the child [1:1 year) of high doses of vitamin E ( 400 units daily) may increase all-cause mortality. 166 d Specific Populations Pregnancy Category A. c Lactation Distributed into human milk. c Common Adverse Effects Usually nontoxic at therapeutic doses. a Interactions for Aquasol E Specific Drugs Drug Interaction Comments Anticoagulants, oral Risk of hemorrhage with large doses of vitamin E a Iron supplements Vitamin E dosages 10 units/kg daily may delay response to iron therapy in children a Mineral oil Possible impaired absorption of vitamin E a Orlistat Possible impaired absorption of fat-soluble vitamins, including vitamin E 150 Administer orlistat 2 hours before or after vitamin E 150 152 156 158 Vitamin A Potential increase in absorption, utilization, and storage of vitamin A a Aquasol E Pharmacokinetics Absorption Bioavailability Absorption from the GI tract depends on biliary and pancreatic secretions, micelle formation, uptake into erythrocytes, and chylomicron secretion. a b Not well absorbed; 20 60% absorbed from dietary sources. a Fraction absorbed decreases as dosage increases. a Distribution Extent Readily distributed into all tissues and stored in adipose tissue. a Crosses the placenta. c Distributed into human milk. c Secreted from the liver in very-low-density lipoproteins (VLDLs); only the R -stereoisomer of α-tocopherol is secreted by the liver. 159 Elimination Metabolism Extensively metabolized, principally in the liver, to glucuronides of tocopheronic acid and its γ-lactone. a Elimination Route Excreted principally in the feces via biliary excretion; also excreted in urine. a 159 Stability Storage Oral Cool dry place. e Actions Chain-breaking antioxidant that prevents propagation of free-radical reactions (e.g., lipid peroxidation); 159 scavenges peroxyl radicals; 159 protects polyunsaturated fatty acids (PUFAs) and other oxygen-sensitive substances such as vitamin A and ascorbic acid from oxidation. a 159 Has been suggested that the antioxidant effects of the vitamin may have beneficial effects in delaying the onset or slowing the progress of Alzheimer s changes. 118 146 147 149 May enhance immune response in healthy geriatric individuals. 142 143 159 Advice to Patients Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as concomitant illnesses. a Importance of proper dietary habits, including taking appropriate AI or RDA of vitamin E. a Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. a Importance of informing patients of other important precautionary information. (See Cautions.) Preparations Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Vitamin E Routes Dosage Forms Strengths Brand Names Manufacturer Bulk oil* Oral Capsules, liquid-filled 100 units* 200 units* 400 units* 600 units* 1000 units* Capsules, water-miscible 100 units* 200 units* 400 units* Liquid, dye-free 4600 units/5 mL* Solution, water-miscible 50 units/mL Solution, aqueous drops 15 units/0.3 mL Aquasol E Drops (as dl -α-tocopheryl acetate; with propylene glycol) Hospira Tablets 100 units* 200 units* 400 units* 500 units* 600 units* 1000 units* Vitamin E is also commercially available in combination with other vitamins, minerals, protein supplements, and infant formulas. AHFS DI Essentials. Copyright 2017, Selected Revisions January 1, 2009. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Use is not currently included in the labeling approved by the US Food and Drug Administration. References Only references cited for selected revisions after 1984 are available electronically. 100. American Academy of Pediatrics Committee on Fetus and Newborn. Vitamin E and the prevention of retinopathy of prematurity. Pediatrics . 