eMedicine Specialties > Endocrinology > Metabolic Disorders

Vitamin E Deficiency: Treatment & Medication

Author: Gary E Caplan, MD, MPH, Occupational Medicine Physician, Workers Compensation Consultant, Harmon Occupational Medicine
Contributor Information and Disclosures

Updated: Jul 9, 2008

Treatment

Medical Care

  • Intramuscular administration is necessary when the deficiency results from a low concentration of bile salts in the lumen of the small intestine, because these patients are unable to absorb oral preparations.
  • Treatment, which may include oral or parenteral vitamin supplementation, must be designed to address the underlying cause of the deficiency.4

Consultations

Consult a gastroenterologist if biliary problems are the underlying cause of vitamin E deficiency.

Medication

The RDA of alpha tocopherol according to age (see Image 1) is as follows:

  • Age 0-6 months - 3 mg
  • Age 6-12 months - 4 mg
  • Age 1-3 years - 6 mg
  • Age 4-10 years - 7 mg
  • Adults and elderly individuals - 8-10 mg
Prevention

Vitamin E supplementation is important, because apparently effective doses are beyond the maximum dietary intake. Supplementation with vitamin E is extremely safe except when normal coagulation mechanisms are impaired.

Replacement recommendations according to disease state are as follows:

  • Abetalipoproteinemia - 100-200 IU/kg/d
  • Chronic cholestasis - 15-25 IU/kg/d
  • Cystic fibrosis - 5-10 IU/kg/d
  • Short-bowel syndrome - 200-3600 IU/d
  • Isolated vitamin E deficiency - 800-3600 IU/d
Larger doses are required in short-bowel syndrome and isolated vitamin E deficiency state.

Pregnancy/lactation
Vitamin E is in the Food and Drug Administration's (FDA's) pregnancy category A. Breastfeeding is safe.

Vitamins

Essential for normal cell function.


Vitamin E (alpha tocopherol)

Protects cell membranes from free radical attacks.

Adult

RDA dose: 8-10 mg/d (12-15 IU/d) PO
Therapeutic dose: 50-2000 IU/d PO
Deficiency: Tab/cap 30-50 mg qd (PO dose usually 4-5 times the RDA)

Pediatric

RDA dose: 3-10 mg/d PO
Therapeutic dose: 1-100 mg/kg/d PO

Reduced absorption with bile sequestrants; may enhance response to oral anticoagulants, perhaps because of interference with effect of vitamin K in clotting factor synthesis
For patients on warfarin or dicumarol, large doses may prolong PT

Documented hypersensitivity; PO use contraindicated in coagulation disorders or with anticoagulant therapy

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

May induce vitamin K deficiency; necrotizing enterocolitis may occur when large doses given; occasional muscle weakness, fatigue, headaches, and nausea may occur; thrombophlebitis has been reported in patients at risk for small vessel disease taking 400 or more IU

More on Vitamin E Deficiency

Overview: Vitamin E Deficiency
Differential Diagnoses & Workup: Vitamin E Deficiency
Treatment & Medication: Vitamin E Deficiency
Follow-up: Vitamin E Deficiency
Multimedia: Vitamin E Deficiency
References
Further Reading
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References

  1. Benomar A, Yahyaoui M, Marzouki N, et al. Vitamin E deficiency ataxia associated with adenoma. J Neurol Sci. Jan 1 1999;162(1):97-101. [Medline].

  2. Sokol RJ. Vitamin E and neurologic deficits. Adv Pediatr. 1990;37:119-48. [Medline].

  3. Sokol RJ, Guggenheim MA, Heubi JE, et al. Frequency and clinical progression of the vitamin E deficiency neurologic disorder in children with prolonged neonatal cholestasis. Am J Dis Child. Dec 1985;139(12):1211-5. [Medline].

  4. Tanyel MC, Mancano LD. Neurologic findings in vitamin E deficiency. Am Fam Physician. Jan 1997;55(1):197-201. [Medline].

  5. Rino Y, Suzuki Y, Kuroiwa Y, et al. Vitamin E malabsorption and neurological consequences after gastrectomy for gastric cancer. Hepatogastroenterology. Sep 2007;54(78):1858-61. [Medline].

  6. Fuller CJ, Huet BA, Jialal I. Effects of increasing doses of alpha-tocopherol in providing protection of low-density lipoprotein from oxidation. Am J Cardiol. Jan 15 1998;81(2):231-3. [Medline].

  7. Hathcock JN. Vitamins and minerals: efficacy and safety. Am J Clin Nutr. Aug 1997;66(2):427-37. [Medline]. [Full Text].

  8. Traber MG, Frei B, Beckman JS. Vitamin E revisited: do new data validate benefits for chronic disease prevention?. Curr Opin Lipidol. Feb 2008;19(1):30-8. [Medline].

  9. Stephens NG, Parsons A, Schofield PM, et al. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet. Mar 23 1996;347(9004):781-6. [Medline].

  10. Yusuf S, Dagenais G, Pogue J, et al. Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. Jan 20 2000;342(3):154-60. [Medline]. [Full Text].

  11. Morley S, Cecchini M, Zhang W, et al. Mechanisms of ligand transfer by the hepatic tocopherol transfer protein. J Biol Chem. Jun 27 2008;283(26):17797-804. [Medline].

  12. Das SK, Gupta G, Rao DN, et al. Effect of lecithin with vitamin-B complex and tocopheryl acetate on long-term effect of ethanol induced immunomodulatory activities. Indian J Exp Biol. Aug 2007;45(8):683-8. [Medline].

  13. Steinraths M, Vallance HD, Davidson AG. Delays in diagnosing cystic fibrosis: can we find ways to diagnose it earlier?. Can Fam Physician. Jun 2008;54(6):877-83. [Medline].

  14. Virtamo J, Rapola JM, Ripatti S, et al. Effect of vitamin E and beta carotene on the incidence of primary nonfatal myocardial infarction and fatal coronary heart disease. Arch Intern Med. Mar 23 1998;158(6):668-75. [Medline]. [Full Text].

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Keywords

vitamin E deficiency, alpha tocopherol deficiency, alpha-tocopherol deficiency, tocopherol deficiency, vitamin deficiencies, antioxidant deficiency, abetalipoproteinemia, fat malabsorption, isolated vitamin E deficiency syndrome, malabsorption syndrome, cystic fibrosis, chronic cholestatic liver disease, short-bowel syndrome, ataxia, peripheral neuropathy

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Contributor Information and Disclosures

Author

Gary E Caplan, MD, MPH, Occupational Medicine Physician, Workers Compensation Consultant, Harmon Occupational Medicine
Gary E Caplan, MD, MPH is a member of the following medical societies: American College of Occupational and Environmental Medicine and American College of Preventive Medicine
Disclosure: Nothing to disclose.

Medical Editor

Harris C Taylor, MD, Clinical Professor of Medicine, Division of Clinical and Molecular Endocrinology, Case Western Reserve University School of Medicine
Harris C Taylor, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Thyroid Association, and Endocrine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Romesh Khardori, MD, Chief, Division of Endocrinology, Metabolism and Molecular Medicine, Professor, Department of Internal Medicine, Southern Illinois University School of Medicine
Romesh Khardori, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Medical Association, American Society of Andrology, Endocrine Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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