Vitamin E capsules 200mg №10×3

NameVitamin E caps. A diet high in selenium and sulfur-containing amino acids reduces the need for vitamin E. With congenital epidermolysis bullosa, white hair may begin to grow in areas affected by alopecia. With prolonged use of the drug and / or the need to prescribe repeated courses of therapy, it is recommended to periodically monitor blood coagulation parameters, as well as blood cholesterol levels. Caution should be used in severe cardiosclerosis, after a myocardial infarction, with an increased risk of thromboembolism, as well as with hypoprothrombinemia (against a background of vitamin K deficiency, it may increase with a dose of vitamin E more than 400 mg). Primary isolated deficiency of vitamin E in humans is rare. The normal value in the blood in adults is about 9.5 mg / l, which corresponds to 22 μmol / l. Deficiency can be caused by defects in absorption, metabolism, or increased consumption of the vitamin under oxidative stress. Deficiency occurs mainly as a result of insufficient dietary intake of the vitamin, so a balanced diet does not cause vitamin E deficiency. The richest sources of vitamin E are germinated grains and most vegetable oils. Other sources include leafy vegetables, animal organs, milk and butter. Estimating vitamin E intake is difficult, in part because of the high variability in vitamin E content in foods due to seasonal fluctuations, as well as losses during storage and during preparation. According to national guidelines, the daily requirement for vitamin E for healthy adults is 15 mg tocopherol equivalent (1 mg alpha-tocopherol acetate = 0.67 mg tocopherol equivalent). During pregnancy and lactation, an additional 2 to 4 mg of tocopherol equivalent per day is required. In addition, the need for tocopherol increases with insufficient intake of unsaturated fatty acids. An additional need also arises with long-term use of certain drugs (for example, chemotherapeutics) and for certain diseases (for example, A-beta-lipoproteinemia). Secondary deficiency of vitamin E in the human body can occur as a result of the following reasons: after gastric resection, with celiac disease, enterocolitis, chronic pancreatitis, cystic fibrosis, cholestasis, short bowel syndrome, A-beta lipoproteinemia, after prolonged parenteral nutrition. Vitamin E deficiency is manifested by severe free radical-induced cell and tissue disorders, especially in preterm infants, such as respiratory distress syndrome, retrolental fibroplasia, and hemolytic anemia. With a clear deficiency of vitamin E, neuromuscular disorders are observed, in particular, spinocerebellar degeneration. Oral forms of vitamin E are not suitable for the treatment of vitamin E deficiency conditions associated with impaired intestinal absorption. Intestinal absorption disorders can be observed, for example, in cholestasis, A-beta-lipoproteinemia and in premature babies. In these cases, parenteral administration of the vitamin is required. Pharmacological properties Pharmacodynamics Vitamin E is an antioxidant, participates in the processes of cell proliferation, tissue metabolism, prevents hemolysis of erythrocytes, prevents increased permeability and fragility of capillaries. The drug prevents the development of atherosclerosis, degenerative-dystrophic changes in the heart muscle and skeletal muscles, improves nutrition and myocardial contractility, reduces myocardial oxygen consumption. It inhibits free radical reactions, prevents the formation of peroxides that damage cellular and subcellular membranes. Stimulates the synthesis of heme and heme-containing enzymes – hemoglobin, myoglobin, cytochromes, catalase, peroxidase. Participates in the metabolism of nucleic acids and prostaglandins, in the cellular respiratory cycle, in the synthesis of arachidonic acid. It improves tissue respiration, stimulates the synthesis of proteins (collagen, enzymatic, structural and contractile proteins of skeletal and smooth muscles, myocardium), protects vitamin A from oxidation, inhibits cholesterol synthesis, and contributes to the normalization of lipid levels in blood plasma. It inhibits the oxidation of unsaturated fatty acids and selenium (a component of the microsomal electron transport system). It activates phagocytosis and is used to maintain normal erythrocyte resistance. In high doses, it prevents platelet aggregation. It has a pronounced positive effect on the human reproductive system. In the absence of vitamin E in the body (avitaminosis E), degenerative changes develop in skeletal muscles, capillary permeability and fragility increase, the epithelium of the seminiferous tubules and testicles is reborn. Embryos have hemorrhages, their intrauterine death occurs. Degenerative changes in nerve cells and damage to the liver parenchyma were also established. With vitamin E deficiency, there is a decrease in the concentration of proteins in the blood serum and the content of nucleic acids in the liver and testicles. Insufficiency of vitamin E in humans can be associated with dietary habits (for example, lack of vegetable fats in food) or due to various diseases, for example, liver, pancreas, etc. Pharmacokinetics Approximately 50% of the administered dose is absorbed from the gastrointestinal tract, the maximum blood level is created after 4 hours. Absorption requires the presence of bile acids, fats, normal pancreatic function. In the process of absorption, it forms a complex with lipoproteins, which are intracellular carriers of vitamin E. It enters mainly into the lymph, then into the general circulation, where it binds mainly to alpha1 and beta-lipoproteins, and partially to serum albumin. If protein metabolism is disturbed, transport becomes difficult. It is deposited in all organs and tissues, especially in adipose tissue. It undergoes metabolism in the liver to derivatives having a quinone structure (some of them have vitamin activity). Excreted in bile (over 90%) and urine (about 6%) unchanged and as metabolites. Penetrates through the placenta in insufficient quantities: 20 – 30% of the concentration