1985; 76:315-6. [PubMed 3895151] 101. Lorch V, Murphy MD, Hoersten LR et al. Unusual syndrome among premature infants: association with a new intravenous vitamin E product. Pediatrics . 1985; 75:598-602. [PubMed 3975131] 102. Bove KE, Kosmetatos N, Wedig KE et al. Vasculopathic hepatotoxicity associated with E-Ferol syndrome in low-birth-weight infants. JAMA . 1985; 254:2422-30. [PubMed 3930760] 103. Centers for Disease Control. Unusual syndrome with fatalities among premature infants: association with a new intravenous vitamin E product. MMWR Morb Mortal Wkly Rep . 1984; 33:198-9. [PubMed 6423951] 104. Butler J, Hutchison M, Sandlin M. Deaths in preterm infants associated with intravenous vitamin E supplement. Am J Hosp Pharm . 1984; 41:1514-6. [PubMed 6475969] 105. Bodenstein CJ. Intravenous vitamin E and deaths in the intensive care unit. Pediatrics . 1984; 73:733. [PubMed 6718133] 106. Phelps DL. E-Ferol: what happened and what now? Pediatrics . 1984; 74:1114-6. Editorial. 107. Lemons JA, Maisels MJ. Vitamin E how much is too much? Pediatrics . 1985; 76:625-7. Editorial. 108. American Academy of Pediatrics Committee on Nutrition. Pediatric nutrition handbook. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2004:35. 109. Committee on Dietary Allowances, Food and Nutrition Board, National Research Council. Recommended dietary allowances. 9th rev ed. Washington, DC: National Academy of Sciences; 1980:63-9. 110. Finer NN, Peters KL, Hayek Z et al. Vitamin E and necrotizing enterocolitis. Pediatrics . 1984; 73:387-93. [PubMed 6546616] 111. Bhat R. Serum, retinal, choroidal vitreal vitamin E concentrations in human infants. Pediatrics . 1986; 78:866-70. [PubMed 3763301] 112. Conyers RAJ, Bais R, Rofe AM. Oxalosis and the E-Ferol toxicity syndrome. JAMA . 1986; 256:2677-8. [PubMed 3773173] 113. Brown RE, Alade SL, Krouse MA. Polysorbates and renal oxalate crystals in the E-Ferol syndrome. JAMA . 1986; 255:2445. [PubMed 3701955] 114. Alade SL, Brown RE, Paquet A Jr. Polysorbate 80 and E-Ferol toxicity. Pediatrics . 1986; 77:593-7. [PubMed 3960626] 115. Balistreri WF, Farrel MK, Bove KE. Lessons from the E-Ferol tragedy. Pediatrics . 1986; 78:503-6. [PubMed 3748688] 116. Phelps DL, Rosenbaum AL, Isenberg SJ et al. Tocopherol efficacy and safety for preventing retinopathy of prematurity: a randomized, controlled, double-masked trial. Pediatrics . 1987; 79:489-500. [PubMed 3547300] 117. National Research Council Food and Nutrition Board Subcommittee on the Tenth Edition of the RDAs. Recommended dietary allowances. 10th ed. Washington, DC: National Academy Press; 1989:99-107. 118. Parnetti L, Senin U, Mecocci P. Cognitive enhancement therapy for Alzheimer s disease: the way forward. Drugs . 1997; 53:752-68. [PubMed 9129864] 119. Diaz MN, Frei B, Vita JA et al. Antioxidants and atherosclerotic heart disease. N Engl J Med . 1997; 337:408-16. [PubMed 9241131] 120. Jha P, Flather M, Lonn E et al. The antioxidant vitamins and cardiovascular disease. Ann Intern Med . 1995; 123:860-72. [PubMed 7486470] 121. Stampfer MJ, Hennekens CH, Manson JE et al. Vitamin E consumption and the risk of coronary disease in women. N Engl J Med . 1993; 328:1444-9. [PubMed 8479463] 122. Rimm EB, Stampfer MJ, Ascherio A et al. Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med . 1993; 328:1450-6. [PubMed 8479464] 123. Kushi LH, Folsom AR, Prineas RJ et al. Dietary antioxidant vitamins and death from coronary heart disease in postmenopausal women. N Engl J Med . 1996; 334:1156-62. [PubMed 8602181] 124. Stephens NG, Parsons A, Schofield PM et al. