Vitamin E

Are there any interactions with medications?



Cyclosporine (Neoral, Sandimmune)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Taking large amounts of vitamin E along with cyclosporine (Neoral, Sandimmune) might increase how much cyclosporine (Neoral, Sandimmune) the body absorbs. By increasing how much cyclosporine the body absorbs, vitamin E might increase the effects and side effects of cyclosporine (Neoral, Sandimmune).



Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Vitamin E might increase how quickly the liver breaks down some medications. Taking vitamin E along with some medications that are broken down by the liver can decrease the effectiveness of some medications. Before taking vitamin E, talk to your healthcare provider if you are taking any medications that are changed by the liver.

Some medications changed by the liver include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and many others.



Medications for cancer (Chemotherapy)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Vitamin E is an antioxidant. There is some concern that antioxidants might decrease the effectiveness of some medications used for cancers. But it is too soon to know if the interaction occurs.



Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Vitamin E might slow blood clotting. Taking vitamin E along with medications that also slow clotting might increase the chances of bruising and bleeding.

Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.



Medications used for lowering cholesterol (Statins)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Taking vitamin E, beta-carotene, vitamin C, and selenium together might decrease the effectiveness of some medications used for lowering cholesterol. It is not known if taking vitamin E alone decreases the effectiveness of some medications used for lowering cholesterol.

Some medications used for lowering cholesterol include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), and pravastatin (Pravachol).



Niacin
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Taking vitamin E along with beta-carotene, vitamin C, and selenium might decrease some of the beneficial effects of niacin. Niacin can increase the good cholesterol. Taking vitamin E along with these other vitamins might decrease the good cholesterol.



Warfarin (Coumadin)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Warfarin (Coumadin) is used to slow blood clotting. Vitamin E can also slow blood clotting. Taking vitamin E along with warfarin (Coumadin) can increase the chances of bruising and bleeding. Be sure to have your blood checked regularly. The dose of your warfarin (Coumadin) might need to be changed.

Dosing considerations for Vitamin E.

The following doses have been studied in scientific research:

BY MOUTH:
  • For vitamin E deficiency: a typical dose in adults is RRR-alpha tocopherol (natural vitamin E) 60-75 IU per day.
  • For the movement disorder called tardive dyskinesia: RRR-alpha-tocopherol (natural vitamin E) 1600 IU daily.
  • For improving male fertility: vitamin E 200-600 IU daily.
  • For Alzheimer's disease: up to 2000 IU daily. Combination therapy of donepezil (Aricept) 5 mg and vitamin E 1000 IU per day has been used for slowing memory decline in people with Alzheimer's disease.
  • For liver disease called non-alcoholic steatohepatitis: 800 IU daily in adults has been used; 400-1200 IU daily has been used in children.
  • For early Huntington's chorea: RRR-alpha-tocopherol (natural vitamin E) 3000 IU.
  • For rheumatoid arthritis pain: vitamin E 600 IU twice daily.
  • For preventing nerve damage caused by cisplatin: vitamin E (alpha-tocopherol) 300 mg daily with each chemotherapy treatment and for up to 3 months after stopping cisplatin therapy.
  • For improving effectiveness of nitrates used for heart disease: vitamin E 200 mg three times daily.
  • To reduce protein in the urine of children with a kidney disease called focal segmental glomerulosclerosis: vitamin E 200 IU.
  • For G6PD deficiency: vitamin E 800 IU daily.
  • For premenstrual syndrome (PMS): RRR-alpha-tocopherol (natural vitamin E) 400 IU daily.
  • For painful menstrual periods: vitamin E 200 IU twice or 500 IU daily starting 2 days before the menstrual period and continuing through the first 3 days of bleeding.
  • For healing the eyes after a surgery called keratectomy: 230 mg vitamin E (alpha-tocopheryl nicotinate) and vitamin A (retinol palmitate) 25,000 units have been used 3 times daily for 30 days, followed by twice daily for 2 months.
  • For fibrosis caused by radiation: vitamin E 1000 IU daily in combination with pentoxifylline 800 mg.
  • For beta-thalassemia: vitamin E 750 IU daily.
  • For preventing sunburn: RRR-alpha-tocopherol (natural vitamin E) 1000 IU in combination with 2 grams of ascorbic acid.
  • For preventing high blood pressure during pregnancy (pre-eclampsia) in high risk women: vitamin E 400 IU with vitamin C 1000 mg daily.
For the most benefit, it's best to take vitamin E that has been made in a lab (all-rac-alpha-tocopherol) with food.

Dosing for vitamin E can be confusing. Current guidelines show recommended dietary allowance (RDA) and upper tolerable limits (UTL) for vitamin E in milligrams. However, most products are still labeled in International Units (IUs).


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