Medications That May Deplete VITAMIN E
Vitamin E is a fat-soluble antioxidant that protects cell membranes. See which medications carry a reported association, how strong the evidence is, and what to discuss with your pharmacist.
Vitamin E is a fat-soluble antioxidant that protects cell membranes.
Common food sources: Vegetable oils; Nuts and seeds; Wheat germ; Leafy greens.
Deficiency is rare; ask your provider before supplementing, particularly if you take blood thinners.
Caution: Discuss vitamin E supplements with your provider if you take any blood thinner.
HelloPharmacist pharmacist-reviewed education. The medication records below are licensed clinical data, shown as published.
Deep dive: Vitamin E — uses, safety & drug interactions
Medications associated with VITAMIN E depletion
Each record is shown as published in our licensed clinical database. Open a medication for its full nutrient report.
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Cholestyramine
Insignificant DepletionBrand names include Questran
Cholestyramine (Questran) and colestipol (Colestid) reduce absorption of dietary fat, so there is concern that they might reduce absorption of fat soluble vitamins, including vitamin E. Some studies suggest that the bile acid sequestrants lower vitamin E levels by 7% to 20%. But other studies have found no effect on vitamin E levels. When decreases did occur, they were often in proportion to the lowering of LDL (on which vitamin E is transported), and did not fall below the lower limit of normal (5 micrograms/mL) with up to 2 years of treatment. Routine vitamin E supplements aren't necessary, but consider them for patients who take high doses of bile acid sequestrants for several years, or who have low serum vitamin E levels.
Vitamin E is a fat-soluble nutrient your body uses as an antioxidant to protect cells from damage. Because cholestyramine works in the gut by binding bile acids and reducing fat absorption, there has been some concern that fat-soluble vitamins like vitamin E could get swept along and absorbed less efficiently. Research on this is actually mixed, though, and any dip seen in vitamin E levels was small and stayed within the normal range even after two years of use. For most people on this medication, this is not something to worry about, but if you have been on a high dose for several years, it is worth a quick conversation with your pharmacist or doctor.
References (7)
- West RJ, Lloyd JK. The effect of cholestyramine on intestinal absorption. Gut 1975;16:93-8. PubMed
- Cywes C, Millar AJ. Assessment of the nutritional status of infants and children with biliary atresia. S Afr Med J 1990;77:131-5.
- Elinder LS, Hadell K, Johansson J, et al. Probucol treatment decreases serum concentrations of diet-derived antioxidants. Arterioscler Thromb Vasc Biol 1995;15:1057-63. PubMed
- Schwarz KB, Goldstein PD, Witztum JL, et al. Fat-soluble vitamin concentrations in hypercholestrolemic children treated with colestipol. Pediatrics 1980;65:243-50.
- Tonstad S, Silverstein M, Aksnes L, Ose L. Low dose colestipol in adolescents with familial hypercholesterolemia. Arch Dis Child 1996;74:157-60.
- Schade RWB, van't Laar A, Majoor CLH, Jansen AP. A comparative study of the effects of cholestyramine and neomycin in the treatment of type II hyperlipoproteinemia. Acta Med Scand 1976;199:175-80..
- Glueck CJ, Tsang RC, Fallat RW, Scheel D. Plasma vitamin A and E levels in children with familial type II hyperlipoproteinemia during therapy with diet and cholestyramine resin. Pediatrics 1974;54:51-5.. DOI
Colestipol
Insignificant DepletionBrand names include Colestid
Cholestyramine (Questran) and colestipol (Colestid) reduce absorption of dietary fat, so there is concern that they might reduce absorption of fat soluble vitamins, including vitamin E. Some studies suggest that the bile acid sequestrants lower vitamin E levels by 7% to 20%. But other studies have found no effect on vitamin E levels. When decreases did occur, they were often in proportion to the lowering of LDL (on which vitamin E is transported), and did not fall below the lower limit of normal (5 micrograms/mL) with up to 2 years of treatment. Routine vitamin E supplements aren't necessary, but consider them for patients who take high doses of bile acid sequestrants for several years, or who have low serum vitamin E levels.
Vitamin E is a fat-soluble nutrient your body uses as an antioxidant to protect cells from damage. Because colestipol works in the gut by binding bile acids and reducing how much dietary fat is absorbed, it can also slightly reduce how much fat-soluble vitamin E your body takes in. That said, studies show the effect is small and levels generally stay within a normal range, so the evidence rates this as insignificant for most people. Unless you've been on a high dose for many years or your doctor has found low vitamin E levels on a blood test, a supplement is not something most patients need to worry about.
References (7)
- West RJ, Lloyd JK. The effect of cholestyramine on intestinal absorption. Gut 1975;16:93-8. PubMed
- Cywes C, Millar AJ. Assessment of the nutritional status of infants and children with biliary atresia. S Afr Med J 1990;77:131-5.
- Elinder LS, Hadell K, Johansson J, et al. Probucol treatment decreases serum concentrations of diet-derived antioxidants. Arterioscler Thromb Vasc Biol 1995;15:1057-63. PubMed
- Schwarz KB, Goldstein PD, Witztum JL, et al. Fat-soluble vitamin concentrations in hypercholestrolemic children treated with colestipol. Pediatrics 1980;65:243-50.
- Tonstad S, Silverstein M, Aksnes L, Ose L. Low dose colestipol in adolescents with familial hypercholesterolemia. Arch Dis Child 1996;74:157-60.
- Schade RWB, van't Laar A, Majoor CLH, Jansen AP. A comparative study of the effects of cholestyramine and neomycin in the treatment of type II hyperlipoproteinemia. Acta Med Scand 1976;199:175-80..
- Glueck CJ, Tsang RC, Fallat RW, Scheel D. Plasma vitamin A and E levels in children with familial type II hyperlipoproteinemia during therapy with diet and cholestyramine resin. Pediatrics 1974;54:51-5.. DOI
Mineral Oil
Insignificant DepletionBrand names include Kondremul Plain
Mineral oil reduces absorption of all fat-soluble vitamins including vitamin E. However, serum vitamin E levels didn't change significantly in children who used mineral oil for up to four months. Occasional or short-term use of mineral oil isn't likely to have a clinically significant effect on vitamin E levels.
Vitamin E is a fat-soluble antioxidant your body uses to protect cells and support immune function. Because mineral oil is not digested or absorbed, it can carry fat-soluble vitamins like vitamin E through the gut before they get a chance to be taken up. That said, studies in children using mineral oil for several months showed no meaningful drop in vitamin E levels, so this is considered an insignificant concern for most people. If you use mineral oil regularly over a long period, it is worth mentioning to your pharmacist or doctor just to be sure.
References (3)
- Hathcock JN. Metabolic mechanisms of drug-nutrient interactions. Fed Proc 1985;44:124-9.
- Becker GL. The case against mineral oil. Am J Digestive Dis 1952;19:344-8. PubMed
- Clark JH, Russell GJ, Fitzgerald JF, et al. Serum beta-carotene, retinol, and alpha-tocopherol levels during mineral oil therapy for constipation. Am J Dis Child 1987;141:1210-2.
Sodium Phenylbutyrate, Taurursodiol
Insignificant DepletionBrand names include Relyvrio
Cholestyramine (Questran) and colestipol (Colestid) reduce absorption of dietary fat, so there is concern that they might reduce absorption of fat soluble vitamins, including vitamin E. Some studies suggest that the bile acid sequestrants lower vitamin E levels by 7% to 20%. But other studies have found no effect on vitamin E levels. When decreases did occur, they were often in proportion to the lowering of LDL (on which vitamin E is transported), and did not fall below the lower limit of normal (5 micrograms/mL) with up to 2 years of treatment. Routine vitamin E supplements aren't necessary, but consider them for patients who take high doses of bile acid sequestrants for several years, or who have low serum vitamin E levels.