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet . 1996; 347:781-6. [PubMed 8622332] 125. Hennekens CH. Platelet inhibitors and antioxidant vitamins in cardiovascular disease. Am Heart J . 1994; 128:1333-6. [PubMed 7977015] 126. Mosca L, Rubenfire M, Mandel C et al. Antioxidant nutrient supplementation reduces the susceptibility of low density lipoprotein to oxidation in patients with coronary artery disease. J Am Coll Cardiol . 1997; 30:392-9. [PubMed 9247510] 127. Freedman JE, Farhat JH, Loscalzo J et al. α-Tocopherol inhibits aggregation of human platelets by a protein kinase C-dependent mechanism. Circulation . 1996; 94:2434-40. [PubMed 8921785] 128. Hodis HN, Mack WJ, LaBree L et al. Serial coronary angiographic evidence that antioxidant vitamin intake reduces progression of coronary artery atherosclerosis. JAMA . 1995; 273:1849-54. [PubMed 7776501] 129. Tardif JC, Cote G, Lesperance J et al. Probucol and multivitamins in the prevention of restenosis after coronary angioplasty. N Engl J Med . 1997; 337:365-72. [PubMed 9241125] 130. Libby P, Ganz P. Restenosis revisited new targets, new therapies. N Engl J Med . 1997; 337:418-9. [PubMed 9241132] 131. Stephens N. Anti-oxidant therapy for ischaemic heart disease: where do we stand? Lancet . 1997; 349:1710-1. Editorial. 132. Rapola JM, Virtamo J, Ripatti S et al. Randomised trial of α-tocopherol and β-carotene supplements on incidence of major coronary events in men with previous myocardial infarction. Lancet . 1997; 349:1715-20. [PubMed 9193380] 133. Greenberg ER. Antioxidant vitamins, cancer, and cardiovascular disease. N Engl J Med . 1996; 334:1189-90. [PubMed 8602188] 134. National Research Council, Committee on Diet and Health, Food and Nutrition Board, Commission on Life Sciences. Diet and health: implications for reducing chronic disease risk. Washington, D.C.: National Academy Press, 1989. 135. The Alpha-tocopherol, Beta Carotene Cancer Prevention Study Group. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med . 1994; 330:1029-35. [PubMed 8127329] 136. Greenberg ER, Baron JA, Tosteson TD et al. A clinical trial of antioxidant vitamins to prevent colorectal adenoma. N Engl J Med . 1994; 331:141-7. [PubMed 8008027] 137. Hunter DJ, Manson JE, Colditz GA et al. A prospective study of the intake of vitamins C, E, and A and the risk of breast cancer. N Engl J Med . 1993; 329:234-40. [PubMed 8292129] 138. Blot WJ, Li JY, Taylor PR et al. Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. J Natl Cancer Inst . 1993; 85:1483-92. [PubMed 8360931] 139. Blot WJ, Li JY, Taylor PR et al. Lung cancer and vitamin supplementation. N Engl J Med . 1994; 331:614. [PubMed 8047094] 140. Hennekens CH, Buring JE, Peto R. Beta carotene, vitamin E, and lung cancer. N Engl J Med . 1994; 331:613-4. 141. Meydani SN, Meydani M, Verdon CP et al. Vitamin E supplementation suppresses prostaglandin E 2 synthesis and enhances the immune response of aged mice. Mech Ageing Dev . 1986; 34:191-201. [PubMed 3487685] 142. Meydani SN, Meydani M, Blumberg J et al. Vitamin E supplementation and in vivo immune response in healthy elderly subjects: a randomized controlled trial. JAMA . 1997; 277:1380-6. [PubMed 9134944] 143. Meydani SN, Barklund PM, Liu S et al. Effect of vitamin E supplementation on immune responsiveness of healthy elderly subjects. Am J Clin Nutr . 1990; 52:557-63. [PubMed 2203257] 144. Food and Drug Administration. Drug products for the treatment and/or prevention of nocturnal leg muscle cramps for over-the-counter human use. 21 CFR Part 310. [Docket No. 77N-0094]. Fed Regist . 1994; 59:43234-52. 