Consultation on Anticoagulants and Vitamin E for Liver Health

Q: Consultation on Anticoagulants and Vitamin E for Liver Health

Hello： 1. <br>One of the non-drug approved uses of vitamin E by the FDA in the United States is for "non-alcoholic fatty liver disease" (NAFLD). <br>Some literature reports indicate that vitamin E can improve liver function tests in patients with NAFLD, and its effectiveness is e

Consultation on Anticoagulants and Vitamin E

Hello, Pharmacist Chen.
My mother is 68 years old and has a history of mild ischemic stroke.
She is currently taking an anticoagulant (Pradaxa 110 mg once daily).
Recently, due to high cholesterol and fatty liver, her liver enzyme levels have become abnormal (within twice the normal range).
From online information, I have seen that appropriate intake of vitamin E may improve fatty liver and lower liver enzyme levels.
I would like to ask you, Pharmacist Chen, if my mother can increase her intake of vitamin E while she is already on anticoagulants.
Will this increase the risk of bleeding or other negative effects? If it is safe to take, how should we choose the dosage and product of vitamin E? I appreciate your time in answering these questions.
Thank you.

Additional information: Recently, when my mother visited the cardiology outpatient clinic, she asked her attending physician, who replied that it is okay to take vitamin E.
However, I have seen online that there may be a risk of bleeding, so I am seeking your opinion, Pharmacist Chen.
Thank you.

JJ, 30~39 year old female. Ask Date: 2018/09/04

Dr. Chen Yuemei reply Pharmacology

Hello: 1.
One of the non-drug approved uses of vitamin E by the FDA in the United States is for "non-alcoholic fatty liver disease" (NAFLD).
Some literature reports indicate that vitamin E can improve liver function tests in patients with NAFLD, and its effectiveness is enhanced when combined with dietary and pharmacological treatments.
There are also reports of vitamin E interacting with anticoagulants (such as warfarin), which may increase the risk of bleeding, although the number of reports on this interaction is limited.
2.
Recommendations: (1) If co-administering, according to the daily nutrient intake recommendations by the Ministry of Health and Welfare of the Republic of China, the recommended amount of vitamin E is 10 mg (α-T.E.).
Vitamin E can be obtained from natural or synthetic sources, depending on individual needs.
During the course of supplementation, it is important to monitor for any signs of bleeding; if bleeding occurs, vitamin E should be discontinued and the physician should be informed.
(2) For liver-related issues, it is advisable to consult a gastroenterologist or hepatologist for professional advice.

Reply Date: 2018/09/04

More Info

When considering the concurrent use of anticoagulants, such as Apixaban (普栓達), and Vitamin E, it is crucial to weigh the potential benefits against the risks, particularly the risk of bleeding. Your mother’s situation, given her history of mild ischemic stroke and current liver issues, necessitates careful consideration.

Vitamin E is known for its antioxidant properties and has been studied for its potential benefits in liver health, particularly in the context of non-alcoholic fatty liver disease (NAFLD). Some studies suggest that Vitamin E can help improve liver function tests and reduce liver fat in patients with NAFLD. However, the interaction between Vitamin E and anticoagulants is a significant concern. Research indicates that Vitamin E may increase the risk of bleeding when taken with anticoagulants. This is primarily due to Vitamin E's ability to inhibit platelet aggregation, which can exacerbate the anticoagulant effects of medications like Apixaban.

Given that your mother is already on an anticoagulant, it is essential to approach the addition of Vitamin E with caution. The American Heart Association and other health organizations recommend that patients on anticoagulants should avoid high doses of Vitamin E, as it may lead to an increased risk of hemorrhage. The recommended dietary allowance (RDA) for Vitamin E is about 15 mg (22.4 IU) per day for adults, and it is generally advised not to exceed 1,000 mg (1,500 IU) of synthetic Vitamin E per day due to the risk of adverse effects.

If you and your mother decide to proceed with Vitamin E supplementation, it is vital to monitor for any signs of bleeding, such as unusual bruising, prolonged bleeding from cuts, or blood in urine or stool. Should any of these symptoms arise, it is crucial to discontinue Vitamin E immediately and consult her healthcare provider.

In terms of product selection, it is advisable to choose a high-quality Vitamin E supplement that provides the appropriate dosage. Look for products that contain d-alpha-tocopherol, which is the natural form of Vitamin E, as it is more bioavailable than synthetic forms. Additionally, consider discussing with her healthcare provider or a pharmacist to ensure that the chosen supplement does not interact with her current medications.

Lastly, given your mother's liver issues, it would be prudent to consult a hepatologist or a gastroenterologist for a comprehensive evaluation and tailored advice regarding her liver health and any potential treatments or lifestyle modifications that could benefit her condition. They may suggest dietary changes, weight management, or other interventions that could help improve her liver function without the risks associated with additional supplements.

In summary, while Vitamin E may offer some benefits for liver health, its use alongside anticoagulants like Apixaban should be approached with caution due to the potential for increased bleeding risk. Always consult healthcare professionals before making any changes to her medication or supplement regimen.

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