in the mother’s blood penetrates into the blood of the fetus. Penetrates into breast milk. Indications for use Treatment of vitamin E deficiency. Vitamin E capsules are not suitable for the treatment of vitamin E deficiency conditions associated with malabsorption syndrome. In this case, the introduction of parenteral drugs is necessary. Dosage and administration The drug is intended only for use by adult patients. Recommended dose: 200 mg vitamin E capsules – 1-2 capsules per day; capsules 400 mg of vitamin E – 1 capsule per day. The maximum daily dose is 800 mg of vitamin E. Capsules should be swallowed whole with some liquid in sufficient quantity (preferably 200 ml of water) during or after meals. The duration of treatment depends on the course of the underlying disease. The dose and duration of treatment are set individually. It is not recommended to use in conjunction with other drugs containing vitamin E, due to the risk of overdose. For children, there are preparations with a lower content of the active substance. Elderly patients Dose adjustment is not required. Patients with impaired renal function Caution should be exercised when used in patients with kidney disease. Patients with impaired liver function Caution should be exercised when used in patients with liver disease. Application during pregnancy and lactation It is well known that there is no clear relationship between the concentration of vitamin E in the blood of the mother and fetus. Short-term vitamin E supplementation by pregnant women prior to delivery significantly increases maternal vitamin E status only. It is believed that vitamin E does not effectively cross the placenta into the baby’s bloodstream. The mechanisms of regulation of placental transmission remain completely unexplored; a regulatory role of α-TTP in the transfer of α-tocopherol across the placental barrier is assumed. Animal studies with vitamin E showed no evidence of teratogenic effects. Tocopherol passes into breast milk. Vitamin E can be taken in an amount corresponding to the daily requirement. The recommended daily dose of vitamin E (tocopherol equivalent) for adults is 15 mg; for pregnant women 17 mg (from the 2nd half of pregnancy), nursing mothers – 19 mg. Controlled studies of the use of vitamin E capsules at a dose of 200 mg (400 mg) in pregnant women have not been conducted. Although no serious side effects are known to date, the drug should be used with caution during pregnancy. During breastfeeding, the use of the drug is recommended only if the potential benefit outweighs the risk to the child. Interaction with other drugs Vitamin E increases the effectiveness of anticonvulsants in patients with epilepsy who have an increased content of lipid peroxidation products in the blood. Anticonvulsants such as phenobarbital, phenytoin, and carbamazepine may decrease plasma vitamin E concentrations. Enhances the effect of steroid and non-steroidal anti-inflammatory drugs, antioxidants. Increases the effectiveness and reduces the toxicity of cardiac glycosides, as well as vitamins A and D. The appointment of vitamin E in high doses can cause a deficiency of vitamin A in the body. The simultaneous use of vitamin E at a dose of more than 400 mg / day with anticoagulants (coumarin and indandione derivatives), antiplatelet agents (clopidogrel and dipyridamole), non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, etc.) increases the risk of hypoprothrombinemia and bleeding. Colestyramine, colestipol, mineral oils, isoniazid, orlistat, sucralfate, and olestra fat substitute reduce the absorption of alpha-tocopheryl acetate. High doses of iron enhance oxidative processes in the body, which increases the need for vitamin E. With the simultaneous use of alpha-tocopheryl acetate with cyclosporine, the absorption of the latter increases. Very high doses of vitamin E have been shown in animal experiments to limit the absorption of vitamins A and K. Oral iron preparations may decrease the absorption of vitamin E in the gut when both are taken at the same time. In this case, it is desirable that these two drugs be taken with a time interval of about 4 hours. In conditions of malabsorption, combined deficiency of vitamin E and vitamin K, as well as in the case of the use of vitamin K antagonists (for example, oral anticoagulants), coagulation should be carefully monitored, since a sharp decrease in vitamin K in the body is possible. Patients receiving anticoagulant therapy or patients with vitamin K deficiency should not use vitamin E without careful medical supervision due to an increased risk of bleeding. ContraindicationsIncreased individual sensitivity to the components of the drug; acute myocardial infarction; children’s age (for this form of release, due to the difficulty of swallowing capsules in children). Composition of alpha-tocopheryl acetate – 200 mg Overdose Symptoms: when taken for a long period at doses of 400 – 800 mg / day – blurred vision, dizziness, headache, nausea, extreme fatigue, diarrhea, gastralgia, asthenia; when taking more than 800 mg / day for a long period – an increase in the risk of bleeding in patients with hypovitaminosis K, impaired metabolism of thyroid hormones, sexual dysfunction, thrombophlebitis, thromboembolism, necrotizing colitis, sepsis, hepatomegaly, hyperbilirubinemia, renal failure, hemorrhages in the retina the membrane of the eye, hemorrhagic stroke, ascites, hemolysis. Treatment: drug withdrawal; prescribe glucocorticoids that accelerate the metabolism of vitamin E in the liver; symptomatic remedies. Side effects Allergic reactions. When taking large doses of 1200 mg alpha-tocopherol acetate (800 mg tocopherol equivalent), creatinuria, gastrointestinal disorders – diarrhea, epigastric pain may occur; nausea, flatulence; an increase in serum creatine kinase activity. Long-term use of alpha-tocopherol at a dose above 600 mg of alpha-tocopherol acetate per day (400 mg of tocopherol equivalent) can lead to a decrease in the level of thyroid hormones in the blood serum. Instructions for use for Vitamin E capsules 200mg №10×3