Vitamin E

Biochemical action of vitamin E

Alpha-tocopherol's main mechanism of action is as a free radical scavenger. By binding to free radicals, it prevents oxidative damage to biological components. Damage to the cells results from the peroxidation of polyunsaturated fatty acids in the cell membrane by free radicals. Vitamin E serves as protection. Furthermore, it prevents platelet aggregation, monocyte adhesion, and cell proliferation.

• Antioxidant: Due to its oxidative inhibitory action, which protects cell membranes against lipid peroxidation, vitamin E is considered one of the most significant and powerful lipid-soluble antioxidants. It prevents the oxidation of LDL and free radical damage to the polyunsaturated fatty acids (PUFAs) found in each cell membrane's phospholipid layer.
• Promotes immunocompetence: Vitamin E influences immunocompetence by enhancing the development of humoral antibodies, bacterial infection resistance, cell-mediated immunity, the T lymphocyte response, tumour necrosis factor production, and natural killer cell activity.

Vitamin E is available in various forms like tablets, capsules, liquids and solutions.

• Tablets/ capsules will be swallowed whole with water/liquid, as applicable.

• Topical Vitamin E is to be applied in a little quantity of medication (about the size of a pea) in a thin layer as prescribed by your doctor, as applicable.
• Liquids should be taken by mouth, as applicable.
• Injectable solutions will be administered parenterally, as applicable.

• Vitamin E enhances to strengthens the immune system and fights invasive germs and viruses when used as a supplement.
• Vitamin E supplements help dilate blood arteries and prevent blood clotting.
• Supplemental Vitamin E is also used by cells to connect and perform various essential functions. Tocopherols in the form of alpha, gamma, and delta have different effects on cancer prevention, each through a unique biochemical mechanism that slows the progression of the disease.
• Vitamin E supplements could prevent or treat age-related macular degeneration (AMD) and cataracts in older people.

Vitamins and natural supplements should not replace a balanced diet

This product is not intended to diagnose, treat or prevent any disease(s)

Vitamin E is a supplement that benefits health in numerous ways.

• Cardiovascular disease: Atherosclerotic plaque formation, progression, and rupture have all been shown to be significantly affected by oxidative stress. Evidence suggests that taking vitamin E supplements can help in preventing blood clots that can cause a heart attack or venous thromboembolism.

• Angina pectoris: Smokers without a history of coronary heart disease see a slight reduction in the frequency of angina pectoris while using low-dose vitamin E supplements (50 mg/day)

• Cancer: Studies have demonstrated, for instance, that high dosages of vitamin E do not consistently lower the incidence of breast and colon cancer. According to a substantial study, using vitamin E supplements for numerous years at 180 mg daily (400 IU) enhanced men's chance of acquiring prostate cancer.

• Hypertension: Clinical studies have shown that vitamin E administration may improve endothelial dysfunction in hypertension lower blood pressure, and LDL oxidation.

• Alzheimer’s dementia and cognitive decline: Vitamin E may block hydrogen peroxide production, slowing the progression of cytotoxicity resulting in reduced beta amyloid cell death.

• Haemodialysis (HD): HD causes atherosclerosis, dialysis-related amyloidosis, and increased oxidative stress. Patients with HD, who are susceptible to high levels of oxidative stress, may benefit from taking vitamin E supplements because there is some evidence that these supplements lower oxidative stress and LDL oxidability in this group.

Vitamin E supplementation may be administered orally, topically or parenterally.

• Orally: When Vitamin E supplements are taken orally, it is best to take them along with a fat-containing meal to promote optimal absorption due to their lipophilic nature.

The dosage and duration of treatment should be as per the clinical judgment of the treating healthcare professional.

• Topically: Vitamin D supplements are applied topically to improve the health of your skin.

The dosage and duration of treatment should be as per the clinical judgment of the treating healthcare professional.

• Parenterally: Injectable solutions will be administered parenterally, as applicable.

The dosage and duration of treatment should be as per the clinical judgment of the treating healthcare professional.

Vitamins and natural supplements should not replace a balanced diet

This product is not intended to diagnose, treat or prevent any disease(s).

