alpha tocopherol

^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]^[16]^[17]^[18]^[19]^[20]^[21]

Introduction

Relative potencies of vitamin Es

vitamin	potency
1 mg of d,l alpha tocopheryl acetate:	1.0 IU
1 mg of d,l alpha tocopherol:	1.1 IU
1 mg of	d alpha tocopheryl acetate:	1.36 IU
1 mg of	d alpha tocopherol:	1.49 IU
1 mg of	d alpha tocopheryl succinate:	1.21 IU
1 mg of d,l alpha tocopheryl succinate:	0.89 IU

Indications

oral leukoplakia
reduction in risk of invasive prostate cancer (100 IU/day)
combination of vitamin E & vitamin C may reduce the risk of Alzheimer's disease; RR = 0.22 for users > 5 years^[5]
in combination with zinc, vitamin C & beta carotene as Ocuvite Preservision may delay progression of macular degeneration (see Ocuvite Preservision)
may reduce risk of cataracts^[10]
may have small benefit in preventing sudden cardiac death in women^[12] (600 IU QOD)
may diminish risk of thromboembolism in women^[14]

Contraindications

does NOT prevent lower respiratory tract infections in nursing home residents^[6]
does not reduce risk of cancer or cancer deaths in women^[12]
of NO benefit in early Alzheimer's disease (2000 IU/day)*
- may increase all-cause mortality^[7]^[8]
- no benefit in patients with minimal cognitive impairment (MCI) see Memory Impairment Study
does not prevent cognitive decline in elderly women^[13]
routine supplementation to prevent cardiovascular disease not indicated^[18]
USPTF recommends against use for prevention of cardiovascular disease or cancer^[19]

* VA study shows improvement in ADL (2000 IU/day) in patients with mild-to-moderate Alzheimer's disease^[17]

pregnancy category = a

safety in lactation = ?

Dosage

RDA: 15 IU
maximum benefit: probably 400 IU/day
maximum dose 2000 IU/day

Pharmacokinetics

50 mg = 100 IU. (alpha-tocopherol)

Adverse effects

(> 800 IU/day^[3])

nausea (may be seen at 400 IU/day)
diarrhea
blurred vision
flatulence
fatigue
hepatotoxic above 2000 IU/day
progressive ataxia^[4]
high dose vitamin E may increase all-cause mortality^[7]^[8]
may accelerate cancer pregression^[9]
vitamin E (400 IU/day) & vitamin C (1000 mg/day) supplements may blunt exercise-induced increase in insulin receptor sensitivity
increased risk for hemorrhagic stroke^[15] (no effect on overall stroke incidence)
vitamin E (400 IU/day) may increase risk of prostate cancer (HR=1.17)^[16]

Drug interactions

interference with absorption of warfarin, iron & vitamin B12
increases risk of bleeding in patients taking anticoagulants^[20]

