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alpha tocopherol

Relative potencies of vitamin Es vitamin potency 1 mg of d,l alpha tocopheryl acetate: 1.0 IU 1 mg of d,l alpha tocopherol: 1.1 IU 1 mg of d alpha tocopheryl acetate: 1.36 IU 1 mg of d alpha tocopherol: 1.49 IU 1 mg of d alpha tocopheryl succinate: 1.21 IU 1 mg of d,l alpha tocopheryl succinate: 0.89 IU Indications: 1) oral leukoplakia 2) reduction in risk of invasive prostate cancer (100 IU/day) 3) combination of vitamin E & vitamin C may reduce the risk of Alzheimer's disease; RR = 0.22 for users > 5 years [5] 4) in combination with zinc, vitamin C & beta carotene as Ocuvite Preservision may delay progression of macular degeneration (see Ocuvite Preservision) 5) may reduce risk of cataracts [10] 6) may have small benefit in preventing sudden cardiac death in women [12] (600 IU QOD) 7) may diminish risk of thromboembolism in women [14] Contraindications: 1) does NOT prevent lower respiratory tract infections in nursing home residents [6] 2) does not reduce risk of cancer or cancer deaths in women [12] 3) of NO benefit in early Alzheimer's disease (2000 IU/day)* a) may increase all-cause mortality [7,8] b) no benefit in patients with minimal cognitive impairment (MCI) see Memory Impairment Study 4) does not prevent cognitive decline in elderly women [13] 5) routine supplementation to prevent cardiovascular disease not indicated [18] 6) USPTF recommends against use for prevention of cardiovascular disease or cancer [19] * VA study shows improvement in ADL (2000 IU/day) in patients with mild-to-moderate Alzheimer's disease [17] Dosage: 1) RDA: 15 IU 2) maximum benefit: probably 400 IU/day 3) maximum dose 2000 IU/day Pharmacokinetics: - 50 mg = 100 IU. (alpha-tocopherol) Adverse effects: (> 800 IU/day [3]) 1) nausea (may be seen at 400 IU/day) 2) diarrhea 3) blurred vision 4) flatulence 5) fatigue 6) hepatotoxic above 2000 IU/day 7) progressive ataxia [4] 8) high dose vitamin E may increase all-cause mortality [7,8] 9) may accelerate cancer pregression [9] 10) vitamin E (400 IU/day) & vitamin C (1000 mg/day) supplements may blunt exercise-induced increase in insulin receptor sensitivity 11) increased risk for hemorrhagic stroke [15] (no effect on overall stroke incidence) 12) vitamin E (400 IU/day) may increase risk of prostate cancer (HR=1.17) [16] Drug interactions: - interference with absorption of warfarin, iron & vitamin B12 - increases risk of bleeding in patients taking anticoagulants [20] Mechanism of action: 1) lipophilic antioxidant 2) concentrates in mitochondria

Specific

alpha tocopheryl acetate alpha tocopheryl succinate

General

vitamin E

Properties

MISC-INFO: pregnancy-category A safety in lactation ?

Database Correlations

PUBCHEM correlations

References

  1. Internal Medicine Alert 20(21):162-63 1998
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. West Los Angeles (WLA) Veterans Affairs (VA) Pharmacy
  4. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  5. Zandi PP, Anthony JC, Khachaturian JS et al Reduced Risk of Alzheimer Disease in Users of Antioxidant Vitamin Supplements. The Cache County Study. Arch Neurol 61:82, 2004 PMID: 14732624 http://archneur.ama-assn.org/cgi/content/abstract/61/1/82
  6. Journal Watch 24(18):124, 2004 Meydani SN, Leka LS, Fine BC, Dallal GE, Keusch GT, Singh MF, Hamer DH. Vitamin E and respiratory tract infections in elderly nursing home residents: a randomized controlled trial. JAMA. 2004 Aug 18;292(7):828-36. Erratum in: JAMA. 2004 Sep 15;292(11):1305. PMID: 15315997
  7. Miller E et al, Meta-analysis: High Dosage Vit E Supplementation May Increase All-Cause Mortality, Annals of Internal Medicine 142(1):1-12, 2005 (online 11/10/04) http://www.annals.org
  8. Prescriber's Letter 11(12): 2004 Vitamin E and All-Cause Mortality Detail-Document#: 201211 (subscription needed) http://www.prescribersletter.com
  9. Journal Watch 25(11):87, 2005 Bairati I, Meyer F, Gelinas M, Fortin A, Nabid A, Brochet F, Mercier JP, Tetu B, Harel F, Masse B, Vigneault E, Vass S, del Vecchio P, Roy J. A randomized trial of antioxidant vitamins to prevent second primary cancers in head and neck cancer patients. J Natl Cancer Inst. 2005 Apr 6;97(7):481-8. PMID: 15812073
  10. Jacques PF, Taylor A, Moeller S Long-term nutrient intake and 5-year change in nuclear lens opacification, Archives of Ophthalmology 123:517, 2005
  11. Journal Watch 25(12):96, 2005 Petersen RC, Thomas RG, Grundman M, Bennett D, Doody R, Ferris S, Galasko D, Jin S, Kaye J, Levey A, Pfeiffer E, Sano M, van Dyck CH, Thal LJ; Alzheimer's Disease Cooperative Study Group. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med. 2005 Jun 9;352(23):2379-88. Epub 2005 Apr 13. PMID: 15829527 - Blacker D Mild cognitive impairment--no benefit from vitamin E, little from donepezil. N Engl J Med. 2005 Jun 9;352(23):2439-41. Epub 2005 Apr 13. PMID: 15829528
  12. Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, Hennekens CH, Buring JE. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a randomized controlled trial. JAMA. 2005 Jul 6;294(1):56-65. PMID: 15998891
  13. Kang JH, Cook N, Manson J, Buring JE, Grodstein F. A randomized trial of vitamin E supplementation and cognitive function in women. Arch Intern Med. 2006 Dec 11-25;166(22):2462-8. PMID: 17159011 - Espeland MA, Henderson VW. Preventing cognitive decline in usual aging. Arch Intern Med. 2006 Dec 11-25;166(22):2433-4. PMID: 17159007
  14. Glynn RJ et al, Effects of random allocation of vitamin E supplementation on the occurrence of venous thromboembolism. Report from the Women's Health Study. Circulation 2007, 116::1497 PMID: 17846285
  15. Schurks M et al, Effects of vitamin E on stroke subtypes: meta-analysis of randomised controlled trials BMJ 2010; 341:c5702 PMID: 21051774 http://www.bmj.com/content/341/bmj.c5702.full
  16. Klein EA et al Vitamin E and the Risk of Prostate Cancer: The Selenium and Vitamin E Cancer Prevention Trial (SELECT) JAMA. 2011;306(14):1549-1556 PMID: 21990298 http://jama.ama-assn.org/content/306/14/1549.full - Prescriber's Letter 18(12): 2011 Vitamin E and Increased Risk of Prostate Cancer Detail-Document#: 271222 (subscription needed) http://www.prescribersletter.com
  17. Dysken MW et al Effect of Vitamin E and Memantine on Functional Decline in Alzheimer Disease. The TEAM-AD VA Cooperative Randomized Trial. JAMA. 2014;311(1):33-4 PMID: 24381967 http://jama.jamanetwork.com/article.aspx?articleid=1810379 - Evans DA et al Vitamin E, Memantine, and Alzheimer Disease. JAMA. 2014;311(1):29-30 PMID: 24381966 http://jama.jamanetwork.com/article.aspx?articleid=1810360
  18. Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022
  19. US Preventive Services Task Force Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer. US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(23):2326-2333. June 21 PMID: 35727271
  20. Incze M. Vitamins and nutritional supplements: what do I need to know? JAMA Intern Med. 2019;179:460. PMID: 30615020
  21. Department of Veterans Affairs, VA National Formulary

