Vitamin E has anticoagulant properties at >400 IU; increased bleeding risk
Additive antiplatelet effects
Vitamin E may reduce HDL-raising effect of niacin combination therapy
Antioxidant may protect cancer cells from oxidative treatment
May alter cyclosporine metabolism
A 2005 meta-analysis of 135,967 participants found high-dose vitamin E (≥400 IU/day) was associated with increased all-cause mortality (RR 1.04, 95% CI 1.01-1.07) (PMID: 15537682). The effect was dose-dependent. This analysis changed clinical practice and led to recommendations against routine high-dose vitamin E supplementation.
Not Prohibited
Reference identifiers on this page are being re-verified against PubMed. Some may not yet link to the paper named beside them.
, Sanyal AJ et al. Pioglitazone, vitamin E, or placebo for NASH (PIVENS trial).
, Dysken MW et al. Effect of vitamin E and memantine on functional decline in Alzheimer disease (TEAM-AD trial).
, Miller ER et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality.
, Lippman SM et al. Effect of selenium and vitamin E on risk of prostate cancer (SELECT trial).
Independently graded against 178,763 indexed supplements and 757 reviewed supplement and medication pairs, sourced from PubMed, FDA CAERS, openFDA, and NIH DSLD | Last updated: April 2026
Not medical advice. Based on published clinical research and systematic reviews.
Safety
Warfarin and other anticoagulants
The adult upper limit is 1,000 mg a day, but bleeding risk has been reported below it. Trials found more hemorrhagic stroke at 50 mg a day, and at 400 IU every other day in people who were mostly also taking aspirin. This matters most if you take a blood thinner.
High-dose vitamin E (over 400 IU per day) increases bleeding risk in warfarin users. Limit vitamin E to nutritional doses (under 100 IU) while on warfarin and monitor for bleeding signs.
Vitamin E doses over 400 IU per day increase bleeding risk with warfarin. Limit to nutritional doses (under 100 IU).
Alpha-tocopherol at over 400 IU per day inhibits platelet aggregation. Large RCT data show increased bleeding risk in anticoagulated patients.
High-dose vitamin E intake can cause serious bleeding events when taken with anticoagulants.
High-dose vitamin E intake inhibits vitamin K-derived coagulation factor synthesis.
Aspirin and NSAIDs
The adult upper limit is 1,000 mg a day, but bleeding risk has been reported below it. Trials found more hemorrhagic stroke at 50 mg a day, and at 400 IU every other day in people who were mostly also taking aspirin. This matters most if you take a blood thinner.
Observational data suggest additive bleeding risk with aspirin. Monitor for unusual bleeding.
Vitamin E high-dose has antiplatelet activity that is observationally additive to aspirin.
Chemotherapy (alkylating agents)
Do not combine
Do not stop your medicine. Ask your prescriber before taking this supplement.
May reduce chemotherapy efficacy. Avoid high-dose supplementation during active treatment.
High-dose antioxidant supplements may reduce chemotherapy efficacy. Avoid during active treatment. Discuss with your oncology team. Dietary antioxidants from food are generally acceptable.
Same antioxidant mechanism as Vitamin C; alpha-tocopherol may interfere with ROS-dependent cytotoxic effects.
Statins combined with niacin
Stop 2 weeks before surgery
High-dose bleeding risk.
Educational information only. This is not medical advice. These statements have not been evaluated by the FDA. Talk to your prescriber before starting, stopping, or combining any supplement with prescription medication.