Mechanism of action

lipophilic antioxidant
concentrates in mitochondria

More general terms

vitamin E

More specific terms

Component of

References

↑ Internal Medicine Alert 20(21):162-63 1998
↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
↑ ^{Jump up to: 3.0} ^3.1 West Los Angeles (WLA) Veterans Affairs (VA) Pharmacy
↑ ^{Jump up to: 4.0} ^4.1 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
↑ ^{Jump up to: 5.0} ^5.1 Zandi PP, Anthony JC, Khachaturian JS et al Reduced Risk of Alzheimer Disease in Users of Antioxidant Vitamin Supplements. The Cache County Study. Arch Neurol 61:82, 2004 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/14732624 <Internet> http://archneur.ama-assn.org/cgi/content/abstract/61/1/82
↑ ^{Jump up to: 6.0} ^6.1 Journal Watch 24(18):124, 2004 Meydani SN, Leka LS, Fine BC, Dallal GE, Keusch GT, Singh MF, Hamer DH. Vitamin E and respiratory tract infections in elderly nursing home residents: a randomized controlled trial. JAMA. 2004 Aug 18;292(7):828-36. Erratum in: JAMA. 2004 Sep 15;292(11):1305. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15315997
↑ ^{Jump up to: 7.0} ^7.1 ^7.2 Miller E et al, Meta-analysis: High Dosage Vit E Supplementation May Increase All-Cause Mortality, Annals of Internal Medicine 142(1):1-12, 2005 (online 11/10/04) http://www.annals.org
↑ ^{Jump up to: 8.0} ^8.1 ^8.2 Prescriber's Letter 11(12): 2004 Vitamin E and All-Cause Mortality Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=201211&pb=PRL (subscription needed) http://www.prescribersletter.com
↑ ^{Jump up to: 9.0} ^9.1 Journal Watch 25(11):87, 2005 Bairati I, Meyer F, Gelinas M, Fortin A, Nabid A, Brochet F, Mercier JP, Tetu B, Harel F, Masse B, Vigneault E, Vass S, del Vecchio P, Roy J. A randomized trial of antioxidant vitamins to prevent second primary cancers in head and neck cancer patients. J Natl Cancer Inst. 2005 Apr 6;97(7):481-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15812073
↑ ^{Jump up to: 10.0} ^10.1 Jacques PF, Taylor A, Moeller S Long-term nutrient intake and 5-year change in nuclear lens opacification, Archives of Ophthalmology 123:517, 2005
↑ Journal Watch 25(12):96, 2005 Petersen RC, Thomas RG, Grundman M, Bennett D, Doody R, Ferris S, Galasko D, Jin S, Kaye J, Levey A, Pfeiffer E, Sano M, van Dyck CH, Thal LJ; Alzheimer's Disease Cooperative Study Group. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med. 2005 Jun 9;352(23):2379-88. Epub 2005 Apr 13. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15829527
Blacker D Mild cognitive impairment--no benefit from vitamin E, little from donepezil. N Engl J Med. 2005 Jun 9;352(23):2439-41. Epub 2005 Apr 13. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15829528
↑ ^{Jump up to: 12.0} ^12.1 ^12.2 Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, Hennekens CH, Buring JE. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a randomized controlled trial. JAMA. 2005 Jul 6;294(1):56-65. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15998891
↑ ^{Jump up to: 13.0} ^13.1 Kang JH, Cook N, Manson J, Buring JE, Grodstein F. A randomized trial of vitamin E supplementation and cognitive function in women. Arch Intern Med. 2006 Dec 11-25;166(22):2462-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17159011
Espeland MA, Henderson VW. Preventing cognitive decline in usual aging. Arch Intern Med. 2006 Dec 11-25;166(22):2433-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17159007
↑ ^{Jump up to: 14.0} ^14.1 Glynn RJ et al, Effects of random allocation of vitamin E supplementation on the occurrence of venous thromboembolism. Report from the Women's Health Study. Circulation 2007, 116::1497 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17846285
↑ ^{Jump up to: 15.0} ^15.1 Schurks M et al, Effects of vitamin E on stroke subtypes: meta-analysis of randomised controlled trials BMJ 2010; 341:c5702 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21051774 <Internet> http://www.bmj.com/content/341/bmj.c5702.full
↑ ^{Jump up to: 16.0} ^16.1 Klein EA et al Vitamin E and the Risk of Prostate Cancer: The Selenium and Vitamin E Cancer Prevention Trial (SELECT) JAMA. 2011;306(14):1549-1556 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21990298 <Internet> http://jama.ama-assn.org/content/306/14/1549.full
Prescriber's Letter 18(12): 2011 Vitamin E and Increased Risk of Prostate Cancer Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=271222&pb=PRL (subscription needed) http://www.prescribersletter.com
↑ ^{Jump up to: 17.0} ^17.1 Dysken MW et al Effect of Vitamin E and Memantine on Functional Decline in Alzheimer Disease. The TEAM-AD VA Cooperative Randomized Trial. JAMA. 2014;311(1):33-4 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24381967 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1810379
Evans DA et al Vitamin E, Memantine, and Alzheimer Disease. JAMA. 2014;311(1):29-30 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24381966 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1810360
↑ ^{Jump up to: 18.0} ^18.1 Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022
↑ ^{Jump up to: 19.0} ^19.1 US Preventive Services Task Force Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer. US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(23):2326-2333. June 21 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35727271
↑ ^{Jump up to: 20.0} ^20.1 Incze M. Vitamins and nutritional supplements: what do I need to know? JAMA Intern Med. 2019;179:460. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30615020
↑ Department of Veterans Affairs, VA National Formulary

Database

[ref1-1] Internal Medicine Alert 20(21):162-63 1998

[ref2-2] Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998

[ref3-3] {Jump up to: 3.0} ^3.1 West Los Angeles (WLA) Veterans Affairs (VA) Pharmacy

[ref4-4] {Jump up to: 4.0} ^4.1 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004

[ref5-5] {Jump up to: 5.0} ^5.1 Zandi PP, Anthony JC, Khachaturian JS et al Reduced Risk of Alzheimer Disease in Users of Antioxidant Vitamin Supplements. The Cache County Study. Arch Neurol 61:82, 2004 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/14732624 <Internet> http://archneur.ama-assn.org/cgi/content/abstract/61/1/82

[ref6-6] {Jump up to: 6.0} ^6.1 Journal Watch 24(18):124, 2004 Meydani SN, Leka LS, Fine BC, Dallal GE, Keusch GT, Singh MF, Hamer DH. Vitamin E and respiratory tract infections in elderly nursing home residents: a randomized controlled trial. JAMA. 2004 Aug 18;292(7):828-36. Erratum in: JAMA. 2004 Sep 15;292(11):1305. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15315997

