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. The Miller 2005 meta-analysis of 19 trials and 135,967 people found a dose-response relationship with all-cause mortality that begins above 150 IU per day, and concluded that 400 IU per day or more should be avoided. That signal is not specific to isolated alpha-tocopherol: 10 of the 19 pooled trials used vitamin E combined with other vitamins or minerals, so a mixed product is not a reason to take more. Vitamin E also did not reduce cardiovascular events in the HOPE trial. Keep any supplemental vitamin E at or below 150 IU per day. 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
Last reviewed 14 September 2026. Each interaction below lists the evidence its assessment drew on: some rest on studies of the exact pair, others on mechanism evidence, where a citation may support one part of the reasoning rather than the exact combination. The evidence line on each entry says which.
Additive antiplatelet effect
Amber Does Vitamin E interact with Acenocoumarol?
High-dose vitamin E can mildly reduce blood clotting, which may add to the blood-thinning effect of acenocoumarol and raise bleeding risk. The one trial in this drug family, with warfarin, found no change in INR, but it did not count bleeding events, so a lower dose cannot be assumed to be free of the concern. Tell your anticoagulant clinic before taking vitamin E at any dose, and stop it at least two weeks before planned surgery.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Vitamin E interact with Apixaban?
Vitamin E at high doses (above 400 IU per day) can raise bleeding risk in its own right, which could add to apixaban. Lower doses have not been studied with apixaban, and a pooled analysis of the trials behind vitamin E's own bleeding signal did not find that the dose explained it, so a low dose cannot be assumed to be free of it. Apixaban has no INR test to monitor this, so tell whoever prescribes your apixaban before taking vitamin E at any dose, and stop vitamin E at least two weeks before planned surgery.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Vitamin E interact with Aspirin?
At high doses (above 400 IU per day) vitamin E can add to aspirin's blood-thinning effect and raise bleeding risk, and a modest dose may add a little too: in a study inside a large vitamin E trial, men taking 50mg a day alongside aspirin had more bleeding from the gums than men taking neither. Use mixed-tocopherol products at modest doses and stop high-dose vitamin E at least two weeks before any surgery.
Evidence: Limited human data, from small studies or case reports.
Amber Does Vitamin E interact with Clopidogrel?
At high doses (above 400 IU per day) vitamin E can add to clopidogrel's blood-thinning effect and raise bleeding risk. The trials that have given a form of vitamin E alongside clopidogrel were not designed to measure bleeding, so they do not settle a low dose either way. One man taking aspirin and clopidogrel, who also used a CPAP breathing mask at night, bruised around both eyes two months after adding 1,000 IU of vitamin E a day and fish oil, and it cleared when he stopped them. With aspirin, another antiplatelet medicine, men taking 50mg of vitamin E a day had more bleeding from the gums than men taking neither, so a low dose cannot be assumed to add nothing. Tell whoever prescribes your clopidogrel before taking vitamin E at any dose, and stop vitamin E at least two weeks before any surgery.
Evidence: Limited human data, from small studies or case reports.
Amber Does Vitamin E interact with Dabigatran etexilate?
Vitamin E at high doses (above 400 IU per day) can raise bleeding risk in its own right, which may add to dabigatran. Lower doses have not been studied with dabigatran, and a pooled analysis of the trials behind vitamin E's own bleeding signal did not find that the dose explained it, so a low dose cannot be assumed to be free of it. Dabigatran has no routine blood test to monitor this, so tell whoever prescribes your dabigatran before taking vitamin E at any dose, and stop vitamin E at least two weeks before planned surgery.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Vitamin E interact with Edoxaban?
Vitamin E at high doses (above 400 IU per day) can raise bleeding risk in its own right, which may add to edoxaban. Lower doses have not been studied with edoxaban, and a pooled analysis of the trials behind vitamin E's own bleeding signal did not find that the dose explained it, so a low dose cannot be assumed to be free of it. Edoxaban has no routine blood test to monitor this, so tell whoever prescribes your edoxaban before taking vitamin E at any dose, and stop vitamin E at least two weeks before planned surgery.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Vitamin E interact with Rivaroxaban?
Vitamin E at high doses (above 400 IU per day) can raise bleeding risk in its own right, which could add to rivaroxaban. Lower doses have not been studied with rivaroxaban, and a pooled analysis of the trials behind vitamin E's own bleeding signal did not find that the dose explained it, so a low dose cannot be assumed to be free of it. Rivaroxaban has no INR test to monitor this, so tell whoever prescribes your rivaroxaban before taking vitamin E at any dose, and stop vitamin E at least two weeks before planned surgery.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Vitamin E interact with Ticagrelor?
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. Lower doses have not been studied with ticagrelor, and with aspirin, another antiplatelet medicine, men taking 50mg of vitamin E a day had more bleeding from the gums than men taking neither, so a low dose cannot be assumed to add nothing. Tell whoever prescribes your ticagrelor before taking vitamin E at any dose, and stop vitamin E at least two weeks before any planned surgery.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Vitamin E interact with Warfarin sodium?
A small double-blind trial in people on long-term warfarin found vitamin E did not change their INR, but it did not count bleeding events, and vitamin E has a mild blood-thinning effect of its own that an INR reading would not show, so a low dose cannot be assumed to add nothing. Tell your anticoagulant clinic before taking vitamin E at any dose, and stop it at least two weeks before planned surgery.
Evidence: Limited human data, from small studies or case reports.
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.
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