eMedicine Specialties > Endocrinology > Metabolic Disorders

Vitamin E Toxicity: Treatment & Medication

Author: Angela Gentili, MD, Director of Geriatrics Fellowship Program, Associate Professor, Department of Internal Medicine, Virginia Commonwealth University Health System and McGuire Veterans Affairs Medical Center
Coauthor(s): Robert A Adler, MD, Chief of Endocrinology and Metabolism, McGuire Veterans Affairs Medical Center; Professor, Departments of Internal Medicine and Epidemiology and Community Health, Virginia Commonwealth University
Contributor Information and Disclosures

Updated: Aug 12, 2008

Treatment

Medical Care

  • Management of vitamin E toxicity consists of discontinuing vitamin E supplements and monitoring the PT if bleeding complications develop.
  • Vitamin K replacement through the oral or subcutaneous route should reverse the elevated PT and decrease the risk of bleeding in patients who are taking anticoagulants or who have vitamin K deficiency.

Consultations

  • Consult a neurosurgeon if evidence of CNS hemorrhage is present.

Medication

No medical treatments are specific to the management of vitamin E toxicity, with the exception of vitamin K, which should be replaced in patients with bleeding or an elevated PT.

Vitamin replacement/nutritional supplements

Essential in many metabolic processes.


Vitamin K, phytonadione (AquaMEPHYTON)

Fat-soluble vitamin absorbed by the gut and stored in the liver. Vitamin K is necessary for the function of clotting factors in the coagulation cascade. It is used to replace essential vitamins not obtained in sufficient quantities in the diet or to further supplement levels.

Adult

10 mg PO/IV/IM/SC should replete the liver stores

Pediatric

1 mg IM

Effects of warfarin, sodium, and dicumarol are antagonized

Pregnancy

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

Ineffective in hereditary hypoprothrombinemia; rapid infusion may result in flushing and a feeling of constriction in the chest; relatively nontoxic, even in massive doses

More on Vitamin E Toxicity

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

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  2. Miller ER 3rd, Pastor-Barriuso R, Dalal D, et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. Jan 4 2005;142(1):37-46. [Medline]. [Full Text].

  3. Corrigan JJ Jr, Marcus FI. Coagulopathy associated with vitamin E ingestion. JAMA. Dec 2 1974;230(9):1300-1. [Medline].

  4. Diplock AT. Safety of antioxidant vitamins and beta-carotene. Am J Clin Nutr. Dec 1995;62(6 Suppl):1510S-6S. [Medline]. [Full Text].

  5. Brown BG, Zhao XQ, Chait A, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med. Nov 29 2001;345(22):1583-92. [Medline]. [Full Text].

  6. Cheung MC, Zhao XQ, Chait A, et al. Antioxidant supplements block the response of HDL to simvastatin-niacin therapy in patients with coronary artery disease and low HDL. Arterioscler Thromb Vasc Biol. Aug 2001;21(8):1320-6. [Medline]. [Full Text].

  7. Hathcock JN, Azzi A, Blumberg J, et al. Vitamins E and C are safe across a broad range of intakes. Am J Clin Nutr. Apr 2005;81(4):736-45.

  8. Vivekananthan DP, Penn MS, Sapp SK, et al. Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomised trials. Lancet. Jun 14 2003;361(9374):2017-23. [Medline].

  9. [Best Evidence] Cook NR, Albert CM, Gaziano JM, et al. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women: results from the Women's Antioxidant Cardiovascular Study. Arch Intern Med. Aug 13-27 2007;167(15):1610-8. [Medline].

  10. Bjelakovic G, Nikolova D, Gluud LL, et al. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA. Feb 28 2007;297(8):842-57. [Medline].

  11. Lonn E, Bosch J, Yusuf S, et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. Mar 16 2005;293(11):1338-47. [Medline]. [Full Text].

  12. Eidelman RS, Hollar D, Hebert PR, et al. Randomized trials of vitamin E in the treatment and prevention of cardiovascular disease. Arch Intern Med. Jul 26 2004;164(14):1552-6. [Medline].

  13. MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. Jul 6 2002;360(9326):23-33. [Medline].

  14. Shekelle PG, Morton SC, Jungvig LK, et al. Effect of supplemental vitamin E for the prevention and treatment of cardiovascular disease. J Gen Intern Med. Apr 2004;19(4):380-9. [Medline]. [Full Text].

