Vitamin E
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Vitamin E (α-tocopherol; mixed natural and synthetic forms)
Generic; many OTC formulations
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Summary
Classes
Common uses
Vitamin E deficiency (often in fat malabsorption: cystic fibrosis, cholestasis, abetalipoproteinemia)0, Nonalcoholic steatohepatitis in non-diabetic adults (high-dose, evidence-based)0, Age-related macular degeneration (AREDS combination)0
Pharmacy
Starting dose
Replacement: 15-30 mg (22.5-45 IU) daily; NASH: 800 IU daily; AREDS-2: 400 IU daily (in combination formula)
Preparations
100, 200, 400 IU softgels and capsules; many proprietary OTC blends; combined formulations (AREDS-2)
US FDA Max
UL 1000 mg (~1500 IU natural)/d in adults; routinely exceeded in older AREDS-1 trials
Pharmacology
Routes
Oral
Onset
Days to weeks for tissue saturation
Duration
Weeks (fat-soluble)
Half-life
~3-4 days plasma; adipose tissue stores last months
Bioavailability
High with fat-containing meal; reduced in malabsorption
Pregnancy
Safe at replacement doses; high-dose use generally avoided.[citation needed]
Legal status
OTC in US
Purported mechanism
α-Tocopherol is the principal lipid-soluble antioxidant in cell membranes, scavenging peroxyl radicals to terminate lipid peroxidation chain reactions; the regenerated tocopheroxyl radical is reduced back to tocopherol by ascorbate and glutathione, integrating the major non-enzymatic antioxidant defenses.0 Beyond antioxidant function, modulates protein kinase C signaling. Bleeding risk with high-dose use (vitamin K antagonism in vitamin K-deficient states; possible platelet effects independent of vitamin K); caution with warfarin or in surgical patients. Some meta-analyses of high-dose supplementation (>400 IU) suggest increased all-cause mortality, tempering routine use outside specific indications.