Vitamin E is a fat-soluble antioxidant that helps protect your cells from damage, and because taurursodiol is itself a bile acid, there is some theoretical concern that it could affect how fat-soluble vitamins like vitamin E are absorbed in the gut. That said, this interaction is rated as insignificant, meaning most people taking this medication are unlikely to see a meaningful drop in their vitamin E levels. For the vast majority of patients, no extra supplement is needed, but if you have been on this medication long-term or have any concerns, it is worth a quick conversation with your pharmacist or doctor.
References (7)
- West RJ, Lloyd JK. The effect of cholestyramine on intestinal absorption. Gut 1975;16:93-8. PubMed
- Cywes C, Millar AJ. Assessment of the nutritional status of infants and children with biliary atresia. S Afr Med J 1990;77:131-5.
- Elinder LS, Hadell K, Johansson J, et al. Probucol treatment decreases serum concentrations of diet-derived antioxidants. Arterioscler Thromb Vasc Biol 1995;15:1057-63. PubMed
- Schwarz KB, Goldstein PD, Witztum JL, et al. Fat-soluble vitamin concentrations in hypercholestrolemic children treated with colestipol. Pediatrics 1980;65:243-50.
- Tonstad S, Silverstein M, Aksnes L, Ose L. Low dose colestipol in adolescents with familial hypercholesterolemia. Arch Dis Child 1996;74:157-60.
- Schade RWB, van't Laar A, Majoor CLH, Jansen AP. A comparative study of the effects of cholestyramine and neomycin in the treatment of type II hyperlipoproteinemia. Acta Med Scand 1976;199:175-80..
- Glueck CJ, Tsang RC, Fallat RW, Scheel D. Plasma vitamin A and E levels in children with familial type II hyperlipoproteinemia during therapy with diet and cholestyramine resin. Pediatrics 1974;54:51-5.. DOI
Full nutrient report for Sodium Phenylbutyrate, Taurursodiol →
Aprobarbital, Butabarbital, Phenobarbital
Moderate DepletionBrand names include Triple Barbital
There is some evidence that children taking phenobarbital have serum vitamin E levels 9% to 26% lower than children with untreated epilepsy. The clinical significance of this effect isn't clear. Vitamin E supplements don't seem to be harmful in children with epilepsy. They've been associated with either no effect on seizure control, or improved seizure control. Advise patients to maintain the recommended dietary intake of vitamin E. Consider supplements if plasma vitamin E levels are low (below 5 micrograms/mL).
Vitamin E is an antioxidant that helps protect your cells from damage and supports immune function. Barbiturates like phenobarbital appear to speed up the liver's metabolism of certain nutrients, and research in children taking phenobarbital has found their vitamin E blood levels can run noticeably lower than those not on the medication. This is rated as a moderate concern, so it is worth paying attention to, especially for long-term users. Eating vitamin E-rich foods is a reasonable first step, and if you are curious whether your levels need checking or a supplement makes sense for you, that is a great conversation to have with your pharmacist or doctor.
References (6)
- Ogunmekan AO. Relationship between age and vitamin E level in epileptic children and normal children. Am J Clin Nutr 1979;32:2269-71.
- Kataoka K, Kanamori N, Oishi M, et al. Vitamin E status in pediatric patients receiving antiepileptic drugs. Devel Pharmacol Ther 1989;14:96-101. DOI
- Ogunmekan AO. Plasma vitamin E (alpha-tocopherol) levels in normal children and in epileptic children with and without anticonvulsant drug therapy. Trop Geog Med 1985;37:175-7.
- Higashi A, Ikeda T, Matsukura M, Matsuda I. Serum zinc and vitamin E concentrations in handicapped children treated with anticonvulsants. Devel Pharmacol Ther 1982;5:109-13. DOI
- Higashi A, Tamari H, Ikeda T, et al. Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants. Pediatr Pharmacol 1980;1:129-34.
- Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84-9.
Full nutrient report for Aprobarbital, Butabarbital, Phenobarbital →
Carbamazepine
Moderate DepletionBrand names include Tegretol, Tegretol XR, Equetro
There is some evidence that children who take carbamazepine have serum vitamin E levels 9% to 26% lower than children with untreated epilepsy. It's suggested more vitamin E is used to quench free radicals generated during metabolism of the anticonvulsant in the liver. The clinical significance isn't clear. Vitamin E supplements don't seem to be harmful in children with epilepsy. They've been associated with either no effect on seizure control, or improved seizure control. Advise patients to maintain the recommended dietary intake of vitamin E. Consider supplements if plasma vitamin E levels are below 5 micrograms/mL.
Vitamin E is an antioxidant your body uses to neutralize harmful byproducts that form during normal cell processes. When carbamazepine is broken down in the liver, it appears to generate extra free radicals, and the body may burn through vitamin E faster than usual trying to mop them up. Studies in children taking carbamazepine found their vitamin E levels running noticeably lower than in children not on the drug, so this is worth keeping an eye on for long-term users. Ask your pharmacist or doctor whether your levels should be checked or whether a supplement makes sense for you.
References (6)
- Ogunmekan AO. Relationship between age and vitamin E level in epileptic children and normal children. Am J Clin Nutr 1979;32:2269-71.
- Kataoka K, Kanamori N, Oishi M, et al. Vitamin E status in pediatric patients receiving antiepileptic drugs. Devel Pharmacol Ther 1989;14:96-101. DOI
- Ogunmekan AO. Plasma vitamin E (alpha-tocopherol) levels in normal children and in epileptic children with and without anticonvulsant drug therapy. Trop Geog Med 1985;37:175-7.
- Higashi A, Ikeda T, Matsukura M, Matsuda I. Serum zinc and vitamin E concentrations in handicapped children treated with anticonvulsants. Devel Pharmacol Ther 1982;5:109-13. DOI
- Higashi A, Tamari H, Ikeda T, et al. Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants. Pediatr Pharmacol 1980;1:129-34.
- Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84-9.
Dehydrocholic Acid, Homatropine Methylbromide, Phenobarbital
Moderate DepletionBrand names include G.B.S.
There is some evidence that children taking phenobarbital have serum vitamin E levels 9% to 26% lower than children with untreated epilepsy. The clinical significance of this effect isn't clear. Vitamin E supplements don't seem to be harmful in children with epilepsy. They've been associated with either no effect on seizure control, or improved seizure control. Advise patients to maintain the recommended dietary intake of vitamin E. Consider supplements if plasma vitamin E levels are low (below 5 micrograms/mL).
Phenobarbital, the anticonvulsant in this combination, has been linked to lower blood levels of vitamin E, the nutrient your body uses to protect cells from damage and support the immune system. Researchers believe phenobarbital may speed up the liver's breakdown of vitamin E, clearing it from the body faster than normal. Studies in children taking phenobarbital found their vitamin E levels ran noticeably lower than those of untreated peers, though whether that gap causes real harm is still not fully understood. If you or your child takes this medication long term, it is worth asking your doctor or pharmacist whether checking vitamin E levels makes sense.
References (6)
- Ogunmekan AO. Relationship between age and vitamin E level in epileptic children and normal children. Am J Clin Nutr 1979;32:2269-71.
