Vitamin E Preparations
Vitamin E in Pediatrics
Key Points
- Fat-soluble antioxidant essential for neurological function
- Eight natural forms (4 tocopherols and 4 tocotrienols)
- Alpha-tocopherol is the most biologically active form
- Critical for neuromuscular and immune system development
Physiological Functions
- Antioxidant protection of cell membranes
- Neurological development and maintenance
- Immune system modulation
- Red blood cell membrane stability
- Gene expression regulation
- Cell signaling pathways
Clinical Uses
Primary Indications
- Vitamin E Deficiency
- Fat malabsorption syndromes
- Cystic fibrosis
- Cholestatic liver disease
- Short bowel syndrome
- Premature Infants
- Prevention of retinopathy of prematurity
- Bronchopulmonary dysplasia
- Intraventricular hemorrhage prevention
- Neurological Conditions
- Ataxia with vitamin E deficiency (AVED)
- Friedreich's ataxia
- Peripheral neuropathies
Secondary Applications
- Dermatological Conditions
- Acne treatment
- Wound healing
- Photoprotection
- Metabolic Disorders
- Beta-thalassemia
- Sickle cell disease
- Abetalipoproteinemia
Available Preparations
Oral Formulations
- D-α-tocopherol (Natural)
- Capsules: 100 IU, 200 IU, 400 IU, 800 IU
- Liquid: 50 IU/mL
- Drops: 100 IU/drop
- DL-α-tocopherol (Synthetic)
- Capsules: 100 IU, 200 IU, 400 IU
- Chewable tablets: 100 IU, 200 IU
- Liquid: 15 IU/mL
- Mixed Tocopherols
- Capsules containing α, β, γ, and δ forms
- Available in various strengths
Parenteral Preparations
- Injectable Solutions
- Concentrations: 100 IU/mL
- Used in severe deficiency
- TPN admixtures
Topical Preparations
- Creams and Ointments
- Concentrations: 0.5-5%
- Combined with other vitamins
- Wound healing formulations
Dosing Guidelines
Recommended Daily Allowance (RDA)
- 0-6 months: 4 IU/day
- 7-12 months: 5 IU/day
- 1-3 years: 6 IU/day
- 4-8 years: 7 IU/day
- 9-13 years: 11 IU/day
- 14-18 years: 15 IU/day
Therapeutic Dosing
- Vitamin E Deficiency
- Mild: 100-400 IU/day
- Severe: 800-1600 IU/day
- Duration: 1-2 months or until normalized
- Specific Conditions
- Cystic Fibrosis: 100-400 IU/day
- Cholestatic Liver Disease: 15-25 IU/kg/day
- Abetalipoproteinemia: 100-300 IU/kg/day
Premature Infants
- Oral: 15-25 IU/day
- Parenteral: 2.8-3.5 IU/kg/day
- Duration based on clinical response
Special Populations
Premature Infants
- Higher requirements
- Risk of deficiency
- Monitor levels closely
- Consider parenteral administration
Malabsorption Syndromes
- Cystic Fibrosis
- Regular monitoring
- Higher doses needed
- Consider water-miscible preparations
- Short Bowel Syndrome
- Parenteral supplementation often required
- Monitor absorption
Genetic Disorders
- AVED
- High-dose supplementation
- Lifelong therapy
- Regular monitoring
- Abetalipoproteinemia
- Very high doses required
- Close monitoring
Safety & Monitoring
Side Effects
- Common (with high doses)
- Nausea
- Diarrhea
- Headache
- Blurred vision
- Less Common
- Increased bleeding risk
- Muscle weakness
- Fatigue
Monitoring Parameters
- Clinical response
- Serum vitamin E levels
- Vitamin E:lipid ratio
- Coagulation parameters
- Neurological function
Drug Interactions
- Anticoagulants (increased bleeding risk)
- Iron supplements (decreased absorption)
- Bile acid sequestrants
- Mineral oil
- Orlistat
