Dosage Guidance:
Dosing: 1 mg of alpha tocopherol (vitamin E) is equivalent to 2.22 units of synthetic form (dl-alpha tocopherol) or 1.49 units of naturally sourced form (d-alpha tocopherol) (Ref).
Adequate intake (AI): Neonates: Oral: 4 mg/day. Note: Adequate intake represents alpha-tocopherol intake from dietary consumption.
Vitamin E deficiency, prevention/treatment, chronic cholestasis/liver disease:
Term neonates: Oral: Usual dose: 25 to 50 units/kg/day; monitor closely and adjust dose as needed to maintain target ratio of serum vitamin E to total serum lipid concentrations. Doses up to 100 units/kg/day have been described in infants with biliary atresia (Ref). Note: Studies were performed with a water miscible preparation of natural vitamin E (d-alpha-tocopherol polyethylene glycol succinate [TPGS]).
Source-specific dosing (mg):
Natural form (d-alpha tocopherol): Oral: Usual dose: 16.8 to 33.6 mg/kg/day; up to 67 mg/kg/day.
Vitamin E supplementation, cystic fibrosis: Neonates: Oral: 40 to 50 units/day (Ref).
Source-specific dosing (mg):
Synthetic form (dl-alpha tocopherol): Oral: 18 to 22.5 mg/day.
Natural form (d-alpha tocopherol): Oral: 26.8 to 33.6 mg/day.
Dosage Guidance:
Dosing: 1 mg of alpha tocopherol (vitamin E) is equivalent to 2.22 units of synthetic form (dl-alpha tocopherol) or 1.49 units of naturally sourced form (d-alpha tocopherol) (Ref).
Vitamin E deficiency, prevention/treatment, chronic cholestasis/liver disease:
Infants, Children, and Adolescents: Oral: Usual dose: 25 to 50 units/kg/day; monitor closely and adjust doses as needed to maintain target ratio of serum vitamin E to total serum lipid concentrations. Reported range: 10 to 50 units/kg/day. Doses up to 100 units/kg/day have been described in infants with biliary atresia (Ref). Note: Studies were performed with a water miscible preparation of natural vitamin E (d-alpha-tocopherol polyethylene glycol succinate [TPGS]).
Source-specific dosing (mg):
Natural form (d-alpha tocopherol): Oral: Usual dose: 16.8 to 33.6 mg/kg/day; reported range: 6.7 to 33.6 mg/kg/day; doses up to 67 mg/kg/day have been described.
Vitamin E dietary supplement: Aqueous Vitamin E Oral Drops (dl-alpha tocopherol 15 mg/0.67 mL) (manufacturer's labeling):
Infants and Children <4 years: dl-alpha tocopherol: Oral: 6.73 mg (0.3 mL).
Children ≥4 years and Adolescents: dl-alpha tocopherol: Oral: 15.7 mg (0.7 mL).
Vitamin E supplementation, cystic fibrosis:
Infants: Oral: 40 to 50 units/day(Ref).
Source-specific dosing (mg):
Synthetic form (dl-alpha tocopherol): Oral: 18 to 22.5 mg/day.
Natural form (d-alpha tocopherol): Oral: 26.8 to 33.6 mg/day.
Children ≤3 years: Oral: 80 to 150 units/day (Ref).
Source-specific dosing (mg):
Synthetic form (dl-alpha tocopherol): Oral: 36 to 67.5 mg/day.
Natural form (d-alpha tocopherol): Oral: 53.7 to 100.7 mg/day.
Children 4 to ≤8 years: Oral: 100 to 200 units/day (Ref).
Source-specific dosing (mg):
Synthetic form (dl-alpha tocopherol): Oral: 45 to 90 mg/day.
Natural form (d-alpha tocopherol): Oral: 67 to 134 mg/day.
Children >8 years and Adolescents: Oral: 200 to 400 units/day (Ref).
Source-specific dosing (mg):
Synthetic form (dl-alpha tocopherol): Oral: 90 to 180 mg/day.
Natural form (d-alpha tocopherol): Oral: 134 to 268 mg/day.