- Kataoka K, Kanamori N, Oishi M, et al. Vitamin E status in pediatric patients receiving antiepileptic drugs. Devel Pharmacol Ther 1989;14:96-101. DOI
- Ogunmekan AO. Plasma vitamin E (alpha-tocopherol) levels in normal children and in epileptic children with and without anticonvulsant drug therapy. Trop Geog Med 1985;37:175-7.
- Higashi A, Ikeda T, Matsukura M, Matsuda I. Serum zinc and vitamin E concentrations in handicapped children treated with anticonvulsants. Devel Pharmacol Ther 1982;5:109-13. DOI
- Higashi A, Tamari H, Ikeda T, et al. Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants. Pediatr Pharmacol 1980;1:129-34.
- Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84-9.
Full nutrient report for Dehydrocholic Acid, Homatropine Methylbromide, Phenobarbital →
Dicyclomine, Phenobarbital
Moderate DepletionBrand names include Bentyl w/ Pb
There is some evidence that children taking phenobarbital have serum vitamin E levels 9% to 26% lower than children with untreated epilepsy. The clinical significance of this effect isn't clear. Vitamin E supplements don't seem to be harmful in children with epilepsy. They've been associated with either no effect on seizure control, or improved seizure control. Advise patients to maintain the recommended dietary intake of vitamin E. Consider supplements if plasma vitamin E levels are low (below 5 micrograms/mL).
Phenobarbital, the anticonvulsant in this combination, is the piece of this medication that researchers have linked to lower vitamin E levels, a nutrient your body uses to protect cells from damage and support immune function. Studies in children taking phenobarbital found their blood vitamin E levels running notably below those of untreated peers, though exactly why is not fully understood. For long-term users, it is worth eating vitamin E-rich foods regularly and asking your pharmacist or doctor whether checking your blood levels makes sense for you.
References (6)
- Ogunmekan AO. Relationship between age and vitamin E level in epileptic children and normal children. Am J Clin Nutr 1979;32:2269-71.
- Kataoka K, Kanamori N, Oishi M, et al. Vitamin E status in pediatric patients receiving antiepileptic drugs. Devel Pharmacol Ther 1989;14:96-101. DOI
- Ogunmekan AO. Plasma vitamin E (alpha-tocopherol) levels in normal children and in epileptic children with and without anticonvulsant drug therapy. Trop Geog Med 1985;37:175-7.
- Higashi A, Ikeda T, Matsukura M, Matsuda I. Serum zinc and vitamin E concentrations in handicapped children treated with anticonvulsants. Devel Pharmacol Ther 1982;5:109-13. DOI
- Higashi A, Tamari H, Ikeda T, et al. Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants. Pediatr Pharmacol 1980;1:129-34.
- Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84-9.
Dyphylline, Ephedrine, Guaifenesin, Phenobarbital
Moderate DepletionBrand names include Lufyllin-EPG
There is some evidence that children taking phenobarbital have serum vitamin E levels 9% to 26% lower than children with untreated epilepsy. The clinical significance of this effect isn't clear. Vitamin E supplements don't seem to be harmful in children with epilepsy. They've been associated with either no effect on seizure control, or improved seizure control. Advise patients to maintain the recommended dietary intake of vitamin E. Consider supplements if plasma vitamin E levels are low (below 5 micrograms/mL).
The phenobarbital component of this combination is the ingredient researchers have linked to lower vitamin E levels, which the body relies on as an antioxidant to protect cells from damage. Studies in children taking phenobarbital found their vitamin E blood levels were noticeably lower than in children not on the medication, though exactly how the drug reduces it is not fully understood. This is rated a moderate concern, so it is worth keeping an eye on, especially with long-term use. Ask your doctor or pharmacist whether your diet is giving you enough vitamin E, or whether checking your blood level makes sense for you.
References (6)
- Ogunmekan AO. Relationship between age and vitamin E level in epileptic children and normal children. Am J Clin Nutr 1979;32:2269-71.
- Kataoka K, Kanamori N, Oishi M, et al. Vitamin E status in pediatric patients receiving antiepileptic drugs. Devel Pharmacol Ther 1989;14:96-101. DOI
- Ogunmekan AO. Plasma vitamin E (alpha-tocopherol) levels in normal children and in epileptic children with and without anticonvulsant drug therapy. Trop Geog Med 1985;37:175-7.
- Higashi A, Ikeda T, Matsukura M, Matsuda I. Serum zinc and vitamin E concentrations in handicapped children treated with anticonvulsants. Devel Pharmacol Ther 1982;5:109-13. DOI
- Higashi A, Tamari H, Ikeda T, et al. Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants. Pediatr Pharmacol 1980;1:129-34.
- Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84-9.
Full nutrient report for Dyphylline, Ephedrine, Guaifenesin, Phenobarbital →
Ephedrine, Guaifenesin, Phenobarbital, Theophylline
Moderate DepletionBrand names include Mudrane GG
There is some evidence that children taking phenobarbital have serum vitamin E levels 9% to 26% lower than children with untreated epilepsy. The clinical significance of this effect isn't clear. Vitamin E supplements don't seem to be harmful in children with epilepsy. They've been associated with either no effect on seizure control, or improved seizure control. Advise patients to maintain the recommended dietary intake of vitamin E. Consider supplements if plasma vitamin E levels are low (below 5 micrograms/mL).
Phenobarbital, one of the medications in this combination, has been linked to lower blood levels of vitamin E, a nutrient your body uses as an antioxidant to protect cells from damage. Researchers think phenobarbital may speed up the liver's breakdown of vitamin E, which could reduce how much the body holds onto over time. Studies in children taking phenobarbital showed their vitamin E levels were noticeably lower compared to children with untreated epilepsy, though whether that difference causes real health problems is still not fully understood. If you or your child has been on this medication long-term, it is worth asking your pharmacist or doctor whether checking vitamin E levels makes sense.
References (6)
- Ogunmekan AO. Relationship between age and vitamin E level in epileptic children and normal children. Am J Clin Nutr 1979;32:2269-71.
- Kataoka K, Kanamori N, Oishi M, et al. Vitamin E status in pediatric patients receiving antiepileptic drugs. Devel Pharmacol Ther 1989;14:96-101. DOI
- Ogunmekan AO. Plasma vitamin E (alpha-tocopherol) levels in normal children and in epileptic children with and without anticonvulsant drug therapy. Trop Geog Med 1985;37:175-7.
- Higashi A, Ikeda T, Matsukura M, Matsuda I. Serum zinc and vitamin E concentrations in handicapped children treated with anticonvulsants. Devel Pharmacol Ther 1982;5:109-13. DOI
- Higashi A, Tamari H, Ikeda T, et al. Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants. Pediatr Pharmacol 1980;1:129-34.
- Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84-9.
Full nutrient report for Ephedrine, Guaifenesin, Phenobarbital, Theophylline →
Ephedrine, Phenobarbital, Potassium Iodide, Theophylline
Moderate DepletionBrand names include Quadrinal, Mudrane
There is some evidence that children taking phenobarbital have serum vitamin E levels 9% to 26% lower than children with untreated epilepsy. The clinical significance of this effect isn't clear. Vitamin E supplements don't seem to be harmful in children with epilepsy. They've been associated with either no effect on seizure control, or improved seizure control. Advise patients to maintain the recommended dietary intake of vitamin E. Consider supplements if plasma vitamin E levels are low (below 5 micrograms/mL).
