alpha tocopherol
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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]
Dosage
Pharmacokinetics
- 50 mg = 100 IU. (alpha-tocopherol)
Adverse effects
- 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
More specific terms
Component of
- alpha tocopherol/silicon dioxide
- alpha tocopherol/menthol/nonivamide/salicylate
- alpha tocopherol/lipoate/ubiquinone
- alpha tocopherol/ascorbate/calcium phosphate/docosahexaenoate/ferrous fumarate/folic acid/pyridoxine/sodium docusate
- alpha tocopherol/menthol
- alpha tocopherol/cyanokit/folic acid/magnesium oxide/pyridoxine
- alpha tocopherol/carnitine/coenzyme/ubiquinone
- alpha tocopherol/ascorbate/cholecalciferol/docosahexaenoate/ferrous fumarate/folic acid/pyridoxine/sodium docusate
- alpha tocopherol/ascorbate/carbonyl iron/cholecalciferol/cobalamin/folic acid/nicotinamide/pyridoxine/riboflavin/thiamine
- alpha tocopherol/ascorbate/calcium phosphate/cholecalciferol/docosahexaenoate/ferrous fumarate/folic acid/pyridoxine/sodium docusate
- alpha tocopherol/ascorbate/calcium citrate/carbonyl iron/cholecalciferol/folic acid/nicotinamide/potassium iodide/pyridoxine/riboflavin/sodium docusate/thiamine/zinc oxide
- alpha tocopherol/ascorbate/calcium citrate/carbonyl iron/cholecalciferol/docosahexaenoate/folic acid/nicotinamide/potassium iodide/pyridoxine/riboflavin/sodium docusate/thiamine/zinc oxide
- alpha tocopherol/ascorbate/calcium carbonate/carbonyl iron/cholecalciferol/cobalamin/cupric oxide/folic acid/magnesium oxide/nicotinamide/pyridoxine/riboflavin/sodium docusate/thiamine/zinc oxide
- alpha tocopherol/ascorbate/biotin/cholecalciferol/cobalamin/folic acid/nicotinamide/panthenol/pyridoxine/riboflavin/thiamine/vitamin a/vitamin k
- alpha tocopherol/ascorbate/biotin/biotin/cobalamin/ergocalciferol/folic acid/multivitamin/nicotinamide/panthenol/pyridoxine/riboflavin/thiamine/vitamin a/vitamin k
- alpha tocopherol/ascorbate/beta carotene/calcium carbonate/cholecalciferol/cobalamin/folic acid/magnesium oxide/nicotinamide/pyridoxine/riboflavin/thiamine/zinc oxide
- alpha tocopherol/ascorbate/beta carotene/calcium carbonate/cholecalciferol/cobalamin/ferrous fumarate/folic acid/nicotinamide/pantothenate/pyridoxine/riboflavin/sodium docusate/thiamine/zinc oxide
- alpha tocopherol/ascorbate/beta carotene/calcium carbonate/cholecalciferol/cobalamin/docosahexaenoate/folic acid/magnesium oxide/nicotinamide/pyridoxine/riboflavin/thiamine/zinc oxide
- alpha tocopherol/ascorbate/calcium phosphate/docosahexaenoate/eicosapentaenoate/ferrous fumarate/folic acid/pyridoxine
- alpha tocopherol/ascorbate/calcium phosphate/docosahexaenoate/eicosapentaenoate/folic acid/pyridoxine
- Ocuvite PreserVision; AREDS formulation
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
- ↑ 3.0 3.1 West Los Angeles (WLA) Veterans Affairs (VA) Pharmacy
- ↑ 4.0 4.1 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ 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 - ↑ 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
- ↑ 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 - ↑ 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
- ↑ 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
- ↑ 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 - ↑ 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 - ↑ 18.0 18.1 Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022
- ↑ 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
- ↑ 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