145. Ryan TJ, Antman EM, Brooks NH et al. ACC/AHA guidelines for management of patients with acute myocardial infarction: 1999 update: report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). From website. 146. Sano M, Ernesto C, Thomas RG et al. A controlled trial of selegiline, alpha- tocopherol, or both as treatment for Alzheimer s disease. N Engl J Med . 1997; 336:1216-22. [PubMed 9110909] 147. Drachman DA, Leber P. Treatment of Alzheimer s disease searching or a breakthrough, settling for less. N Engl J Med . 1997; 336:1245-7. [PubMed 9110915] 148. Small GW, Rabins PV, Barry PP et al. Diagnosis and treatment of Alzheimer disease and related disorders: consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer s Association, and the American Geriatric Society. JAMA . 1997; 278:1363-71. [PubMed 9343469] 149. American Psychiatric Association. Practice guideline for the treatment of patients with Alzheimer s disease and other dementias of late life. Am J Psychiatry . 1997; 154(Suppl):1-39. 150. Roche Laboratories Inc. Xenical (orlistat) capsules prescribing information. Nutley, NJ; 1999 April. 151. Sjöström L, Rissanen A, Andersen T et al. Randomized placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. Lancet . 1998; 352:167-72. [PubMed 9683204] 152. Davidson MH, Hauptman J, DiGirolamo M et al. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat. JAMA . 1999; 281:235-42. [PubMed 9918478] 153. Hollander PA, Elbein SC, Hirsch IB et al. Role of orlistat in the treatment of obese patients with type 2 diabetes: a 1-year randomized double-blind study. Diabetes Care . 1998; 21:1288-94. [PubMed 9702435] 154. Melia AT, Koss-Twardy SG, Zhi J. The effect of orlistat, an inhibitor of dietary fat absorption, on the absorption of vitamins A and E in healthy volunteers. J Clin Pharmacol . 1996; 36:647-53. [PubMed 8844448] 155. Zhi J, Melia AT, Koss-Twardy SG et al. The effect of orlistat, an inhibitor of dietary fat absorption, on the pharmacokinetics of β-carotene in healthy volunteers. J Clin Pharmacol . 1996; 36:152-9. [PubMed 8852391] 156. Roche Laboratories Inc. Xenical (orlistat) capsules patient information. Nutley, NJ; 1999 April. 157. James WP, Avenell A, Broom J et al. A one-year trial to assess the value of orlistat in the management of obesity. Int J Obes Relat Metab Disord . 1997; 21(Suppl 3):S24-30. [PubMed 9225173] 158. Roche Laboratories Inc, Nutley, NJ: Personal communication on Orlistat 56:40. 159. Committee on the Scientific Evaluation of Dietary Reference Intakes of the Food and Nutrition Board, Institute of Medicine, National Academy of Sciences. Dietary reference intakes for Vitamin C, Vitamin E, selenium, and carotenoids. Washington, DC: National Academy Press; 2000. 160. The Heart Prevention Evaluation Study Investigators. Vitamin E supplementation and cardiovascular events in high-risk patients. N Engl J Med . 2000; 342:154-60. [PubMed 10639540] 161. GISSI-Prevenzione Investigators. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet . 1999; 354:447-55. [PubMed 10465168] 162. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes of the Food and Nutrition Board, Institute of Medicine, National Academy of Sciences. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington, DC: National Academy Press; 1997. (Uncorrected proofs.) 163. Doody RS, Stevens JC, Beck C et al. Practice parameter: management of dementia (an evidence-based review). Report of the quality standards subcommittee of the American Academy of Neurology. Neurology . 2001; 56:1154-66. [PubMed 11342679] 164. Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss. Arch Ophthalmol . 