What is the indication for Evit (Vitamin E) 400Mg?

Indications for Vitamin E (Evit) 400mg

Vitamin E 400mg is primarily indicated for the treatment of vitamin E deficiency, particularly in patients with fat malabsorption disorders such as cystic fibrosis, bariatric surgery patients, and those with neurological symptoms due to vitamin E deficiency. 1

Primary Indications

Treatment of Vitamin E Deficiency

• Confirmed deficiency: When plasma α-tocopherol levels are below 12 μmol/L 2, 1
• Severe deficiency with neurological symptoms: 400-800 IU daily is recommended 1
• Fat malabsorption conditions:
  • Cystic fibrosis 2
  • Short bowel syndrome 2, 1
  • Cholestatic liver disease 3
  • Post-bariatric surgery 2

Specific Patient Populations

Bariatric Surgery Patients

• After biliopancreatic diversion (BPD), 400 IU vitamin E daily is recommended as part of standard supplementation 2
• Should be started 2-4 weeks after surgery 2

Cystic Fibrosis Patients

• Regular supplementation to maintain serum α-tocopherol:cholesterol ratio above 5.4 mg/g 2
• Water-soluble preparations may be needed for patients with cholestasis 2, 4

Patients with Non-Alcoholic Fatty Liver Disease (NAFLD)

• Vitamin E 800 IU daily has shown benefits in non-diabetic NAFLD patients 2
• The 400mg dose may be used as part of a treatment regimen, though higher doses have more evidence 2

Dosing Considerations

Standard Dosing

• Mild to moderate deficiency: 100-400 IU daily 1
• Severe deficiency: 400-800 IU daily 1
• Maintenance therapy: Continue until serum levels normalize, typically checking after 3 months 1

Monitoring

• Serum levels should be assessed at least annually in at-risk patients 2
• Follow-up testing 3-6 months after dosage changes 2, 1
• Monitor as ratio to lipids (α-tocopherol:cholesterol) for more accurate assessment 2

Precautions and Contraindications

• Anticoagulant therapy: High-dose vitamin E may increase bleeding risk in patients on warfarin or other anticoagulants 2, 1
• Vitamin K deficiency: Vitamin E supplementation may exacerbate existing vitamin K deficiency 2, 1
• Upper limit: The tolerable upper intake level for adults is 1000 mg (2325 μmol) 2

Clinical Pearls

• Always check for other fat-soluble vitamin deficiencies (A, D, K) when treating vitamin E deficiency 1
• Water-miscible or emulsified preparations improve absorption in patients with fat malabsorption 1, 4
• Vitamin E deficiency can manifest as accelerated red blood cell destruction and neuromuscular deficits 5
• Early treatment (before age 3) of vitamin E deficiency in children with cholestatic liver disease can prevent or reverse neurological symptoms 3

While vitamin E has been studied for cardiovascular disease prevention 6 and dermatological applications 7, the 400mg dose is primarily indicated for treating established deficiency rather than for these purposes.