Phenobarbital, one of the medications in this combination, has been linked to lower blood levels of vitamin E, a nutrient your body uses to protect cells from damage and support immune function. Researchers think phenobarbital may speed up the liver's breakdown of vitamin E, leaving less of it circulating in the blood. Studies in children taking phenobarbital found their vitamin E levels were noticeably lower compared to children not on the drug, though how much that affects health day-to-day is still not fully understood. If you or your child takes phenobarbital long-term, it is worth asking your pharmacist or doctor whether vitamin E levels should be checked.
References (6)
- Ogunmekan AO. Relationship between age and vitamin E level in epileptic children and normal children. Am J Clin Nutr 1979;32:2269-71.
- Kataoka K, Kanamori N, Oishi M, et al. Vitamin E status in pediatric patients receiving antiepileptic drugs. Devel Pharmacol Ther 1989;14:96-101. DOI
- Ogunmekan AO. Plasma vitamin E (alpha-tocopherol) levels in normal children and in epileptic children with and without anticonvulsant drug therapy. Trop Geog Med 1985;37:175-7.
- Higashi A, Ikeda T, Matsukura M, Matsuda I. Serum zinc and vitamin E concentrations in handicapped children treated with anticonvulsants. Devel Pharmacol Ther 1982;5:109-13. DOI
- Higashi A, Tamari H, Ikeda T, et al. Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants. Pediatr Pharmacol 1980;1:129-34.
- Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84-9.
Full nutrient report for Ephedrine, Phenobarbital, Potassium Iodide, Theophylline →
Ephedrine, Phenobarbital, Theophylline
Moderate DepletionBrand names include Tedral
There is some evidence that children taking phenobarbital have serum vitamin E levels 9% to 26% lower than children with untreated epilepsy. The clinical significance of this effect isn't clear. Vitamin E supplements don't seem to be harmful in children with epilepsy. They've been associated with either no effect on seizure control, or improved seizure control. Advise patients to maintain the recommended dietary intake of vitamin E. Consider supplements if plasma vitamin E levels are low (below 5 micrograms/mL).
Phenobarbital, a seizure medication, has been linked to lower blood levels of vitamin E, a nutrient your body uses to protect cells from damage and support immune function. Researchers think phenobarbital may speed up how the liver processes and clears vitamin E, leaving less of it circulating in the bloodstream. Studies in children taking phenobarbital have found their vitamin E levels noticeably lower than in untreated peers, so this is worth paying attention to rather than brushing aside. If you or your child is on phenobarbital long-term, it is reasonable to ask your doctor or pharmacist whether checking vitamin E levels or adjusting dietary intake makes sense for your situation.
References (6)
- Ogunmekan AO. Relationship between age and vitamin E level in epileptic children and normal children. Am J Clin Nutr 1979;32:2269-71.
- Kataoka K, Kanamori N, Oishi M, et al. Vitamin E status in pediatric patients receiving antiepileptic drugs. Devel Pharmacol Ther 1989;14:96-101. DOI
- Ogunmekan AO. Plasma vitamin E (alpha-tocopherol) levels in normal children and in epileptic children with and without anticonvulsant drug therapy. Trop Geog Med 1985;37:175-7.
- Higashi A, Ikeda T, Matsukura M, Matsuda I. Serum zinc and vitamin E concentrations in handicapped children treated with anticonvulsants. Devel Pharmacol Ther 1982;5:109-13. DOI
- Higashi A, Tamari H, Ikeda T, et al. Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants. Pediatr Pharmacol 1980;1:129-34.
- Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84-9.
Full nutrient report for Ephedrine, Phenobarbital, Theophylline →
Ergotamine, Belladonna, Phenobarbital
Moderate DepletionBrand names include Bellaspas, Bellamine, Eperbel-S
There is some evidence that children taking phenobarbital have serum vitamin E levels 9% to 26% lower than children with untreated epilepsy. The clinical significance of this effect isn't clear. Vitamin E supplements don't seem to be harmful in children with epilepsy. They've been associated with either no effect on seizure control, or improved seizure control. Advise patients to maintain the recommended dietary intake of vitamin E. Consider supplements if plasma vitamin E levels are low (below 5 micrograms/mL).
Phenobarbital, one of the ingredients in this combination, is the component researchers have linked to lower vitamin E levels. Vitamin E is an antioxidant that helps protect your cells from damage. Studies in children taking phenobarbital found blood vitamin E levels noticeably below those of children not on the drug, possibly because phenobarbital speeds up liver enzymes that break down fat-soluble vitamins faster than usual. Given the moderate rating here, long-term users are worth monitoring, so it is reasonable to ask your doctor or pharmacist whether checking your vitamin E level makes sense for you.
References (6)
- Ogunmekan AO. Relationship between age and vitamin E level in epileptic children and normal children. Am J Clin Nutr 1979;32:2269-71.
- Kataoka K, Kanamori N, Oishi M, et al. Vitamin E status in pediatric patients receiving antiepileptic drugs. Devel Pharmacol Ther 1989;14:96-101. DOI
- Ogunmekan AO. Plasma vitamin E (alpha-tocopherol) levels in normal children and in epileptic children with and without anticonvulsant drug therapy. Trop Geog Med 1985;37:175-7.
- Higashi A, Ikeda T, Matsukura M, Matsuda I. Serum zinc and vitamin E concentrations in handicapped children treated with anticonvulsants. Devel Pharmacol Ther 1982;5:109-13. DOI
- Higashi A, Tamari H, Ikeda T, et al. Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants. Pediatr Pharmacol 1980;1:129-34.
- Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84-9.
Full nutrient report for Ergotamine, Belladonna, Phenobarbital →
Hyoscyamine, Phenobarbital
Moderate DepletionBrand names include Levsin Pb, Levsinex Pb Timecaps
There is some evidence that children taking phenobarbital have serum vitamin E levels 9% to 26% lower than children with untreated epilepsy. The clinical significance of this effect isn't clear. Vitamin E supplements don't seem to be harmful in children with epilepsy. They've been associated with either no effect on seizure control, or improved seizure control. Advise patients to maintain the recommended dietary intake of vitamin E. Consider supplements if plasma vitamin E levels are low (below 5 micrograms/mL).
Vitamin E is an antioxidant your body uses to protect cells and support immune function, and research in children taking phenobarbital has found their vitamin E levels running noticeably lower than expected. The leading theory is that phenobarbital speeds up liver enzymes that break down vitamin E faster than normal, leaving less of it circulating in the blood. Because this is rated moderate depletion, it is worth paying attention to, especially for longer-term users. Eating vitamin E-rich foods like nuts, seeds, and leafy greens is a reasonable first step, and if you are concerned about your levels, ask your pharmacist or doctor whether blood testing or a supplement makes sense for you.
References (6)
- Ogunmekan AO. Relationship between age and vitamin E level in epileptic children and normal children. Am J Clin Nutr 1979;32:2269-71.
- Kataoka K, Kanamori N, Oishi M, et al. Vitamin E status in pediatric patients receiving antiepileptic drugs. Devel Pharmacol Ther 1989;14:96-101. DOI
- Ogunmekan AO. Plasma vitamin E (alpha-tocopherol) levels in normal children and in epileptic children with and without anticonvulsant drug therapy. Trop Geog Med 1985;37:175-7.
- Higashi A, Ikeda T, Matsukura M, Matsuda I. Serum zinc and vitamin E concentrations in handicapped children treated with anticonvulsants. Devel Pharmacol Ther 1982;5:109-13. DOI
- Higashi A, Tamari H, Ikeda T, et al. Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants. Pediatr Pharmacol 1980;1:129-34.
- Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84-9.
