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📰Read the full Vitamin E evidence review on GMJ News →Complete clinical article, references and updates on news.gmj.ge. This page is the structured safety summary.⚠ Progressive ataxia and peripheral neuropathy in a patient with fat malabsorption — check serum alpha-tocopherol [3]
⚠ Doses >400 IU/day in patients on warfarin or antiplatelet therapy — increased hemorrhage risk [4]
⚠ Discontinue high-dose vitamin E 2–4 weeks before elective surgery [4]
⚠ Premature infants with hemolytic anemia — consider vitamin E deficiency [6]
🥗 Food first — build your daily 15 mg
Check the foods you regularly eat — the bar fills toward your daily target.
Wheat germ oil (1 tbsp)20.3 mg alpha-tocopherol
Sunflower seeds (28 g)7.4 mg alpha-tocopherol
Almonds (28 g)7.3 mg alpha-tocopherol
Sunflower oil (1 tbsp)5.6 mg alpha-tocopherol
Hazelnuts (28 g)4.3 mg alpha-tocopherol
Peanut butter (2 tbsp)2.9 mg alpha-tocopherol
Spinach, cooked (125 mL)1.9 mg alpha-tocopherol
Avocado (half)2.1 mg alpha-tocopherol
Check your regular foods above
☑ Risk checker
Fat malabsorption syndromes (celiac disease, Crohn disease, chronic pancreatitis) [3]
Abetalipoproteinemia (genetic — alpha-TTP mutation) [3]
Cystic fibrosis [3]
Short bowel syndrome or bariatric surgery [5]
Premature infants (very low birth weight) [6]
Chronic cholestatic liver disease [3]
Select factors
🔬 Lab interpreter
Recommended test
Serum alpha-tocopherol
Serum alpha-tocopherol
Reference range / target
12–46 µmol/L (5–20 mg/L)
12–46 µmol/L (5–20 mg/L)
Serum levels are influenced by lipid levels — ratio to total cholesterol (>2.2 µmol/mmol) may be more accurate [3].
Full lab monitoring ↓⚕ For professionals — confirm ranges against your local laboratory.
Clinical verdict
Vitamin E deficiency is clinically significant in fat malabsorption disorders but exceedingly rare in healthy adults. Large trials have not demonstrated benefit from high-dose supplementation for cardiovascular disease or cancer prevention, and doses exceeding 400 IU/day may increase hemorrhage risk [9] [11].
1 How much do I need?
👤 Adults: Specific dosage data under clinical review
👴 Elderly: Specific dosage data under clinical review
🤰 Pregnancy: Specific dosage data under clinical review
👦 Pediatric: Specific dosage data under clinical review
🏃 Athletes: Standard dose
⚖️ Obesity: Standard dose
Fat-soluble compounds may require dose adjustment in obesity.
🩺 Renal: Consult specialist
Dose adjustment may be needed in renal impairment.
🌱 Vegan: Standard dose
How to take
🍽 Timing: Take with the largest meal of the day for optimal absorption [1].
💊 With food: Must be consumed with dietary fat. Absorption is approximately 20–80% depending on fat intake. Nuts, oils, and avocado enhance absorption [1].
2 Which form?
| Form | Bioavailability | Vegan | Cost |
|---|---|---|---|
| ['d-alpha-tocopherol (RRR)', 'preferred', 'Natural form with highest biological activity. 1 mg = 1.49 IU. Preferentially retained by hepatic transfer protein [1].'] | Standard | Check label | |
| ['dl-alpha-tocopherol (all-rac)', '', 'Synthetic racemic mixture of 8 stereoisomers. Only 12.5% is the RRR form. 1 mg = 1.1 IU. Less biologically active than natural form [1].'] | Standard | Check label | |
| ['Mixed tocopherols', '', 'Contains alpha, beta, gamma, and delta tocopherols. Gamma-tocopherol has distinct anti-inflammatory properties not shared by alpha-tocopherol alone [2].'] | Standard | Check label | |
| ['Tocotrienols', '', 'Emerging evidence for cardiovascular and neuroprotective effects. Not interchangeable with tocopherols for meeting RDA. Research is preliminary [2].'] | Standard | Check label |
3 Common questions
Is vitamin E supplementation beneficial for heart health? ▼
What is the difference between natural and synthetic vitamin E? ▼
Natural vitamin E (d-alpha-tocopherol, labeled RRR) has approximately twice the biological activity of synthetic vitamin E (dl-alpha-tocopherol, all-rac). The liver preferentially retains the natural form via alpha-tocopherol transfer protein [1]. Check labels: 'd-alpha' is natural, 'dl-alpha' is synthetic.
