Merck Manual

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Vitamin E Toxicity


Larry E. Johnson

, MD, PhD, University of Arkansas for Medical Sciences

Reviewed/Revised Nov 2022

Relatively large amounts of vitamin E usually cause no harm but occasionally muscle weakness, fatigue, nausea, and diarrhea occur. The most significant risk is bleeding, mainly with doses > 1000 mg a day.

Vitamin E is a group of compounds (including tocopherols and tocotrienols) that have similar biologic activities. The most biologically active is alpha-tocopherol, but beta-, gamma-, and delta-tocopherols, 4 tocotrienols, and several stereoisomers may also have important biologic activity. These compounds act as antioxidants, which prevent lipid peroxidation of polyunsaturated fatty acids in cellular membranes (see table ). Dietary sources of vitamin E include vegetable oils and nuts.

Plasma tocopherol levels vary with total plasma lipid levels. Normally, the plasma alpha-tocopherol level is 5 to 20 mcg/mL (11.6 to 46.4 mcmol/L).

Although the amount of vitamin E in many fortified foods and supplements is given in units, current recommendations are to use mg.

Many adults take relatively large amounts of vitamin E (alpha-tocopherol 400 to 800 mg/day) for months to years without any apparent harm. Occasionally, muscle weakness, fatigue, nausea, and diarrhea occur. The most significant risk is bleeding. However, bleeding is uncommon unless the dose is > 1000 mg/day or the patient takes oral coumarin or warfarin. Thus, the upper limit for adults aged ≥ 19 years is 1000 mg for any form of tocopherol.

Analyses of previous studies report that high supplemental vitamin E intake may increase the risk of hemorrhagic stroke and premature death.

Vitamin E toxicity is treated by stopping the vitamin or reducing intake to less than the upper limit of 1000 mg per day.


Drugs Mentioned In This Article

Drug Name Select Trade
Alph-E-Mixed , AQUA-E, Aquasol E , Aquavite-E
Coumadin, Jantoven
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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