• Tablet: 200units, 400units, 600units,1000units
• Capsule: 100units, 200units, 400units

• Liquid: 400units/15mL
• Solution:15units/0.3mL

Dosage Adjustment for Adult Patients

Dosage Adjustment for Adult Patients

Vitamin E Deficiency

60-75 units oral qDay

Postherpetic Neuralgia (Off-label)

400 units oral twice or four times daily

Vitamin E is available in various forms like tablets, capsules, liquids and solutions.

• The advantages of Vitamin E are countered by any meal or drink that contains caffeine, including coffee, tea, chocolate, and soda.
• Limit alcoholic beverages.
• Stay within your daily calorie needs.

Recommended Daily Allowance (RDA)

15 mg (35 µmol)/day of α-tocopherol is recommended for men and women.

Upper Tolerable Intake (UTL):

For adults,it is set at 1,000 mg (2,325 µmol)/day

The dietary restriction should be individualized as per patient requirements.

The use of vitamin E supplements is regarded as safe.

• Users of high-dose supplements should do so under the supervision of a doctor if they have coagulation issues, genetic bleeding diseases, a history of hemorrhagic stroke, a vitamin K deficiency, or are at risk for pulmonary embolism or thrombophlebitis. Evidence does not support the idea that supplements taken in large dosages will considerably raise blood pressure, contradicting the assumption that those with hypertension who want to take supplements should start with moderate doses. One week before major surgery, stop taking large dosages (>1000 IU/day).
• May induce vitamin K deficiency. It is recommended to use with caution in Vitamin K deficiency, bleeding propensity or lesions (bleeding peptic ulcers, haemophilia, etc.)
• High doses of vitamin E of ≥400 units daily administered in long-term administration for more than one year may increase all-cause mortality.

The risk of bleeding may be increased by taking vitamin E together with blood thinners like warfarin.

People with any pre-existing medical disorders, such as diabetes or cardiovascular disease, should take vitamin E supplements with caution.

Due to its fat-soluble nature, vitamin A is not easily eliminated from the body; thus, it is essential to follow the recommended dosage since exceeding it may result in difficulties.

It is excreted in breastmilk; Safe to use during breastfeeding.

Vitamin E is generally well-tolerated. Adverse effects are dose-related and tend to occur only at very high supplemental doses (>1200 IU/day)

The adverse reactions related to Vitamin E can be categorized as-

• Common: Weakness, nausea, fatigue, palpitations, headache and diarrhea.
• Less Common: Double vision, flatulence and gastrointestinal upset,
• Rare: Risk of hemorrhagic stroke, premature Infants, mild increase in urine creatinine and necrotizing enterocolitis.

• Oral contraceptive pill: A relatively small cross-sectional investigation indicates that coenzyme Q10 and alpha-tocopherol levels were considerably decreased by the oral contraceptive pill. Additional research is required.
• HMG-CoA reductase inhibitors (statins): A risk factor for the development of statin-associated myopathy has been reported as the effect of statins on reducing blood lipid levels of vitamin E. Additional research is required.
• Chloroquine: Vitamin E decreases medication absorption in human cultured fibroblasts, according to in vitro study. This observation's relevance to medicine is unclear.Keep a watch on patients undergoing this treatment.
• Chlorpromazine: Vitamin E is known to prevent medication absorption in human cultured fibroblasts, according to in vitro study. Examine patients who are taking this combination; the therapeutic relevance of this observation is unknown.
• Cisplatin: When vitamin E and cisplatin were combined, the incidence of chemotherapy-induced peripheral neuropathy was considerably decreased in all four clinical studies that were reviewed. Positive interaction, but it should only be used under the supervision of a health worker.
• Warfarin: Reduced levels of vitamin K may be more susceptible to the effects of vitamin E, potentiating warfarin activity.
• Nitrates: Oral vitamin E prevented nitrate tolerance when given concurrently with transdermal nitroglycerin (10 mg/24 hours). Beneficial interaction is possible.
• NSAIDs and simple analgesics: Vitamin E may improve a drug's ability to reduce pain. Positive interaction is possible; the medicine dose may need to be changed.