Mephenytoin
Moderate DepletionBrand names include Mesantoin
There is some evidence that children who take phenytoin have serum vitamin E levels 9% to 26% lower than children with untreated epilepsy. The clinical significance of this effect isn't clear. Vitamin E supplements don't seem to be harmful in children with epilepsy. They've been associated with either no effect on seizure control, or improved seizure control. Advise patients to maintain the recommended dietary intake of vitamin E. Consider supplements if plasma vitamin E levels are low (below 5 micrograms/mL).
Vitamin E is an antioxidant your body uses to protect cells and support immune function, and there is research suggesting that phenytoin-related medications like mephenytoin may be associated with noticeably lower vitamin E levels, possibly because the drug speeds up how the liver processes and clears certain fat-soluble nutrients. Studies in children showed serum levels running 9 to 26 percent below those not on the medication, which is enough that this is rated a moderate concern worth paying attention to. Eating vitamin E-rich foods is a reasonable starting point, and if you have been on this medication long-term, it is worth asking your doctor or pharmacist whether checking your levels makes sense.
References (6)
- Ogunmekan AO. Relationship between age and vitamin E level in epileptic children and normal children. Am J Clin Nutr 1979;32:2269-71.
- Kataoka K, Kanamori N, Oishi M, et al. Vitamin E status in pediatric patients receiving antiepileptic drugs. Devel Pharmacol Ther 1989;14:96-101. DOI
- Ogunmekan AO. Plasma vitamin E (alpha-tocopherol) levels in normal children and in epileptic children with and without anticonvulsant drug therapy. Trop Geog Med 1985;37:175-7.
- Higashi A, Ikeda T, Matsukura M, Matsuda I. Serum zinc and vitamin E concentrations in handicapped children treated with anticonvulsants. Devel Pharmacol Ther 1982;5:109-13. DOI
- Higashi A, Tamari H, Ikeda T, et al. Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants. Pediatr Pharmacol 1980;1:129-34.
- Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84-9.
Orlistat
Moderate DepletionBrand names include Xenical, Alli
Orlistat decreases absorption of fat-soluble vitamins including vitamin E. In most studies, vitamin E levels fall but remain within reference ranges, and only a few patients require supplements. However, the manufacturer of orlistat recommends that all patients take a multivitamin supplement containing all fat-soluble vitamins. Tell patients to separate the dose of the multivitamin by at least 2 hours from orlistat.
Orlistat works by blocking your gut from absorbing dietary fat, and since vitamin E (a nutrient your cells use as an antioxidant to protect themselves from damage) travels through the body attached to fat, less fat absorption means less vitamin E gets in too. Research shows levels do tend to dip, though they usually stay within a normal range for most people. That said, this is rated a moderate concern, so the maker of orlistat recommends taking a daily multivitamin that includes fat-soluble vitamins. Just be sure to take it at least two hours apart from your orlistat dose, and check with your pharmacist about whether a standalone vitamin E supplement makes sense for you.
References (5)
- Melia AT, Koss-Twardy SG, Zhi J. The effect of orlistat, an inhibitor of dietary fat absorption, on the absorption of vitamins A and E in healthy volunteers. J Clin Pharmacol 1996;36:647-53. PubMed
- Roche, Inc. Xenical package insert. Nutley, NJ. May 1999.
- McDuffie JR, Calis KA, Booth SL, et al. Effects of orlistat on fat-soluble vitamins in obese adolescents. Pharmacotherapy 2002;22:814-22.. PubMed
- Davidson MH, Hauptman J, DiGirolamo M, et al. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat. JAMA 1999;281:235-42. DOI
- Sjostrom L, Rissanen A, Andersen T, et al. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. Lancet 1998;352:167-73.. DOI
Phenobarbital
Moderate DepletionBrand names include Solfoton, Luminal
There is some evidence that children taking phenobarbital have serum vitamin E levels 9% to 26% lower than children with untreated epilepsy. The clinical significance of this effect isn't clear. Vitamin E supplements don't seem to be harmful in children with epilepsy. They've been associated with either no effect on seizure control, or improved seizure control. Advise patients to maintain the recommended dietary intake of vitamin E. Consider supplements if plasma vitamin E levels are low (below 5 micrograms/mL).
Vitamin E is an antioxidant your body uses to protect cells from damage, and children taking phenobarbital long-term have been found to have noticeably lower blood levels of it, possibly because the drug speeds up the liver enzymes that break vitamin E down. This is rated a moderate depletion, so it is worth paying attention to, especially for kids on this medication for seizure control. Eating vitamin E-rich foods (nuts, seeds, leafy greens) is a reasonable everyday step, and if levels look low on a blood test, a supplement may be worth discussing. Talk with your doctor or pharmacist about whether checking vitamin E levels makes sense for you or your child.
References (6)
- Ogunmekan AO. Relationship between age and vitamin E level in epileptic children and normal children. Am J Clin Nutr 1979;32:2269-71.
- Kataoka K, Kanamori N, Oishi M, et al. Vitamin E status in pediatric patients receiving antiepileptic drugs. Devel Pharmacol Ther 1989;14:96-101. DOI
- Ogunmekan AO. Plasma vitamin E (alpha-tocopherol) levels in normal children and in epileptic children with and without anticonvulsant drug therapy. Trop Geog Med 1985;37:175-7.
- Higashi A, Ikeda T, Matsukura M, Matsuda I. Serum zinc and vitamin E concentrations in handicapped children treated with anticonvulsants. Devel Pharmacol Ther 1982;5:109-13. DOI
- Higashi A, Tamari H, Ikeda T, et al. Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants. Pediatr Pharmacol 1980;1:129-34.
- Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84-9.
Phenobarbital, Phenytoin
Moderate DepletionBrand names include Dilantin with PB
There is some evidence that children who take phenytoin have serum vitamin E levels 9% to 26% lower than children with untreated epilepsy. The clinical significance of this effect isn't clear. Vitamin E supplements don't seem to be harmful in children with epilepsy. They've been associated with either no effect on seizure control, or improved seizure control. Advise patients to maintain the recommended dietary intake of vitamin E. Consider supplements if plasma vitamin E levels are low (below 5 micrograms/mL).
Vitamin E is an antioxidant your body uses to protect cells and support immune function, and there is some evidence that phenytoin in particular may lower blood levels of it, possibly because these medications affect how the liver processes fat-soluble vitamins. Studies in children taking phenytoin have found levels noticeably lower than in untreated peers, though what that means clinically is still not fully understood. This is rated moderate, so it is worth keeping on your radar, especially for longer-term users. Ask your pharmacist or doctor whether checking your vitamin E level makes sense for you, and focus on getting plenty of vitamin E through food in the meantime.
References (6)
- Ogunmekan AO. Relationship between age and vitamin E level in epileptic children and normal children. Am J Clin Nutr 1979;32:2269-71.
- Kataoka K, Kanamori N, Oishi M, et al. Vitamin E status in pediatric patients receiving antiepileptic drugs. Devel Pharmacol Ther 1989;14:96-101. DOI
- Ogunmekan AO. Plasma vitamin E (alpha-tocopherol) levels in normal children and in epileptic children with and without anticonvulsant drug therapy. Trop Geog Med 1985;37:175-7.
- Higashi A, Ikeda T, Matsukura M, Matsuda I. Serum zinc and vitamin E concentrations in handicapped children treated with anticonvulsants. Devel Pharmacol Ther 1982;5:109-13. DOI
- Higashi A, Tamari H, Ikeda T, et al. Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants. Pediatr Pharmacol 1980;1:129-34.
- Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84-9.
Phenobarbital, Sodium Nitrate
Moderate DepletionBrand names include Soniphen
There is some evidence that children taking phenobarbital have serum vitamin E levels 9% to 26% lower than children with untreated epilepsy. The clinical significance of this effect isn't clear. Vitamin E supplements don't seem to be harmful in children with epilepsy. They've been associated with either no effect on seizure control, or improved seizure control. Advise patients to maintain the recommended dietary intake of vitamin E. Consider supplements if plasma vitamin E levels are low (below 5 micrograms/mL).
Vitamin E is an antioxidant your body uses to protect cells from damage, and phenobarbital has been linked to lower blood levels of it, particularly in children. Researchers think the drug may speed up how the liver processes vitamin E, causing it to be broken down and cleared faster than normal. Studies in children with epilepsy have found levels noticeably lower than in untreated peers, so this is worth paying attention to over the long term. If you or your child takes phenobarbital regularly, it is a good idea to ask your doctor or pharmacist whether checking vitamin E levels or eating more vitamin E-rich foods makes sense for your situation.
References (6)
- Ogunmekan AO. Relationship between age and vitamin E level in epileptic children and normal children. Am J Clin Nutr 1979;32:2269-71.
- Kataoka K, Kanamori N, Oishi M, et al. Vitamin E status in pediatric patients receiving antiepileptic drugs. Devel Pharmacol Ther 1989;14:96-101. DOI
- Ogunmekan AO. Plasma vitamin E (alpha-tocopherol) levels in normal children and in epileptic children with and without anticonvulsant drug therapy. Trop Geog Med 1985;37:175-7.
- Higashi A, Ikeda T, Matsukura M, Matsuda I. Serum zinc and vitamin E concentrations in handicapped children treated with anticonvulsants. Devel Pharmacol Ther 1982;5:109-13. DOI
- Higashi A, Tamari H, Ikeda T, et al. Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants. Pediatr Pharmacol 1980;1:129-34.
- Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84-9.
Phenytoin
Moderate DepletionBrand names include Dilantin Kapseals, Dilantin, Di-Phen
There is some evidence that children who take phenytoin have serum vitamin E levels 9% to 26% lower than children with untreated epilepsy. The clinical significance of this effect isn't clear. Vitamin E supplements don't seem to be harmful in children with epilepsy. They've been associated with either no effect on seizure control, or improved seizure control. Advise patients to maintain the recommended dietary intake of vitamin E. Consider supplements if plasma vitamin E levels are low (below 5 micrograms/mL).
Vitamin E is an antioxidant that helps protect your cells from damage, and there is some evidence that phenytoin, particularly in children, may be associated with noticeably lower vitamin E levels in the blood. Researchers aren't entirely sure why, but it may have to do with how phenytoin affects the way the body processes and uses fat-soluble vitamins. This is rated as a moderate concern, so it's worth paying attention to, especially for long-term users. Ask your doctor or pharmacist whether checking your vitamin E levels or adjusting your diet makes sense for your situation.
References (6)
- Ogunmekan AO. Relationship between age and vitamin E level in epileptic children and normal children. Am J Clin Nutr 1979;32:2269-71.
- Kataoka K, Kanamori N, Oishi M, et al. Vitamin E status in pediatric patients receiving antiepileptic drugs. Devel Pharmacol Ther 1989;14:96-101. DOI
- Ogunmekan AO. Plasma vitamin E (alpha-tocopherol) levels in normal children and in epileptic children with and without anticonvulsant drug therapy. Trop Geog Med 1985;37:175-7.
- Higashi A, Ikeda T, Matsukura M, Matsuda I. Serum zinc and vitamin E concentrations in handicapped children treated with anticonvulsants. Devel Pharmacol Ther 1982;5:109-13. DOI
- Higashi A, Tamari H, Ikeda T, et al. Serum vitamin E concentration in patients with severe multiple handicaps treated with anticonvulsants. Pediatr Pharmacol 1980;1:129-34.
- Ogunmekan AO, Hwang PA. A randomized, double-blind, placebo-controlled, clinical trial of D-alpha-tocopheryl acetate (vitamin E), as add-on therapy, for epilepsy in children. Epilepsia 1989;30:84-9.
Altretamine
Insufficient EvidenceBrand names include Hexalen
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant that helps protect your cells from damage, and it plays a role in immune function and nerve health. Altretamine belongs to a class of chemotherapy drugs called alkylating agents, and there is some early research suggesting these medications may reduce vitamin E levels in the blood, possibly because they place extra oxidative stress on the body that uses up this vitamin. That said, the evidence here is genuinely thin, and experts simply do not yet know whether this matters clinically for most patients. If you have concerns about your nutrient levels while on chemotherapy, that is a good conversation to bring to your oncologist or pharmacist.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Bendamustine
Insufficient EvidenceBrand names include Treanda, Belrapzo, Vivimusta
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant that helps protect your cells from damage, and some alkylating chemotherapy drugs, the class bendamustine belongs to, have been linked to lower vitamin E levels in the blood, possibly because these powerful drugs place extra oxidative stress on the body and may use up vitamin E faster than usual. That said, the evidence here is listed as insufficient, meaning researchers simply do not yet have enough data to know how often this happens with bendamustine or whether it causes real problems. If you are on bendamustine long-term, it is worth mentioning this topic to your oncologist or pharmacist before considering any supplements.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Bendamustine Hydrochloride
Insufficient EvidenceBrand names include Bendeka
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant that helps protect your cells from damage, and some chemotherapy drugs in the same class as bendamustine have been linked to lower levels of it in the blood, possibly because these drugs place extra oxidative stress on the body that uses vitamin E up more quickly. That said, the evidence for bendamustine specifically is thin, and whether any dip in vitamin E levels actually causes harm is not yet clear. If you are taking bendamustine long-term, it is worth mentioning this to your oncologist or pharmacist, but please do not start a vitamin E supplement on your own without checking first.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Busulfan
Insufficient EvidenceBrand names include Myleran, Busulfex
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant that helps protect your cells from damage, and it plays a role in immune function. Research has found that busulfan and some similar chemotherapy drugs can be associated with lower vitamin E levels in the blood, possibly because these powerful medications affect how the body handles certain nutrients, especially at high doses. That said, the evidence here is limited and the clinical significance is simply not known yet, so this is not something most patients need to worry about on their own. If you have questions about your nutrient levels during chemotherapy, your doctor or pharmacist is the right person to ask.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Carboplatin
Insufficient EvidenceBrand names include Paraplatin
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant your body uses to protect cells from damage, and there is some early research suggesting that alkylating chemotherapy drugs, a group that includes carboplatin, may lower vitamin E levels in the blood, possibly because these powerful drugs place extra demands on the body's antioxidant defenses. That said, the evidence here is genuinely limited, and researchers do not yet know whether this matters clinically for most patients. If you are on carboplatin long-term and are curious about your vitamin E status, it is worth raising the question with your oncologist or pharmacist before considering any supplements.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Carmustine
Insufficient EvidenceBrand names include Gliadel, BiCNU, Gliadel Wafer
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant your body uses to protect cells from damage, and there is some early research suggesting that alkylating chemotherapy drugs like carmustine may lower blood levels of it, possibly because these powerful drugs affect how the body processes certain nutrients at high doses. That said, the evidence here is genuinely thin, and researchers do not yet know whether this matters much in practice. If you are on carmustine, this is worth mentioning to your oncologist or pharmacist, but there is not enough information right now to recommend any specific action.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Chlorambucil
Insufficient EvidenceBrand names include Leukeran
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant your body uses to protect cells from damage, including cells that are already under stress from chemotherapy. Chlorambucil belongs to a class of drugs called alkylating agents, and there is some early research suggesting that drugs in this group may lower vitamin E levels in the blood, possibly by increasing how fast the body uses it up during treatment. That said, the evidence here is really thin, and right now we simply do not know whether this matters clinically for patients taking chlorambucil. If you have questions about your nutrient levels during treatment, your oncologist or pharmacist is the right person to ask before considering any supplements.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Cisplatin