(For additional information see "Vitamin E (systemic): Drug information")
Units |
Synthetic form (dl-alpha tocopherol) |
Natural form (d-alpha tocopherol) |
---|---|---|
a 1 unit of vitamin E is equivalent to 0.45 mg of the synthetic form (dl-alpha tocopherol) and 0.67 mg of the natural form (d-alpha tocopherol) (NIH 2021). | ||
30 units |
13.5 mg |
20.1 mg |
35 units |
15.7 mg |
23.4 mg |
100 units |
45 mg |
67 mg |
200 units |
90 mg |
134 mg |
400 units |
180 mg |
268 mg |
800 units |
360 mg |
536 mg |
1,000 units |
450 mg |
670 mg |
Dietary supplement:
Oral (capsule, tablet): Varies by product. Dosages range from 100 to 1,000 units/day (45 to 450 mg/day of dl-alpha tocopherol or 67 to 670 mg/day of d-alpha tocopherol).
Oral (aqueous drops): Varies by product. Dosages range from 30 to 35 units/day (13.5 mg to 15.7 mg/day of dl-alpha tocopherol).
Metabolic dysfunction associated steatohepatitis (off-label use):
Oral: 800 units (360 mg dl-alpha tocopherol or 536 mg of d-alpha tocopherol) once daily (Ref).
There are no adverse reactions listed in the manufacturer’s labeling.
Hypersensitivity to vitamin E or any component of the formulation
Concerns related to adverse effects:
• Vitamin K deficiency: May induce vitamin K deficiency (Corkins 2010).
Special populations:
• Low birth weight infants: Necrotizing enterocolitis has been associated with oral administration of large dosages (eg, >200 mg of alpha-tocopherol/day) of a hyperosmolar vitamin E preparation in low birth weight infants.
Dosage form specific issues:
• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer’s labeling.
Excessive intake of vitamin E may be associated with adverse effects, including hemorrhagic effects; use caution when total daily intake from all sources (any form of alpha-tocopherol) exceeds the recommended age-based daily upper limit: 1 to 3 years: 200 mg; 4 to 8 years: 300 mg; 9 to 13 years: 600 mg; 14 to 18 years: 800 mg; ≥19 years: 1,000 mg; monitor serum concentrations (IOM 2000).
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule, Oral:
True Vitamin E: 450 mg, 180 mg
Generic: 100 units, 400 units, 180 mg, 200 units, 450 MG (1000 UT)
Capsule, Oral [preservative free]:
E-400-Clear: 400 units [dye free]
Generic: 100 units, 400 units [DSC], 180 mg, 450 MG (1000 UT)
Liquid, Oral:
Generic: 90 mg/mL (60 mL)
Solution, Oral:
Aqueous Vitamin E: 6.75 mg/0.3 mL (30 mL [DSC]) [anise-butterscotch flavor]
SoluVita E: 6.75 mg/0.3 mL (30 mL [DSC]) [dye free, gluten free, lactose free, sugar free; contains methylparaben, polysorbate 80, propylene glycol, saccharin sodium]
Generic: 6.75 mg/0.3 mL (30 mL)
Tablet, Oral:
Natural Vitamin E: 200 units, 400 units [animal products free, gelatin free, gluten free, kosher certified, lactose free, no artificial color(s), no artificial flavor(s), starch free, sugar free, yeast free]
Generic: 100 units, 200 units, 400 units
Yes
Capsules (Vitamin E Oral)
45 MG(100 UNIT) (per each): $0.03 - $0.04
90 MG(200 UNIT) (per each): $0.04 - $0.06
180 MG(400 UNIT) (per each): $0.07 - $0.26
450 MG(1000 UT) (per each): $0.10 - $0.18
Liquid (Vitamin E Oral)
90 mg/mL (per mL): $8.25
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Oil, Injection:
Generic: 100 units/mL ([DSC])
Vitamin E, also known as alpha-tocopherol, occurs as several different isomers. Two are biologically active: Naturally sourced vitamin E (RRR-alpha-tocopherol; commonly labeled d-alpha tocopherol) is found in foods; synthetic-sourced vitamin E (2,S and 2,R sterioisomers or all-racemic alpha-tocopherol; commonly labeled dl-alpha tocopherol) is found in fortified foods and supplements (IOM 2000; NIH 2021).