2001; 119:1417-36. [PubMed 11594942] 165. Jampol LM. Antioxidants, zinc, and age-related macular degeneration. Arch Ophthalmol . 2001; 119:1533-4. [PubMed 11594957] 166. Miller ER, Pastor-Barriuso R, Dalal D, et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med . 2005:142. From Annals of Internal Medicine website (). Accessed 11 Nov 2004. 167. Peterson RC, Thomas RG, Grundman M et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med . 2005; 352:2379-88. [PubMed 15829527] 168. Gualler E, Hanley DF, Miller ER. An editorial update: Annus horribilis for vitamin E. Ann Intern Med . 2005; 143:143-5. [PubMed 16027457] 169. Lee IM, Cook NR, Gaziano JM et al. Vitamin E in the primary prevention of cardiovascular disease and cancer The Women's Health Study: a randomized controlled trial. JAMA . 2005; 294:56-65. [PubMed 15998891] 170. Ford ES, Ajani UA, Mokdad AH. Brief communication: The prevalence of high intake of vitamin E from the use of supplements among U.S. adults. Ann Intern Med . 2005: 143:116-20. 171. The HOPE and HOPE-TOO trial investigators. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: A randomized trial. JAMA . 2005; 293:1338-47. [PubMed 15769967] 172. Brown BG, Crowley J. Is there any hope for vitamin E? JAMA . 2005; 293:1387-90. Editorial. 173. American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia. Am J Psychiatr . 2004; 161(Suppl):1-56. 174. Klein EA, Thompson IM, Lippman SM et al. SELECT: the selenium and vitamin E cancer prevention trial: rationale and design. Prostate Cancer Prostatic Dis . 2000: 3:145-51 175. National Cancer Institute. Selenium and vitamin E cancer prevention trial (SELECT). 2008 Oct 31. From . Accessed 2008 Nov 21. a. AHFS drug information 2007. McEvoy GK, ed. Vitamin E. Bethesda, MD: American Society of Health-System Pharmacists; 2007:3645-9. b. Dietary reference intakes: the essential guide to nutrient requirements. Institute of Medicine of the National Academies. Washington, D.C.: National Academies Press, 2006: 235 43. c. Vitamin E. In: Briggs GG, Freeman RK, Yaffe SJ, eds. Drug in pregnancy and lactation: a reference guide to fetal and neonatal risk. 7th ed.Philadelphia: Lippincott, Williams & Wilkins; 2005:1735-7. d. Bjelakovic F, Nikolova D, Gluud LL et al. Mortality in randomized trials of antioxidant supplements for primary or secondary prevention: systematic review and meta-analysis. JAMA . 2007; 297:842-57. [PubMed 17327526] e. Nature's Bounty 100% natural vitamin E 400 IU, softgels product information. From Walgreen's website. Accessed 24 Mar 2008. f. American Psychiatric Association. Practice Guideline for the treatment of patients with Alzheimer's disease and other dementias. 2007 Oct. From the American Psychiatric Association website. Next Interactions Print this page Add to My Med List More about Aquasol E (vitamin e) Side Effects During Pregnancy Dosage Information Drug Interactions Support Group En Español 0 Reviews Add your own review/rating Drug class: vitamins Consumer resources Aquasol E Aquasol E (Advanced Reading) Professional resources Vitamin E (AHFS Monograph) Related treatment guides Alzheimer's Disease Anemia, Sickle Cell Cystic Fibrosis Dietary Supplementation ... +4 more]} FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Drug Status Rx OTC Availability Rx and/or OTC C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Drug Class Vitamins Related Drugs Dietary Supplementation biotin , multivitamin , Fish Oil , ascorbic acid , More... Alzheimer's Disease Aricept , Exelon , donepezil , Namenda , memantine , vitamin e , More... 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