  15. Orrell RW, Lane RJ, Ross M. A systematic review of antioxidant treatment for amyotrophic lateral sclerosis/motor neuron disease. Amyotroph Lateral Scler. Mar 14 2008;1-16. [Medline].

  16. Lane JS, Magno CP, Lane KT, et al. Nutrition impacts the prevalence of peripheral arterial disease in the United States. J Vasc Surg. Jun 27 2008;[Medline].

  17. Mahabir S, Schendel K, Dong YQ, et al. Dietary alpha-, beta-, gamma- and delta-tocopherols in lung cancer risk. Int J Cancer. Sep 1 2008;123(5):1173-80. [Medline].

  18. Liede KE, Haukka JK, Saxén LM, et al. Increased tendency towards gingival bleeding caused by joint effect of alpha-tocopherol supplementation and acetylsalicylic acid. Ann Med. Dec 1998;30(6):542-6. [Medline].

  19. Leppala JM, Virtamo J, Fogelholm R, et al. Controlled trial of alpha-tocopherol and beta-carotene supplements on stroke incidence and mortality in male smokers. Arterioscler Thromb Vasc Biol. Jan 2000;20(1):230-5. [Medline]. [Full Text].

  20. Handelman GJ. High-dose vitamin supplements for cigarette smokers: caution is indicated. Nutr Rev. Oct 1997;55(10):369-70. [Medline].

  21. Bardosi A, Dickmann U. Necrotizing myopathy with paracrystalline inclusion bodies in hypervitaminosis E. Acta Neuropathol (Berl). 1987;75(2):166-72. [Medline].

  22. Brown BG, Crowley J. Is there any hope for vitamin E?. JAMA. Mar 16 2005;293(11):1387-90. [Medline].

  23. Kaegi E. Unconventional therapies for cancer: 5. Vitamins A, C and E. The Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative. CMAJ. Jun 2 1998;158(11):1483-8. [Medline].

  24. Kappus H, Diplock AT. Tolerance and safety of vitamin E: a toxicological position report. Free Radic Biol Med. 1992;13(1):55-74. [Medline].

  25. Kitagawa M, Mino M. Effects of elevated d-alpha(RRR)-tocopherol dosage in man. J Nutr Sci Vitaminol (Tokyo). Apr 1989;35(2):133-42. [Medline].

  26. Meydani SN, Meydani M, Blumberg JB, et al. Assessment of the safety of supplementation with different amounts of vitamin E in healthy older adults. Am J Clin Nutr. Aug 1998;68(2):311-8. [Medline].

  27. Meydani SN, Meydani M, Rall LC. Assessment of the safety of high-dose, short-term supplementation with vitamin E in healthy older adults. Am J Clin Nutr. Nov 1994;60(5):704-9. [Medline].

  28. Meyers DG, Maloley PA, Weeks D. Safety of antioxidant vitamins. Arch Intern Med. May 13 1996;156(9):925-35. [Medline].

  29. Omaye ST. Safety of megavitamin therapy. Adv Exp Med Biol. 1984;177:169-203. [Medline].

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Further Reading

Related eMedicine topics:
 Toxicity, Vitamin
Vitamin E Deficiency
Vitamin K Deficiency

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Keywords

vitamin E toxicity, hypervitaminosis E, vitamin poisoning, vitamin toxicity, vitamin E, alpha tocopherol, alpha-tocopherol, all-rac-alpha-tocopherol acetate, RRR–alpha tocopherol, RRR-alpha-tocopherol, antioxidant, free radical scavenger, fat-soluble vitamin, Alpha-Tocopherol, Beta Carotene Cancer Prevention Study, fatal subarachnoid hemorrhage, increased risk of bleeding, increased prothrombin time, necrotizing enterocolitis, intracranial hemorrhage, vitamin K

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Contributor Information and Disclosures

Author

Angela Gentili, MD, Director of Geriatrics Fellowship Program, Associate Professor, Department of Internal Medicine, Virginia Commonwealth University Health System and McGuire Veterans Affairs Medical Center
Angela Gentili, MD is a member of the following medical societies: American Geriatrics Society
Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Adler, MD, Chief of Endocrinology and Metabolism, McGuire Veterans Affairs Medical Center; Professor, Departments of Internal Medicine and Epidemiology and Community Health, Virginia Commonwealth University
Robert A Adler, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Bone and Mineral Research, and Endocrine Society
Disclosure: Eli Lilly Consulting fee Consulting

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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