Insufficient EvidenceBrand names include Platinol-AQ
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant your cells use to protect themselves from damage. High-dose cisplatin and similar chemotherapy drugs have been associated with lower vitamin E levels in the blood, though exactly why is not fully understood. The evidence here is still thin, and whether this actually affects how you feel or how well treatment goes remains unclear. If you are on cisplatin long-term or at high doses, it is worth mentioning this to your oncologist or pharmacist rather than starting a supplement on your own.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Cyclophosphamide
Insufficient EvidenceBrand names include Cytoxan, Neosar
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant your cells use to protect themselves from damage, and there is some research suggesting that cyclophosphamide and similar chemotherapy drugs may lower vitamin E levels in the blood, possibly because the treatment increases oxidative stress and the body uses more of it up. That said, the evidence here is rated as insufficient, meaning researchers have noticed a possible connection but it is not yet clear how often this matters or whether it affects how well treatment works or how a patient feels. Some studies even found that levels bounced back between treatment cycles. If you are on cyclophosphamide long-term and curious about this, it is worth bringing up with your oncologist or pharmacist before considering any supplement.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Dacarbazine
Insufficient EvidenceBrand names include DTIC-Dome
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant your body uses to protect cells from damage, including damage that can sometimes come from chemotherapy itself. Dacarbazine belongs to a class of drugs called alkylating agents, and there is some early research suggesting that drugs in this group may lower vitamin E levels in the blood, possibly by interfering with how the body handles it during treatment. That said, the evidence for dacarbazine specifically is thin and the clinical significance is simply not known yet. If you have questions about whether any monitoring or dietary changes make sense for you, that is worth a conversation with your oncology team or pharmacist.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Estramustine Phosphate Sodium
Insufficient EvidenceBrand names include Emcyt
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant that helps protect your cells from damage throughout the body. Estramustine is part of a class of drugs called alkylating agents, and some drugs in this family have been linked to lower vitamin E levels in the blood, possibly because they increase the body's demand for it or interfere with how it is used. That said, the evidence for estramustine specifically is quite limited, so we honestly do not know how much this matters in practice. If you have questions about your vitamin levels during treatment, your oncologist or pharmacist is the right person to ask.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Gemfibrozil
Insufficient EvidenceBrand names include Lopid
Data on the effects of gemfibrozil on vitamin E levels is conflicting. Some studies found decreased levels while others did not. The clinical significance of any change isn't known.
Vitamin E is an antioxidant that helps protect your cells from damage and supports your immune system. A handful of studies have looked at whether gemfibrozil, a cholesterol-lowering medication, affects vitamin E levels in the blood, and the results have pointed in different directions. Some found a modest drop, others found no change at all, so right now there simply is not enough consistent evidence to say whether this is something to worry about. Most people taking gemfibrozil do not need to act on this, but if you have concerns, it is worth a quick conversation with your pharmacist or doctor.
References (4)
- Aberg F, Appelkvist EL, Broijersen A, et al. Gemfibrozil-induced decrease in serum ubiquinone and alpha- and gamma- tocopherol levels in men with combined hyperlipidaemia. Eur J Clin Invest 1998;28:235-42.
- Bredie SJ, de Bruin TW, Demacker PN, et al. Comparison of gemfibrozil versus simvastatin in familial combined hyperlipidemia and effects on apolipoprotein-B-containing lipoproteins, low-density lipoprotein subfraction profile, and low-density lipoprotein
- Yoshida H, Ishikawa T, Ayaori M, et al. Beneficial effect of gemfibrozil on the chemical composition and oxidative susceptibility of low density lipoprotein: a randomized, double-blind, placebo-controlled study. Atherosclerosis 1998;139:179-87. PubMed
- Aberg F, Appelkvist EL, Broijersen A, et al. Gemfibrozil-induced decrease in serum ubiquinone and alpha- and gamma-tocopherol levels in men with combined hyperlipidaemia. Eur J Clin Invest 1998;28:235-42.
Ifosfamide
Insufficient EvidenceBrand names include Ifex
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant your cells use to protect themselves from damage, and there is some early research suggesting that alkylating chemotherapy drugs like ifosfamide may reduce vitamin E levels in the blood, possibly because these powerful drugs affect how the body handles certain nutrients during treatment. That said, the evidence here is genuinely thin, and researchers do not yet know whether this drop is meaningful in practice. If you are on ifosfamide long-term or at high doses, it is worth mentioning this to your oncologist or pharmacist, who can help decide whether monitoring makes sense for your situation.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Lomustine
Insufficient EvidenceBrand names include Ceenu
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant that helps protect your cells from damage, and some research suggests that alkylating chemotherapy drugs like lomustine may lower levels of it in the blood, especially at higher doses. The exact reason is not fully understood, though it may relate to how these medications affect the body's stored nutrients during treatment. That said, the evidence here is genuinely thin, so this is not something to worry about on your own. If you are on lomustine long-term, it is worth mentioning this topic to your oncologist or pharmacist so they can guide you appropriately.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Lurbinectedin
Insufficient EvidenceBrand names include Zepzelca
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant your cells use to protect themselves from damage, and some chemotherapy drugs in the same broad class as lurbinectedin have been linked to lower vitamin E levels in the blood, possibly because they place extra oxidative stress on the body. That said, the evidence for lurbinectedin specifically is quite limited, and researchers do not yet know whether this is a meaningful concern in practice. Most patients taking lurbinectedin will not need to act on this, but if you are curious about your levels or whether a supplement makes sense for you, it is worth a quick conversation with your oncology pharmacist or doctor.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Mechlorethamine Hydrochloride
Insufficient EvidenceBrand names include Valchlor
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant that helps protect your cells from damage, and there is some early research suggesting that alkylating chemotherapy drugs like mechlorethamine may lower levels of it in the blood, possibly by increasing how much the body uses up while fighting the stress of treatment. That said, the evidence here is genuinely limited, and for mechlorethamine specifically, no one has firmly established whether this is a real concern or how meaningful it is. If you are on this medication long-term, it is worth mentioning to your doctor or pharmacist, but please do not start a vitamin E supplement on your own without that conversation first.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Melphalan
Insufficient EvidenceBrand names include Alkeran, Hepzato
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant your body uses to protect cells from damage, including in nerves and muscles. Melphalan is an alkylating agent, and some drugs in this class have been linked to lower vitamin E levels in the blood, possibly because the chemotherapy process uses up or disrupts the body's antioxidant stores, especially at higher doses. That said, the evidence here is genuinely insufficient, meaning researchers simply do not yet know how much this matters in practice. If you are on melphalan long-term, it is worth mentioning this to your oncologist or pharmacist before considering any supplements.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Melphalan Flufenamide
Insufficient EvidenceBrand names include Pepaxto
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant your body uses to protect cells from damage, and there is some research suggesting that certain alkylating chemotherapy drugs, a class that includes melphalan flufenamide, may lower serum vitamin E levels, particularly at higher doses. The honest answer right now is that the evidence for this specific drug is too limited to draw firm conclusions, and the clinical significance simply is not known. Most people going through chemotherapy do not need to act on this on their own, but if you have questions about monitoring your vitamin E levels during treatment, that is a great conversation to have with your oncologist or pharmacist.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Melphalan Hydrochloride