Can vitamin E increase bleeding risk? ▼
Should I take vitamin E with other antioxidants? ▼
4 Clinical evidence
Strong
Correction of neurological deficits (ataxia, peripheral neuropathy) in abetalipoproteinemia and other vitamin E deficiency states when treated early [3]. Prevention of retinopathy of prematurity in very-low-birth-weight infants with supplementation [6]. HIGH
Moderate
The AREDS/AREDS2 formulation (400 IU vitamin E + other antioxidants) reduced progression of intermediate age-related macular degeneration by 25% over 5 years [7]. Non-alcoholic fatty liver disease: some evidence for reduced steatohepatitis activity with 800 IU/day in the PIVENS trial (n = 247) [8]. MODERATE
Insufficient
Cardiovascular disease prevention: large trials (HOPE, n = 9,541; GISSI, n = 11,324) found no benefit from vitamin E supplementation [9]. Cancer prevention: the SELECT trial (n = 35,533) found no reduction in prostate cancer; a statistically non-significant 17% increase was observed [10]. All-cause mortality: a meta-analysis suggested possible increased mortality at doses exceeding 400 IU/day, though this remains debated [11]. LOW
5 Safety, toxicity & adverse events
Absolute contraindications
✕ Known hypersensitivity
Relative
⚠ Vitamin K deficiency or anticoagulant therapy (high-dose >400 IU may increase bleeding risk)
⚠ Pre-surgical (discontinue 2 weeks prior at high doses)
🚩 Red flags
● Unexplained bleeding or prolonged bruising in a supplement user — check vitamin E dose and coagulation [4]
● Doses exceeding 400 IU/day in patients on anticoagulant therapy — hemorrhage risk [4]
● Progressive ataxia and areflexia in a patient with cholestasis or malabsorption — measure serum alpha-tocopherol [3]
● Premature infant with hemolytic anemia — consider deficiency and initiate replacement [6]
6 Interactions
Drug interactions
Warfarin (and other vitamin K antagonists) Major
Mechanism: Vitamin E inhibits vitamin K-dependent gamma-carboxylation of clotting factors II, VII, IX, X, decreasing their activity. [4]
Effect: Prolonged INR, increased hemorrhage risk, especially at doses >400 IU/day. [4]
Action: Monitor INR closely if supplementation is necessary. Do not exceed RDA without medical supervision [4].
Antiplatelet agents (aspirin, clopidogrel) Major
Mechanism: Vitamin E has intrinsic antiplatelet activity via inhibition of platelet aggregation pathways. Additive with other antiplatelet drugs. [4]
Effect: Increased bleeding risk, particularly gastrointestinal and intracranial hemorrhage. [4]
Action: Avoid doses above 200 IU/day in patients on dual antiplatelet therapy [4].
Cyclosporine Moderate
Mechanism: Vitamin E may alter cyclosporine absorption and metabolism. [5]
Effect: Unpredictable changes in cyclosporine levels, risking either toxicity or rejection. [5]
Action: Monitor cyclosporine trough levels if adding or changing vitamin E supplementation [5].
Statins (with niacin combination) Moderate
Mechanism: In the HATS trial, antioxidant vitamins (including E) blunted the HDL-raising effect of niacin-simvastatin combination. [9]
Effect: Potentially reduced cardiovascular benefit of statin-niacin therapy. [9]
Action: Clinical significance debated. Avoid high-dose antioxidant supplements with statin-niacin regimens pending further evidence [9].
Supplement synergies
Vitamin C · 200–500 mg/day
Vitamin C reduces oxidized alpha-tocopheroxyl radical back to active alpha-tocopherol, restoring antioxidant function [2].
Vitamin C reduces oxidized alpha-tocopheroxyl radical back to active alpha-tocopherol, restoring antioxidant function [2].
Selenium · 55–200 µg/day
Complementary antioxidant mechanisms — selenium-dependent glutathione peroxidase works synergistically with vitamin E to protect cell membranes [1].
Complementary antioxidant mechanisms — selenium-dependent glutathione peroxidase works synergistically with vitamin E to protect cell membranes [1].
Omega-3 fatty acids · 1–2 g EPA+DHA/day
High omega-3 intake increases oxidative stress on cell membranes; vitamin E protects these polyunsaturated fats from peroxidation [2].
High omega-3 intake increases oxidative stress on cell membranes; vitamin E protects these polyunsaturated fats from peroxidation [2].
7 Regulatory
United States (FDA): Classified as a dietary supplement. Labeling requires mg alpha-tocopherol. No prescription requirement. The FDA recognizes a qualified health claim for vitamin E and reduced risk of certain cancers with caveats.
European Union (EFSA): Authorized health claims for protection of cells from oxidative stress [13]. Tolerable upper intake level: 300 mg/day for adults [4].
Japan (MHLW): Eligible for Foods with Function Claims. Adequate intake: 6.5 mg/day (adult males). Upper limit: 750–900 mg/day depending on age.
South Korea (MFDS): Registered health functional food ingredient. Approved claim: antioxidant activity and cell protection.
8 US supplement products
3,692
on-market products containing Vitamin E (NIH DSLD)
Brands carrying Vitamin E (720)
Click a brand to see its Vitamin E products.
9 Frequently paired with
10 Cite this page
Vancouver: Pkhakadze G. Vitamin E — safety profile [Internet]. Tbilisi: PHIG; 2026 [cited 2026 Jul 15]. Available from: https://supplement.ge/ingredients/vitamin-e/
APA 7th: Pkhakadze, G. (2026). Vitamin E — Safety profile. Public Health Institute of Georgia. https://supplement.ge/ingredients/vitamin-e/
📋 Editorial information
Author: Prof. G. Pkhakadze, MD, MPH, PhD
Institution: Public Health Institute of Georgia (PHIG)
Affiliation: David Tvildiani Medical University (DTMU)
First published: January 2026
Last reviewed: 2026-05-29
Next review: January 2027
References: 13 cited sources
COI: SupplementIndex receives no funding from supplement manufacturers. All content independently authored by PHIG.
Process: Systematic literature review
📄 License & reuse
Published under Creative Commons Attribution 4.0 International (CC BY 4.0). You may share and adapt for any purpose with attribution.
Pkhakadze G. "Vitamin E — Safety Profile." SupplementIndex, PHIG, 2026. https://supplement.ge/ingredients/vitamin-e/ CC BY 4.0.
GP
Prof. G. Pkhakadze, MD, MPH, PhD
Professor of Public Health · Head of Department, DTMU
Editor-in-Chief, Georgian Medical Journal (ISSN 3088-4322)
Chair, Public Health Institute of Georgia · UEMS Public Health Section
Educational and public health purposes. CC BY 4.0. Consult your healthcare provider before starting any supplement. Corrections: info@accreditation.ge. Publisher: PHIG