Dosage and formulation issues: oral vitamin E therapy in children

Abstract

PurposeOral vitamin E is used in several childhood diseases, but dosage recommendations differ. Few oral products have a marketing authorization for therapeutic use in children. Preliminary data indicate differences in bioavailability among the various vitamin E compounds. Our objective was to review published data on oral vitamin E therapy in neonates and children in order to establish dosage recommendations at a local level.MethodsA literature search was conducted, including Medline Ovid, EMBASE (1980-Feb 2008), Cochrane databases, product monographs, handbooks, and textbooks.ResultsThe main vitamin E compounds being used in children are α-tocopherol, α-tocopheryl acetate, and tocofersolan. The most data are available on tocopheryl acetate, both in neonates and older children. In children with malabsorption disorders, tocofersolan appears to have an increased bioavailability compared to tocopherol or tocopheryl acetate. Published data on pharmacokinetics and dosages for clinical use are few and heterogeneous. No pharmacokinetic studies were found for tocofersolan in neonates and infants. There are few comparative studies on pharmacokinetics, therapeutic use, and adverse drug reactions (ADRs) in children. Dosages used in clinical studies and dosage recommendations in handbooks differ considerably.ConclusionsThe differences in dosing recommendations in children may be due to lack of systematic studies. Existing published data on oral vitamin E do not provide a basis for evaluation of dosage recommendations in children. Comparative clinical studies are required for scientific evaluation of pharmacokinetics, dosage regimens, and efficacy/ADR assessments in children.

Fabrication of vitamin E-enriched nanoemulsions: Factors affecting particle size using spontaneous emulsification

“…Consumption of sufficient levels of a-tocopherol has been reported to help prevent cardiovascular disease [4,5] and carcinogenesis [6][7][8]. However, the utilization of a-tocopherol as a functional ingredient in food and beverages is currently limited owing to its heat and oxygen sensitivity, poor water-solubility, and low and variable bioavailability [9][10][11][12]. A number of different a-tocopherol delivery systems have been investigated as potential means to overcome these problems, including oil-in-water (O/W) nanoemulsions and emulsions [13][14][15][16][17][18], nanodispersions [19], nanostructured lipid particles [20], liposomes [21], and biopolymer-based nanoparticles [22][23][24].…”

Effect of Vitamin E With Therapeutic Iron Supplementation on Iron Repletion and Gut Microbiome in US Iron Deficient Infants and Toddlers

“…Specifically, in one study, a palm oil extract containing approximately 7 mg of Vitamin E administered along with iron therapy was associated with reduced fecal oxidation susceptibility [10]. Alpha-tocopherol is the most studied form of Vitamin E and has been shown to reduce biomarkers of total body oxidative stress and inflammation [9, 11]. Because high dose iron therapy may trigger an inflammatory response that reduces iron absorption, our primary objective was to determine whether adding vitamin E could enhance the efficacy of therapeutic iron for infants and toddlers who have a dietary iron deficiency, potentially through reducing iron-induced inflammation.…”

α-Tocopherol in breast milk of women with preterm delivery after a single postpartum oral dose of vitamin E

“…Experts have suggested giving vitamin E supplements to preterm infants to prevent vitamin E deficiency (1,10) ; however, many challenges are associated with vitamin and trace-element supplementation of newborns because their basic requirements, appropriate administration route and proper dosage are not well defined and vary considerably (11)(12)(13) . Moreover, breast milk vitamin E concentrations may fall during lactation (14) .…”