Vitamin E ( Evion ) - Uses, Dose, MOA, and Brand Names

Vitamin E (Evion) protects against hemolysis, prevents the oxidation of Vitamin A and Vitamin C, and prevents the polyunsaturated fatty acids from free radicals.

  • It is used as a dietary supplement in patients with malabsorption and chronic cholestatic jaundice.

  • It is not recommended for the prevention of stroke and ischemic heart disease.

Vitamin E Dose in Adults

Vitamin E Dose as a dietary supplement:

    • Dosages range from 100 - 400 units/day orally.
    • Aqueous Oral Drops: 30 units/day orally.

Vitamin E Dose in Childrens

Vitamin E Supplementation in patients with chronic Cholestasis:

  • Infants:
    • 20 - 50 units/kg/day orally.

Vitamin E dose in Biliary atresia, post-hepatoportoenterostomy:

    • 100 units/day initially using Aqua ADEK (2 mL).
    • Titrate the dose based upon serum concentrations in 25 units/kg/day increments up to 100 units/kg/day.
    • The target alpha-tocopherol serum concentration range is 3.8 to 20.3 mcg/mL and vitamin E: Total serum lipids ratio of 0.6 mg/gms.
    • Patients with a total bilirubin of less than 2 mg/dL may require lower doses

Children:

    • 1 unit/kg/day.
    • The water-soluble formulation is preferred

Vitamin E (Evion) Dose in the treatment of Deficiency of vitamin E associated with malabsorption:

  • Children:
    • 1 unit/kg/day.
    • Adjust the dose based on serum concentrations.
    • The water-soluble formulation is preferred in patients with malabsorption.

Vitamin E (Evion) Supplementation in patients with Cystic fibrosis:

  • 1 to 12 months:
    • 40 - 50 units/day orally.
  • 1 to 3 years:
    • 80 - 150 units/day orally.
  • 4 to 8 years:
    • 100 - 200 units/day orally.
  • older than 8 years:
    • 200 - 400 units/day orally.

Vitamin E (Evion) Dose in the prevention of deficiency or as a dietary supplement:

Aqueous Oral Drops (50 units/mL):

  • Infants:
    • 5 units daily orally (0.1 mL)
  • Children less than 4 years:
    • 10 units daily orally (0.2 mL)
  • Children older than 4 years and Adolescents:
    • 30 units daily orally (0.6 mL)

Pregnancy Risk Factor: C

  • Vitamin E crosses the placental boundary
  • As pregnancy progresses, maternal serum levels of tocopherol rise.
  • Patients who are pregnant do not need to take an extra dose.

Use during breastfeeding:

  • It is excreted from breast milk.
  • The concentrations in the breasts are highest immediately after birth and gradually decrease with time.
  • Breast concentration is affected by maternal intake
  • Supplementation for breastfeeding mothers is not necessary.

Vitamin E Dose in kidney disease:

The manufacturer has not recommended any dose adjustment in patients with renal disease. 

Vitamin E Dose in liver disease:

  • It may cause the deficiency of vitamin K. Patients with cirrhosis are deficient in coagulation factors.
  • Its use may further lead to worsening of the bleeding diathesis as seen in patients with liver disease. It should be used with caution.

Side effects of Vitamin E:

There are no adverse reactions related to its use listed in the manufacturer’s labeling. 

Contraindications to Vitamin E (Evion):

  • Allergy to tocopherol (vitamin A) or any component in the formulation

Warnings and Precautions

  • Vitamin K deficiency:
    • It could lead to a deficiency in vitamin K.
  • Intracranial bleeding
    • High doses or prolonged administration may cause intracranial bleeding, possibly due to vitamin K deficiency.

Vitamin E (systemic): Drug Interaction

Risk Factor C (Monitor therapy)

Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.)

Vitamin E (Systemic) may enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Anticoagulants

Vitamin E (Systemic) may enhance the anticoagulant effect of Anticoagulants.

CycloSPORINE (Systemic)

Vitamin E (Systemic) may decrease the serum concentration of CycloSPORINE (Systemic).

Ibrutinib

Vitamin E (Systemic) may enhance the antiplatelet effect of Ibrutinib.

Risk Factor D (Consider therapy modification)

Orlistat

May decrease the serum concentration of Vitamins (Fat Soluble). Management: Administer oral fat soluble vitamins at least 2 hours before or after the administration of orlistat. Similar precautions do not apply to parenterally administered fat soluble vitamins.

Tipranavir

May enhance the adverse/toxic effect of Vitamin E (Systemic). Management: Patients taking tipranavir oral solution are advised to avoid taking additional vitamin E, beyond the amounts contained in a multivitamin product. This interaction does not apply to tipranavir capsules.

Monitoring Parameters:

  • Monitoring is usually not required, however, plasma tocopherol concentrations may be done. 

How to administer Vitamin E (Evion)?

  • The capsules should be swallowed whole. It should not be crushed or chewed.

Mechanism of action of Vitamin E (Evion):

  • It protects vitamin A and C from oxidation, protects membranes from free radical attack, and protects red blood cells against hemolysis.

AbsorptionMalabsorption is lower in premature infants, low birth weight infants, and malabsorption. Higher doses of bile are more effective for absorption.

It isdistributedAll body tissues, including fat cells and adipose. It is

MetabolizedBy the liver to glucuronides

excretedIn the feces.

International Brand Names of Vitamin E:

  • Alph-E
  • Alph-E-Mixed 1000
  • Alph-E-Mixed
  • Aqueous Vitamin E
  • E-400
  • E-400-Clear
  • E-400-Mixed
  • E-Max-1000
  • E-Pherol
  • Formula E 400
  • Natural Vitamin E
  • Nutr-E-Sol
  • SoluVita E
  • Vita-Plus E
  • Altocaps-400
  • Armilla
  • Auxina E
  • Best
  • Bio E
  • Bio-E
  • E Natural
  • E Viton
  • E-400
  • E-Cap
  • E-Drops
  • E-Fertoc
  • E-Tabs
  • Evicotrat
  • E-vimin
  • E-Viton
  • Egogyn
  • Enat
  • Enervon-E
  • Ephynal
  • Epol
  • Erevit
  • Etec
  • Etocovit
  • Eugerminol
  • Eusovit
  • Eviol
  • Evion
  • Evit
  • Evitol
  • Evon
  • Grandpherol
  • Hijuven
  • Ixopalet
  • Livingpherol
  • Nat E
  • Natopherol
  • Naturee
  • Nuenat
  • Optovit E
  • Su Le Kang
  • Vedrop
  • Vieta
  • Zyme

Vitamin E brand names in Pakistan:

E-Ace ACE
E-soft Maxitech
Evion Martin Dow Marker
Evit Paramount
Vitamin E Ethical
Vitamin E Geofman
Vitamin E Laderly
Zescap Zafa

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