Oral: May administer with or without food. Swallow capsules whole; do not crush or chew.
Swallow capsules whole; do not crush or chew.
Protect from light.
Vitamin E dietary supplement (OTC product: FDA approved in all ages). Note: Approved ages and uses for OTC products vary; consult labeling for specific information.
Aquasol E may be confused with Anusol
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Agents with Antiplatelet Effects: Vitamin E (Systemic) may increase antiplatelet effects of Agents with Antiplatelet Effects. Risk C: Monitor
Anticoagulants: Vitamin E (Systemic) may increase anticoagulant effects of Anticoagulants. Risk C: Monitor
CycloSPORINE (Systemic): Vitamin E (Systemic) may decrease serum concentration of CycloSPORINE (Systemic). Vitamin E (Systemic) may increase serum concentration of CycloSPORINE (Systemic). Risk C: Monitor
Ibrutinib: Vitamin E (Systemic) may increase antiplatelet effects of Ibrutinib. Risk C: Monitor
Orlistat: May decrease absorption of Vitamins (Fat Soluble). Management: Administer oral fat soluble vitamins at least 2 hours before or 2 hours after the administration of orlistat. Avoid concomitant administration due to the risk of impaired vitamin absorption. Risk D: Consider Therapy Modification
Selumetinib: May increase adverse/toxic effects of Vitamin E (Systemic). Management: If selumetinib is combined with additional vitamin E supplements, ensure that the total daily intake of vitamin E (including the amount of vitamin E in selumetinib and the supplement) does not exceed the recommended or safe limits. Risk D: Consider Therapy Modification
Therapeutic Antiplatelets: Vitamin E (Systemic) may increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor
Tipranavir: May increase adverse/toxic effects of Vitamin E (Systemic). Management: Patients taking tipranavir oral solution are advised to avoid taking additional vitamin E, beyond the amounts contained in a multivitamin product. This interaction does not apply to tipranavir capsules. Risk D: Consider Therapy Modification
Dietary Recommended intake (IOM 2000): Note: Adequate intake (AI) and recommended dietary allowance (RDA) represent alpha-tocopherol intake from dietary consumption.
1 to 6 months: AI: 4 mg/day.
7 to 12 months: AI: 5 mg/day.
1 to 3 years: RDA: 6 mg/day.
4 to 8 years: RDA: 7 mg/day.
9 to 13 years: RDA: 11 mg/day.
14 to 18 years: RDA: 15 mg/day.
>18 years: RDA: 15 mg/day.
Pregnant female:
14 to 18 years: RDA: 15 mg/day.
19 to 50 years: RDA: 15 mg/day.
Lactating female:
14 to 18 years: RDA: 19 mg/day.
19 to 50 years: RDA: 19 mg/day.
Vitamin E crosses the placenta. Maternal serum concentrations of α tocopherol increase with lipid concentrations as pregnancy progresses; however, placental transfer remains constant. Additional supplementation is not needed in pregnant patients without deficiency (IOM 2000).
Plasma tocopherol concentrations, vitamin E to serum lipids ratio.
Plasma tocopherol: 5 to 20 mcg/mL (SI: 11.6 to 46.4 micromole/L), some method variation (IOM 2000).
Serum vitamin E to serum lipid ratio (AAP 2019):
Deficiency:
Infants: <0.6 mg total tocopherol/g total lipid.
Children and Adolescents: <0.8 mg total tocopherol/g total lipid.
Target for deficiency correction: 0.8 to 1 mg total tocopherol/g total lipid.
Prevents oxidation of vitamin A and C; protects polyunsaturated fatty acids in membranes from attack by free radicals and protects red blood cells against hemolysis
Absorption: Depends on presence of bile; reduced in conditions of malabsorption, in low birth weight premature infants, and as dosage increases; water miscible preparations are better absorbed than oil preparations
Distribution: To all body tissues, especially adipose tissue, where it is stored
Metabolism: Hepatic to glucuronides
Excretion: Feces