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System Formulary Update
Vitamin E (alpha-tocopherol and d-alpha tocopheryl)
September 16, 2025

Situation
Vitamin E (alpha-tocopherol) 20 IU (13.4 mg) per mL oral emulsion (Aqua-E) has been discontinued by the sole manufacturer. The same manufacturer is now marketing a 75 IU (50 mg) per mL concentrated product.

Background
Vitamin E (alpha-tocopherol) oral emulsion (Aqua-E) is a dietary supplement currently on UNC Health System formulary and on entity-level formularies at UNC Med Center and UNC Rex. While primarily used as a supplement in vitamin E deficiency, there is limited or conflicting data to support vitamin E use in a number of other conditions including atopic eczema/dermatitis, epilepsy (along with baseline anticonvulsant therapy), dysmenorrhea, and metabolic dysfunction-associated steatohepatitis (MASH).

Assessment
From 7/1/2024 through 6/30/2025, 79 administrations were documented in Epic across UNC Health. Of these, 76 (96%) were at UNC Med Center and 38 (48%) were in pediatric patients. 

Recommendation
REMOVE Vitamin E (alpha-tocopherol) 20 IU (13.4 mg) per mL oral emulsion (Aqua-E) from UNC Health System formulary
ADD Vitamin E (d-alpha tocopheryl) 75 IU (50 mg) per mL oral liquid (Aqua-E Concentrate) to UNC Health System formulary