The common side effects of Vitamin E include the following:

• Weakness
• Nausea
• Fatigue
• Palpitations
• Headache
• Diarrhea
• Increased serum creatinine
• Rash
• Intestinal cramps
• Blurred vision

• Pregnancy

Pregnancy Category: A; Vitamin E is safe to use during pregnancy.

Pregnant Females

Below 18 years: 15 mg PO qday; not to exceed 800 mg/day

More than 18 years old: 15 mg PO qday, with a maximum of 1000 mg.

• Paediatrics: Vitamin E is used in several childhood diseases, such as for the prevention of retinopathy of prematurity (ROP), growth retardation, fat malabsorption (e.g., cystic fibrosis, cholestatic diseases), and other chronic diseases in infants and children with vitamin E deficiency.

Dosage Adjustment for Paediatric Patients

Cystic Fibrosis Supplementation (Off-label)

1-12 months: 40-50 units/day

1-3 years: 80-150 units/day

4-8 years: 100-200 units/day

>8 years: 200-400 units/day

• Geriatrics: In humans, several studies have shown the clinical benefit of vitamin E supplementation in the elderly.

The immune system of the elderly has been shown to respond better to vitamin E, and this vitamin has been recommended for use in prophylactic measures for this age group.

200 IU/d is most effective for improving immune function in the elderly.

• Lactating mothers: Vitamin E is a normal component of human milk and is a crucial milk antioxidant. Daily maternal vitamin E supplementation from prenatal multivitamins can safely and modestly increase milk vitamin E levels and improve the vitamin E status of the breastfed infant compared to no supplementation.

Lactating Females

Below 18 years: 15 mg PO qday; not to exceed 800 mg/day

More than 18 years old: 15 mg PO qday, with a maximum of 1000 mg.

Dosage Adjustment in Kidney Impairment

There are no specific dosage adjustments provided.

There is no sufficient scientific evidence traceable regarding the dosage adjustment of vitamin E in these special populations.

Dosage Adjustment in Hepatic Impairment

There are no specific dosage adjustments provided.

There is no sufficient scientific evidence traceable regarding the dosage adjustment of vitamin E in these special populations

Biochemistry profile Vitamin E

Tocopherols and tocotrienol are components of vitamin E, a natural supplement that is obtained from plants. Vitamin E comprises eight lipophilic compounds, which include four tocopherols and four tocotrienols, each of these are designated as α-, β-, γ-, and δ-, which are synthesised by plants from homogentisic acid containing a chromanol ring and a lipophilic tail. Tocotrienols also differ from tocopherols because of their unsaturated side chains. α-tocopherol is the only vitamin E form capable of reversing nutrient deficiency symptoms.

Kinetic Profile:

• Absorption: Vitamin E is mainly obtained orally from the diet. It is absorbed from the intestinal lumen and depends upon adequate fat digestion via a micelle to enter the intestinal cells and incorporate into a chylomicron, leaving the intestinal cells to enter the lymph system and eventually enter circulation in the thoracic duct.
• Distribution: Vitamin E enters the lymphatic and systemic circulation, where it is transported in chylomicrons. Most α-tocopherol is stored in adipose tissue, although some storage also occurs in cell membranes, such as the plasma mitochondrial and microsomal membranes of the heart, muscles, testes, uterus, adrenal and pituitary glands, and blood.
• Metabolism: In the liver, the breakdown of chylomicrons in the blood releases some vitamin E, which is then taken up by circulating lipoproteins such as low-density lipoprotein (LDL) and high-density lipoprotein (HDL). The remaining vitamin E is transported via chylomicron remnants to the liver. Here, the R alpha-tocopherol form is preferentially secreted back into the circulation in very low-density lipoprotein (VLDL).
• Elimination: The inactive oxidated end product conjugates enter bile and are mainly excreted in the faeces and urine. However, the skin has also been implicated in its evacuation via sebaceous secretions.

• https://ods.od.nih.gov/factsheets/list-all/#A
• https://www.ncbi.nlm.nih.gov/books/NBK554545/
• https://www.ncbi.nlm.nih.gov/books/NBK225461/
• https://www.nin.res.in/rdabook/brief_note.pdf
• Braun L, Cohen M. October 1, 2014.Herbs and Natural Supplements; 4^th Edition Vol-2. Australia. Elsevier.