What are the contraindications to Vitamin E (Tocopherol)?

From the Guidelines

Vitamin E supplementation should be avoided in individuals with bleeding disorders, those taking anticoagulant or antiplatelet medications, and patients scheduled for surgery due to its blood-thinning properties that can increase bleeding risk. The most recent and highest quality study, 1, found that vitamin E supplements may induce bleeding risks, particularly in individuals taking anticoagulant drugs like warfarin and those who are vitamin K deficient. Some key points to consider when evaluating the contraindications of vitamin E supplementation include:

• Individuals with bleeding disorders or those taking anticoagulant or antiplatelet medications should not take vitamin E supplements without medical supervision
• Patients scheduled for surgery should avoid vitamin E supplements due to the increased risk of bleeding
• People with vitamin K deficiency should also avoid vitamin E as it may worsen clotting problems
• The study 1 also notes that toxic effects from high doses of vitamin E are rare, even after high intake for several years, but the UL for adults is set at 1000 mg (2325 mmol)
• Other studies, such as 2, 3, and 4, provide additional information on the benefits and harms of vitamin supplementation, but the most recent and highest quality study, 1, provides the most relevant guidance on the contraindications of vitamin E supplementation.

From the Research

Contraindications to Vitamin E (Tocopherol)

• The use of vitamin E may be contraindicated in patients receiving oral anticoagulant therapy, as it may increase the risk of bleeding 5
• High doses of vitamin E may potentiate vitamin K deficiency in animals and possibly humans, although this effect is not clinically obvious with 400 IU/day or less 6
• Vitamin E supplementation is not recommended for the prevention of cardiovascular disease or cancer, as the harms may outweigh the benefits 7

Bleeding Risk

• Higher serum levels of vitamin E have been associated with an increased risk of bleeding in patients receiving oral anticoagulant therapy 5
• The risk of bleeding may be higher in patients with a history of coronary heart disease, high HAS-BLED scores, and high serum vitamin E levels 5

Interactions with Anticoagulants

• Vitamin E may interact with warfarin and other anticoagulants, increasing the risk of bleeding 6, 5
• The use of vitamin K may be necessary to reverse the effects of warfarin and other anticoagulants, although high doses of vitamin K may be associated with anaphylactoid reactions 8, 9