Vitamin E and medications.
Vitamin E is in the Distil supplement database, evidence Grade A. The page below lists every medication we have explicitly assessed it against.
Vitamin E is an essential fat-soluble antioxidant, and while the vitamin itself is Grade A, the evidence for supplementing above dietary levels is mixed and depends heavily on form. Mixed tocopherols and tocotrienols are the sensible choice; tocotrienols specifically show preclinical and early cardiovascular and neuroprotective signals. The important limit is dose and isolation. High-dose isolated alpha-tocopherol above 400 IU per day was linked to slightly higher all-cause mortality in the Miller 2005 meta-analysis and did not reduce cardiovascular events in the HOPE trial, so isolated high-dose alpha-tocopherol should never be recommended. The interaction angle is bleeding. Vitamin E reduces platelet adhesion, an effect that is modest at 100 to 200 IU but climbs above 400 IU, so it is a hard exclusion with anticoagulants such as warfarin and apixaban and should be stopped before surgery. Vitamin C offers antioxidant network synergy. Keep doses moderate, choose mixed forms, and avoid it entirely if you are on a blood thinner.
Below are the 9 documented pairs we have explicitly assessed for Vitamin E: 9 amber. The pairs cluster around 1 mechanism: Additive antiplatelet effect. Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not listed here is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by medication, and the missing-item form at the bottom of the page routes any uncatalogued medication into our next curation pass.
Documented interactions
Additive antiplatelet effect
High-dose vitamin E can mildly reduce blood clotting, which may add to the blood-thinning effect of acenocoumarol and raise bleeding risk. The concern is with high supplemental doses. If you take acenocoumarol, keep vitamin E intake modest and tell your anticoagulant clinic.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Vitamin E at high doses (above 400 IU per day) can raise bleeding risk in its own right, which could add to apixaban. At low supplement doses (100 to 200 IU) the effect is minimal. Apixaban has no INR test to monitor this, so keep vitamin E modest and tell your GP if you take high-dose vitamin E. Stop it six weeks before planned surgery.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
At low supplement doses (100 to 200 IU) vitamin E adds little to aspirin. At high doses (above 400 IU per day) it can add to aspirin's blood-thinning effect and raise bleeding risk. Use mixed-tocopherol products at modest doses and stop high-dose vitamin E six weeks before any surgery.
At low supplement doses (100 to 200 IU) vitamin E adds little to clopidogrel. At high doses (above 400 IU per day) it can add to clopidogrel's blood-thinning effect and raise bleeding risk. Keep vitamin E to modest mixed-tocopherol doses and stop high-dose vitamin E six weeks before any surgery.
Vitamin E at high doses (above 400 IU per day) can raise bleeding risk in its own right, which may add to dabigatran. At low supplement doses (100 to 200 IU) the effect is minimal. Dabigatran has no routine blood test to monitor this, so keep vitamin E modest and tell your GP if you take high-dose vitamin E. Stop it six weeks before planned surgery.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Vitamin E at high doses (above 400 IU per day) can raise bleeding risk in its own right, which may add to edoxaban. At low supplement doses (100 to 200 IU) the effect is minimal. Edoxaban has no routine blood test to monitor this, so keep vitamin E modest and tell your GP if you take high-dose vitamin E. Stop it six weeks before planned surgery.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Vitamin E at high doses (above 400 IU per day) can raise bleeding risk in its own right, which could add to rivaroxaban. At low supplement doses (100 to 200 IU) the effect is minimal. Rivaroxaban has no INR test to monitor this, so keep vitamin E modest and tell your GP if you take high-dose vitamin E. Stop it six weeks before planned surgery.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Vitamin E at high doses (above 400 IU per day) can raise bleeding risk in its own right, which may add to ticagrelor's blood-thinning effect. At low supplement doses (100 to 200 IU) the effect is minimal. Keep vitamin E to modest mixed-tocopherol doses, tell your GP if you take high-dose vitamin E, and stop it six weeks before any planned surgery.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Vitamin E at low supplement doses (100 to 200 IU) has little effect on warfarin. At high doses (above 400 IU per day) it can add to bleeding risk and may nudge your INR. Tell your anticoagulant clinic if you take high-dose vitamin E, and stop it six weeks before planned surgery.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope. Use the checker below to surface any medication, and submit a missing item if you take something we have not catalogued.
How we grade severity, choose what's in scope, and what we exclude.
Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.
Read the full methodologyWant this checked across everything you take?
This page checks the pairs you enter. The personalised Distil report goes further:
- the same graded, cited interaction check across your whole stack, not just the pairs you thought to type in
- where your current routine may be leaving you short of your goals
- the evidence-backed compounds worth adding, and the ones worth dropping
It's a paid report: £79, or £49 for the first 25 customers. The interactions check is one section of it, and you can read a real one in full before you buy.
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If a supplement or medication you take isn't in our autocomplete, tell us. We go through what people flag every week and add what's missing.