[ref7-7] {Jump up to: 7.0} ^7.1 ^7.2 Miller E et al, Meta-analysis: High Dosage Vit E Supplementation May Increase All-Cause Mortality, Annals of Internal Medicine 142(1):1-12, 2005 (online 11/10/04) http://www.annals.org

[ref8-8] {Jump up to: 8.0} ^8.1 ^8.2 Prescriber's Letter 11(12): 2004 Vitamin E and All-Cause Mortality Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=201211&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref9-9] {Jump up to: 9.0} ^9.1 Journal Watch 25(11):87, 2005 Bairati I, Meyer F, Gelinas M, Fortin A, Nabid A, Brochet F, Mercier JP, Tetu B, Harel F, Masse B, Vigneault E, Vass S, del Vecchio P, Roy J. A randomized trial of antioxidant vitamins to prevent second primary cancers in head and neck cancer patients. J Natl Cancer Inst. 2005 Apr 6;97(7):481-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15812073

[ref10-10] {Jump up to: 10.0} ^10.1 Jacques PF, Taylor A, Moeller S Long-term nutrient intake and 5-year change in nuclear lens opacification, Archives of Ophthalmology 123:517, 2005

[ref11-11] Journal Watch 25(12):96, 2005 Petersen RC, Thomas RG, Grundman M, Bennett D, Doody R, Ferris S, Galasko D, Jin S, Kaye J, Levey A, Pfeiffer E, Sano M, van Dyck CH, Thal LJ; Alzheimer's Disease Cooperative Study Group. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med. 2005 Jun 9;352(23):2379-88. Epub 2005 Apr 13. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15829527
Blacker D Mild cognitive impairment--no benefit from vitamin E, little from donepezil. N Engl J Med. 2005 Jun 9;352(23):2439-41. Epub 2005 Apr 13. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15829528

[ref12-12] {Jump up to: 12.0} ^12.1 ^12.2 Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, Hennekens CH, Buring JE. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a randomized controlled trial. JAMA. 2005 Jul 6;294(1):56-65. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15998891

[ref13-13] {Jump up to: 13.0} ^13.1 Kang JH, Cook N, Manson J, Buring JE, Grodstein F. A randomized trial of vitamin E supplementation and cognitive function in women. Arch Intern Med. 2006 Dec 11-25;166(22):2462-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17159011
Espeland MA, Henderson VW. Preventing cognitive decline in usual aging. Arch Intern Med. 2006 Dec 11-25;166(22):2433-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17159007

[ref14-14] {Jump up to: 14.0} ^14.1 Glynn RJ et al, Effects of random allocation of vitamin E supplementation on the occurrence of venous thromboembolism. Report from the Women's Health Study. Circulation 2007, 116::1497 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17846285

[ref15-15] {Jump up to: 15.0} ^15.1 Schurks M et al, Effects of vitamin E on stroke subtypes: meta-analysis of randomised controlled trials BMJ 2010; 341:c5702 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21051774 <Internet> http://www.bmj.com/content/341/bmj.c5702.full

[ref16-16] {Jump up to: 16.0} ^16.1 Klein EA et al Vitamin E and the Risk of Prostate Cancer: The Selenium and Vitamin E Cancer Prevention Trial (SELECT) JAMA. 2011;306(14):1549-1556 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21990298 <Internet> http://jama.ama-assn.org/content/306/14/1549.full
Prescriber's Letter 18(12): 2011 Vitamin E and Increased Risk of Prostate Cancer Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=271222&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref17-17] {Jump up to: 17.0} ^17.1 Dysken MW et al Effect of Vitamin E and Memantine on Functional Decline in Alzheimer Disease. The TEAM-AD VA Cooperative Randomized Trial. JAMA. 2014;311(1):33-4 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24381967 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1810379
Evans DA et al Vitamin E, Memantine, and Alzheimer Disease. JAMA. 2014;311(1):29-30 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24381966 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1810360

[ref18-18] {Jump up to: 18.0} ^18.1 Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022

[ref19-19] {Jump up to: 19.0} ^19.1 US Preventive Services Task Force Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer. US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(23):2326-2333. June 21 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35727271

[ref20-20] {Jump up to: 20.0} ^20.1 Incze M. Vitamins and nutritional supplements: what do I need to know? JAMA Intern Med. 2019;179:460. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30615020

[ref21-21] Department of Veterans Affairs, VA National Formulary

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alpha tocopherol

Contents

Introduction

Indications

Contraindications

Dosage

Pharmacokinetics

Adverse effects

Drug interactions

Mechanism of action

More general terms

More specific terms

Component of

References

Database

Navigation menu

alpha tocopherol

Introduction

Indications

Contraindications

Dosage

Pharmacokinetics

Adverse effects

Drug interactions

Mechanism of action

More general terms

More specific terms

Component of

References

Database

Navigation menu

Search