Vitamin E Toxicity

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).

High-dose vitamin E supplements do not protect against cancer or cardiovascular disorders; whether supplements can protect against tardive dyskinesia Adverse effects of antipsychotic drugs Antipsychotic drugs are divided into conventional antipsychotics and 2nd-generation antipsychotics (SGAs) based on their specific neurotransmitter receptor affinity and activity. SGAs may offer... read more is controversial. There is no convincing evidence that doses of up to 2000 units/day slow the progression of Alzheimer disease Alzheimer Disease Alzheimer disease causes progressive cognitive deterioration and is characterized by beta-amyloid deposits and neurofibrillary tangles in the cerebral cortex and subcortical gray matter. Diagnosis... read more or decrease the risk of cancer; one study suggested an increased risk of prostate cancer with vitamin E supplementation (1 Reference 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 >... read more ).

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.

(See also Overview of Vitamins Overview of Vitamins Vitamins may be Fat soluble (vitamins A, D, E, and K) Water soluble (B vitamins and vitamin C) The B vitamins include biotin, folate, niacin, pantothenic acid, riboflavin (B2), thiamin (B1)... read more .)