In fat‑malabsorption states and cholestatic liver disease, vitamin E deficiency can amplify oxidative injury because α‑tocopherol is normally carried on circulating lipoproteins and helps shield both cell membranes and lipids from ongoing free‑radical damage. In severe genetic fat‑malabsorption such as abetalipoproteinemia, very low plasma vitamin E levels have been linked to progressive ophthalmopathy and neuropathy, and even with aggressive supplementation, HDL particles can remain severely oxidized, signaling persistent lipid peroxidation and oxidative modification of lipoproteins. Together, these observations support the idea that vitamin E deficiency layered on top of structurally abnormal or depleted lipoproteins creates a “perfect storm” for heightened oxidative stress in tissues, underscoring the need for early detection, carefully absorbed α‑tocopherol formulations, and close monitoring of at‑risk patients with chronic cholestasis or malabsorption. This medication is commonly used for High Cholesterol.
Burnett JR, Hooper AJ. Vitamin E and oxidative stress in abetalipoproteinemia and familial hypobetalipoproteinemia. Free Radic Biol Med. 2015 Nov;88(Pt A):59-62. Siener R, Machaka I, Alteheld B, Bitterlich N, Metzner C. Effect of Fat-Soluble Vitamins A, D, E and K on Vitamin Status and Metabolic Profile in Patients with Fat Malabsorption with and without Urolithiasis. Nutrients. 2020 Oct 12;12(10):3110. Margareth L. G. SaronI, et al. Nutritional status of patients with biliary atresia and autoimmune hepatitis related to serum levels of vitamins A, D and E. Department of Pediatrics. UNICAMP, Campinas, SP, Brazil 2008. Granot E, Kohen R. Oxidative stress in abetalipoproteinemia patients receiving long-term vitamin E and vitamin A supplementation. Am J Clin Nutr. 2004 Feb;79(2):226-30.
Some side effects may be linked to nutrient depletion caused by this medication.
Fenofibrate has been shown in studies to increase the toxic effect of ultraviolet (UV) radiation that may lead to side effects such as hives, itching, and skin rash. Taking vitamin E before UV exposure is found in research to significantly help block UV-fenofibrate effects on the skin. Vitamin E supplementation should be considered when taking this drug therapy.
Fenofibrate has been shown in studies to increase the toxic effect of ultraviolet (UV) radiation that may lead to side effects such as hives, itching, and skin rash. Taking vitamin C before UV exposure is found in research to significantly help block UV-fenofibrate effects on the skin. Vitamin C supplementation should be considered when taking this drug therapy.
Research demonstrates that fibrates, particularly fenofibrate, are known to increase homocysteine levels. Elevated levels of homocysteine is associated with increased risk of a range of health problems including atherosclerosis, stroke, and neurological diseases, and vitamin Bs including vitamin B6 helps facilitate the breakdown of homocysteine and may be helpful in reducing homocysteine levels.