d-Alpha-tocopherol

(Vitamin E)

Myra E
400 IU soft gel capsule

FORMULATION
Each capsule contains:
d-Alpha-Tocopherol (Vitamin E)…………………………………………………………………………. 400 IU

PRODUCT DESCRIPTION
This product is an oblong, orange soft gelatin capsule printed with “Myra E 400”

WHAT IS IN THE MEDICINE?

Antioxidants function as scavengers to detoxify free radicals. Free radicals are highly re active
and unstable chemicals formed in the body during normal physiological and biochemical
process such as respiration, metabolism and immune response.

This product contains d-Alpha-Tocopherol, the natural form of vitamin E, which has higher
biologic activity, stays longer in the blood and is preferentially resecreted by the liver to be
utilized by body tissues compared to the synthetic form. Moreover, it can be recycled to its
active unionized form, which can be used by the body.

Vitamin E helps maintain membrane integrity in all cells of the body including the nerve tissues
by acting as the body’s fat – soluble antioxidants which acts as the first defense against free
radicals in the lipid (fat) phase of cells. It promotes cell and tissue renewal of the skin, heart, lungs
and liver. It modulates the synthesis of prostaglandins important for the body’s immune response.
Vitamin E is also involved in the metabolism of nucleic acid and the functioning which is the
main site of energy production in cells.

STRENGTH OF THE MEDICINE

Please see formulation

WHAT IS THE MEDICINE USED FOR?

For the prevention and treatment of vitamin E deficiency

HOW MUCH AND HOW OFTEN SHOULD YOU USE THIS PRODUCT?
Orally, one soft gel capsule once a day.
Or, as prescribed by a physician.

WHEN SHOULD YOU NOT TAKE THIS MEDICINES?

If you are allergic to any component in the product.

UNDESIRABLE EFFECTS
  Vitamin E is relatively nontoxic and is usually tolerated. Most adults can tolerate 100 to
800 mg (equivalent to 149 to 1,192 IU of d-Alpha-Tocopherol) daily without undesirable
effects. However, the vitamin (e.g at dosages exceeding 300 IU daily) has rarely caused
nausea, diarrhea, abdominal pain/intestinal cramps, fatigue/weakness, headache,
dizziness, blurred vision, emotional disturbances and rash. Myopathy (muscle disorder),
hypertension, thrombophlebitis (vein inflammation related to blood clot), gonodal
dysfunction , breast soreness/gynecomastia, creatinuria (increased concentration of
creatine in the urine), increased serum creatine kinase, serum cholesterol, and
triglycerides, increased urinary estrogens and androgens and thyroid problems have also
been have been noted. These effects generally disappeared after discontinuing the
vitamin.
 Doses of vitamin E greater than 1,000 mg (equivalent to 1,490 IU of d-Alpha-Tocopherol)
daily for prolonged periods have occasionally been associated with the increasing
bleeding tendency in vitamin K- deficient patients such as those taking oral anti-
coagulants. It has also been suggested that it may be increased the risk of thrombosis in
some patients, such as those taking oral anti-coagulants. It has also been suggested that
it may increase the risk of thrombosis in some patients, such as those taking estrogens.

WHAT OTHER MEDICINE OR FOODS SHOULD BE AVOIDED WHLE TAKING THE MEDICINES?
 Vitamin E reported may be anti-vitamins K effects; concomitant intake anticoagulants
(e.g.,warfarins) and vitamin E may result in hemorrhage (bleeding)
 High doses of vitamin E may also potentiate the effects of antiplatelets (e.g., aspirin,
clopidogrel , ticlopidine) and herbs with antithrombotic activity such as garlic and
gingko.
 Vitamin E may enhance the side effects of some drugs (i.e., amiodarone ciclosporin and
zidovudine)
 Vitamin E may reduce the requirement for digoxin and/or insulin. Monitoring is
recommended.
 Orlistat may result in decreased vitamin E, absorption. Therefore, orlistat should be taken
two hours before or two hours after vitamin E administration. Other drugs that may be
interfere with absorption/utilization of vitamin E include colestyramine colestipol; isoniazid
mineral oil, neomycin and sucralfate.
 Anticonvulsants (e.g., phenobarbital, phenytoin, carbamazepine) and/or oral
contraceptives may lower plasma levels of vitamin E.
 Dietary fiber supplementation may decrease the antioxidative effect of a supplement
containing vitamin E (d-Alpha-Tocopherol)

WHAT SHOULD YOU DO IF YOU MISS DOSE?

If you miss a dose, just take the next dose and the subsequent doses at the usual recommended
schedule, i.e., once a day. Do not double the dose.

HOW SHOULD YOU KEEP THE MEDICINE?

 Keep the product out of sight and reach of children
 Store at temperatures not exceeding 30 C
 Protect from light.
SIGNS AND SYMPTOMS OF OVERDOSAGE
There are no available data on acute over dosage of vitamin E. However, larger doses (>1,490
IU daily for prolonged period) have occasionally been associated with the side effects (see
UNDESIRABLE EFFECTS)

WHAT DO YOU DO WHEN YOU HAVE USED MORE THAN THE RECOMMENEDED DOSAGE?
If you have taken more than the recommended dosage, consult a doctor.

CARE THAT SHOULD BE TAKEN WHEN TAKING THIS MEDICINES.

 High doses of vitamin E (i.e., doses greater than 100 mg (equivalent to 149 IU) daily of d-
Alpha-Tocopherol ) should be used with caution in patients on warfarin. Monitoring of
international normalized ratio (INR) and just adjusting of warfarin dose (if indicated) are
recommended. Likewise, those with vitamin K deficiencies, such as patients with liver
failure should be cautions in taking high doses of vitamin E.
 Vitamin E should be used with extreme cautions in those with many lesions that have a
tendency to bleed (e.g., bleeding peptic ulcers) those with a history of hemorrhagic
stroke, and those with inherited bleeding disorders (e.g., hemophilia.)
 High dose of vitamin E supplementation should be stopped about one month before a
surgical procedure and may be resumed following recovery from the procedures, or as
directed by a doctor.
 Do not use more than recommended dose.
 Do not use after expiry date on the label.

WHEN SHOULD YOU CONSULT A DOCTOR?

If any of undesirable effects occurs
If you are pregnant or think you may be, or planning to become pregnant, or are breastfeeding.
The effects of high vitamin E during pregnancy and breastfeeding are not yet known.