Insufficient EvidenceBrand names include Evomela
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant that helps protect your cells from damage, and there is some early research suggesting that alkylating chemotherapy drugs like melphalan may lower levels of it in the blood, possibly because high doses of these drugs place extra oxidative stress on the body and use up available vitamin E more quickly. That said, the evidence here is genuinely thin, and no one knows yet whether this matters clinically for most patients. If you are on long-term melphalan therapy, it is worth mentioning this to your oncologist or pharmacist so they can help you weigh whether any monitoring makes sense for your situation.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Oxaliplatin
Insufficient EvidenceBrand names include Eloxatin
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant that helps protect your cells from damage, and oxaliplatin belongs to a drug class that has been linked to lower vitamin E levels in the blood, possibly because these medications interfere with how the body processes or stores it. That said, the evidence here is truly preliminary, and researchers do not yet know whether this matters clinically for most patients taking oxaliplatin. If you are on long-term chemotherapy with this drug, it is worth mentioning to your oncologist or pharmacist, but please do not start a vitamin E supplement on your own without talking to your care team first.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Procarbazine
Insufficient EvidenceBrand names include Matulane
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Procarbazine is an alkylating chemotherapy agent, and there is some early research suggesting that drugs in this class may reduce vitamin E levels in the blood, particularly at higher doses. Vitamin E is an antioxidant your cells use to protect themselves from damage. Researchers have wondered whether lower levels during chemotherapy could affect how well a patient tolerates treatment, but the evidence for procarbazine specifically is far too limited to draw any firm conclusions. If you have questions about your nutrient levels during treatment, your oncologist or pharmacist is the right person to ask.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Streptozocin
Insufficient EvidenceBrand names include Zanosar
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant that helps protect your cells from damage, and there is some early research suggesting that alkylating chemotherapy drugs like streptozocin could lower its levels in the blood, possibly because these powerful drugs affect how the body manages certain nutrients at high doses. That said, the evidence here is genuinely thin, so no one can say yet whether this is a real concern for most patients or how often it actually happens. If you are on streptozocin and curious about your vitamin E status, it is worth raising with your oncologist or pharmacist before considering any supplement.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Temozolomide
Insufficient EvidenceBrand names include Temodar
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant your body uses to protect cells from damage, and there is some early research suggesting that alkylating chemotherapy drugs as a class may lower blood levels of it, possibly by affecting how the body processes or stores it during treatment. Temozolomide belongs to that same drug family, so this connection has been noted, though the evidence specific to temozolomide is thin and the clinical significance is simply not known yet. For most people, this is not something to act on right now, but if you are on long-term treatment, it is worth bringing up with your oncologist or pharmacist.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Thiotepa
Insufficient EvidenceBrand names include Thioplex, Tepadina
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant your body uses to protect cells from damage, including the cells affected during cancer treatment. Thiotepa, as an alkylating chemotherapy agent, has been reported to reduce vitamin E levels in the blood, possibly because these powerful drugs interfere with how the body handles certain nutrients, especially at higher doses. That said, the evidence here is genuinely thin, and researchers are still unsure whether this dip in vitamin E actually causes problems in practice. If you are on thiotepa and have questions about your nutritional status, it is worth raising with your oncologist or pharmacist before considering any supplement.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
Trabectedin
Insufficient EvidenceBrand names include Yondelis
Some alkylating chemotherapy drugs might reduce serum vitamin E levels, usually when used in high doses. These drugs include cisplatin, etoposide, busulfan, cyclophosphamide, cytosine arabinoside, and thiotepa. The clinical significance isn't clear, but there is some concern that low vitamin E levels might increase the risk of chemotherapy-associated toxicity. In some cases, vitamin E levels return to normal between chemotherapy cycles. The role of supplements hasn't been established.
Vitamin E is an antioxidant your body uses to protect cells from damage, including during times of physical stress like chemotherapy. Trabectedin belongs to a class of drugs that, at higher doses, has been loosely linked to lower vitamin E levels in the blood, though exactly how this happens is not fully understood. The evidence here is rated insufficient, meaning researchers have noticed a possible connection but cannot yet say whether it matters clinically. If you are on a long course of trabectedin and have concerns, it is worth raising the topic with your oncologist or pharmacist before considering any supplement.
References (4)
- Jonas CR, Puckett AB, Jones DP, et al. Plasma antioxidant status after high-dose chemotherapy: a randomized trial of parenteral nutrition in bone marrow transplantation patients. Am J Clin Nutr 2000;72:181-9. PubMed
- Pace A, Savarese A, Picardo M, et al. Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 2003;21:927-31.. PubMed
- Weijl NI, Hopman GD, Wipkink-Bakker A, et al. Cisplatin combination chemotherapy induces a fall in plasma antioxidants of cancer patients. Ann Oncol 1998;9:1331-7. PubMed
- Ladas EJ, Jacobson JS, Kennedy DD, et al. Antioxidants and cancer therapy: a systematic review. J Clin Oncol 2004;22:517-28. PubMed
This tool is educational and is not a substitute for professional medical advice. An association is not a diagnosis and does not mean a deficiency will occur. Always talk to your pharmacist or healthcare provider before starting, stopping, or changing any medication or supplement.
Disclaimer: This checker finds which nutrients might be depleted by prescription or over-the-counter medications. Each nutrient depletion issue is rated based on clinical significance. Use your own professional judgment prior to making clinical decisions.© 2026 Therapeutic Research Center Licensed records refresh weekly · last updated July 3, 2026.
What drug-induced nutrient depletion means
Some medications can, over time, lower the levels of certain vitamins, minerals, or other nutrients — through reduced absorption, increased loss, or changes in how the body uses them.
Association is not deficiency
An entry here means a depletion has been reported or studied — not that it happens to everyone, or that you are deficient. Dose, duration, diet, and your own health all matter.
Evidence varies by pair
Some drug–nutrient links (like metformin and vitamin B12) are well studied; others rest on limited or preliminary research. Each entry shows the evidence rating from our licensed clinical database.
When to ask about labs
If you take an associated medication long-term, ask your healthcare provider whether monitoring is appropriate for you. Not everyone needs testing — your provider can weigh your dose, duration, and symptoms.
Don't self-supplement blindly
Supplements are not risk-free: some can interact with medications, and some (like potassium or magnesium) can be risky with kidney disease. Talk to your pharmacist before adding anything.
Never stop a medication over this
These medications are prescribed for good reasons, and the benefit usually far outweighs a manageable nutrient consideration. Any change belongs in a conversation with your prescriber.
Food first, usually
For many nutrients, a varied diet covers the gap. Each entry lists common food sources; a supplement is a decision to make with your pharmacist or provider, not a default.
VITAMIN E & medications: FAQs
Which medications can lower VITAMIN E?
I take one of these medications — am I deficient in VITAMIN E?
Should I start a VITAMIN E supplement?
Where does this information come from?
Other commonly implicated nutrients
Wondering about your VITAMIN E levels?
Ask a licensed pharmacist — free, no appointment needed.
Sources & How We Checked
Medication associations with VITAMIN E are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for drug-induced nutrient depletions, supplements, and interactions — the basis for this page.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for medication overviews across the site.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.