vitamin E:

Some medications are changed and broken down by the liver. Vitamin E might increase how quickly the liver breaks down some medications. Taking vitamin E along with some medications that are broken down by the liver can decrease the effectiveness of some medications. Before taking vitamin E talk to your healthcare provider if you are taking any medications that are changed by the liver.
Some medications changed by the liver include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and many others.

Medications for cancer (Chemotherapy) interacts with Vitamin E:

Vitamin E is an antioxidant. There is some concern that antioxidants might decrease the effectiveness of some medications used for cancers. But the interaction is not clear.

Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs) interacts with Vitamin E:

Vitamin E might slow blood clotting. Taking vitamin E along with medications that also slow clotting might increase the chances of bruising and bleeding.
Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.

Medications used for lowering cholesterol (Statins) interacts with Vitamin E:

Taking vitamin E, beta-carotene, vitamin C, and selenium together might decrease the effectiveness of some medications used for lowering cholesterol. It is not known if taking vitamin E alone decreases the effectiveness of some medications used for lowering cholesterol.
Some medications used for lowering cholesterol include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), and pravastatin (Pravachol).

Niacin interacts with Vitamin E:

Taking vitamin E along with beta-carotene, vitamin C, and selenium might decrease some of the beneficial effects of niacin. Niacin can increase the good cholesterol. Taking vitamin E along with these other vitamins might decrease the good cholesterol.

Warfarin (Coumadin) interacts with Vitamin E:

Warfarin (Coumadin) is used to slow blood clotting. Vitamin E can also slow blood clotting. Taking vitamin E along with warfarin (Coumadin) can increase the chances of bruising and bleeding. Be sure to have your blood checked regularly. The dose of your warfarin (Coumadin) might need to be changed.

Dosing:

Dosing for vitamin E can be confusing. Current guidelines show recommended dietary allowance (RDA) and upper tolerable limits (UTL) for vitamin E in milligrams. However, most products are still labeled in International Units (IUs). The following doses have been studied in scientific research and is recommended:

By Mouth:

For vitamin E deficiency:

A typical dose in adults is RRR-alpha tocopherol (natural vitamin E) 60-75 IU per day.

For the movement disorder called tardive dyskinesia:

RRR-alpha-tocopherol (natural vitamin E) 1600 IU daily.

For improving male fertility:

Vitamin E 200-600 IU daily.

For Alzheimer's disease:

Up to 2000 IU daily. Combination therapy of donepezil (Aricept) 5 mg and vitamin E 1000 IU per day has been used for slowing memory decline in people with Alzheimer's disease.

For liver disease called non-alcoholic steatohepatitis:

800 IU daily in adults has been used. 400-1200 IU daily has been used in children.

For early Huntington's chorea:

RRR-alpha-tocopherol (natural vitamin E) 3000 IU.

For rheumatoid arthritis pain:

Vitamin E 600 IU twice daily.

For preventing nerve damage caused by cisplatin:

Vitamin E (alpha-tocopherol) 300 mg daily with each chemotherapy treatment and for up to 3 months after stopping cisplatin therapy.

For improving effectiveness of nitrates used for heart disease:

Vitamin E 200 mg three times daily.

To reduce protein in the urine of children with a kidney disease called focal segmental glomerulosclerosis:

Vitamin E 200 IU.

For G6PD deficiency:

Vitamin E 800 IU daily.

For premenstrual syndrome (PMS):

RRR-alpha-tocopherol (natural vitamin E) 400 IU daily.

For painful menstrual periods:

Vitamin E 200 IU twice or 500 IU daily starting 2 days before the menstrual period and continuing through the first 3 days of bleeding.

For healing the eyes after a surgery called keratectomy:

230 mg vitamin E (alpha-tocopheryl nicotinate) and vitamin A (retinol palmitate) 25,000 units have been used 3 times daily for 30 days, followed by twice daily for 2 months.

For fibrosis caused by radiation:

Vitamin E 1000 IU daily in combination with pentoxifylline 800 mg.

For beta-thalassemia:

vitamin E 750 IU daily.

For preventing sunburn:

RRR-alpha-tocopherol (natural vitamin E) 1000 IU in combination with 2 grams of ascorbic acid.

For preventing high blood pressure during pregnancy (pre-eclampsia) in high risk women:

Vitamin E 400 IU with vitamin C 1000 mg daily.
It is always advisable to take vitamin E that has been made in a lab (all-rac-alpha-tocopherol) with food for the most benefit.