Substructures

benzene isoprene

Component-of

alpha tocopherol/ascorbate/beta carotene/calcium carbonate/cholecalciferol/cobalamin/docosahexaenoate/folic acid/magnesium oxide/nicotinamide/pyridoxine/riboflavin/thiamine/zinc oxide alpha tocopherol/ascorbate/beta carotene/calcium carbonate/cholecalciferol/cobalamin/ferrous fumarate/folic acid/nicotinamide/pantothenate/pyridoxine/riboflavin/sodium docusate/thiamine/zinc oxide alpha tocopherol/ascorbate/beta carotene/calcium carbonate/cholecalciferol/cobalamin/folic acid/magnesium oxide/nicotinamide/pyridoxine/riboflavin/thiamine/zinc oxide alpha tocopherol/ascorbate/biotin/biotin/cobalamin/ergocalciferol/folic acid/multivitamin/nicotinamide/panthenol/pyridoxine/riboflavin/thiamine/vitamin a/vitamin k alpha tocopherol/ascorbate/biotin/cholecalciferol/cobalamin/folic acid/nicotinamide/panthenol/pyridoxine/riboflavin/thiamine/vitamin a/vitamin k alpha tocopherol/ascorbate/calcium carbonate/carbonyl iron/cholecalciferol/cobalamin/cupric oxide/folic acid/magnesium oxide/nicotinamide/pyridoxine/riboflavin/sodium docusate/thiamine/zinc oxide alpha tocopherol/ascorbate/calcium citrate/carbonyl iron/cholecalciferol/docosahexaenoate/folic acid/nicotinamide/potassium iodide/pyridoxine/riboflavin/sodium docusate/thiamine/zinc oxide alpha tocopherol/ascorbate/calcium citrate/carbonyl iron/cholecalciferol/folic acid/nicotinamide/potassium iodide/pyridoxine/riboflavin/sodium docusate/thiamine/zinc oxide alpha tocopherol/ascorbate/calcium phosphate/cholecalciferol/docosahexaenoate/ferrous fumarate/folic acid/pyridoxine/sodium docusate alpha tocopherol/ascorbate/calcium phosphate/docosahexaenoate/eicosapentaenoate/ferrous fumarate/folic acid/pyridoxine alpha tocopherol/ascorbate/calcium phosphate/docosahexaenoate/eicosapentaenoate/folic acid/pyridoxine alpha tocopherol/ascorbate/calcium phosphate/docosahexaenoate/ferrous fumarate/folic acid/pyridoxine/sodium docusate alpha tocopherol/ascorbate/carbonyl iron/cholecalciferol/cobalamin/folic acid/nicotinamide/pyridoxine/riboflavin/thiamine alpha tocopherol/ascorbate/cholecalciferol/docosahexaenoate/ferrous fumarate/folic acid/pyridoxine/sodium docusate alpha tocopherol/carnitine/coenzyme/ubiquinone alpha tocopherol/cyanokit/folic acid/magnesium oxide/pyridoxine alpha tocopherol/lipoate/ubiquinone alpha tocopherol/menthol alpha tocopherol/menthol/nonivamide/salicylate alpha tocopherol/silicon dioxide