In addition to preventing the oxidation of vitamins A and vitamin C and PUFAs from free radicals, vitamin E (Evion) also protects against hemolysis.

• 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:

• • The oral dosage ranges from 100 to 400 units per day.
  • Aqueous Oral Drops: Orally take 30 units each day.

Vitamin E Dose in Children

Vitamin E Supplementation in patients with chronic Cholestasis:

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

Vitamin E dose in Biliary atresia, post-hepatoportoenterostomy:

• • Initially, 100 units per day using Aqua ADEK (2 mL).
  • The dose should be titrated depending on serum concentrations in increments of 25 units/kg/day up to 100 units/kg/day.
  • Lower doses may be needed for those whose total bilirubin is less than 2 mg/dL.
  • Target ranges for serum alpha-tocopherol concentration and vitamin E:total serum lipid ratio are 3.8 to 20.3 mcg/mL and 0.6 mg/gms, respectively.

Children:

• • It is preferred to use a water-soluble formulation.
  • 1 unit per kg daily.

Treatment for Vitamin E Deficiency Associated with Malabsorption with Vitamin E (Evion) Dose:

• Minors:
  • 1 unit per kg daily.
  • Depending on serum concentrations, adjust the dose.
  • Patients with malabsorption are more likely to benefit from the water-soluble formulation.

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

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

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

Aqueous Oral Drops (50 units/mL):

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

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.

Systemic vitamin E and drug interactions

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, and low birth weight infants, and malabsorption. Higher doses of bile are more effective for absorption.

It is distributed to all body tissues, including fat cells and adipose. It is

metabolised by the liver to glucuronides

excreted in the feces.

International Brand Names of Vitamin E:

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

Vitamin E brand names in Pakistan: