The short answer
Tocophersolan can increase oral cyclosporine exposure, and supervised dose or monitoring changes may be needed. It is a particular water-soluble vitamin E form, not interchangeable with every vitamin E supplement. Do not start it to boost cyclosporine absorption or change either prescribed dose on your own.
What this answer covers
Oral tocophersolan, d-alpha-tocopheryl polyethylene glycol 1000 succinate or TPGS, with systemic oral cyclosporine. Historical Liqui-E and current Vedrop are identified separately. Ordinary tocopherol, tocopheryl acetate, topical vitamin E and unspecified excipient amounts are not assigned the same effect.
- Supplement or preparation
- Tocophersolan
- Medication ingredient
- cyclosporine
What did the transplant report find?
A small report treated seven people with unusually poor cyclosporine absorption: six children after liver transplantation and one young adult with hepatobiliary graft-versus-host disease. Five responded to added TPGS, allowing their clinicians to lower cyclosporine doses over two months; two did not respond. These selected patients are quite different from a typical stable transplant recipient, so the reported dose reductions are not a general dosing guide.
Was there a study outside that setting?
Yes. Ten healthy volunteers received oral cyclosporine with and without a specific TPGS product in randomized order. Average total cyclosporine exposure increased with TPGS, with substantial variation between participants. This supports a real absorption interaction, but a single-dose experiment cannot predict how much an individual’s long-term regimen should change.
What does the current product information advise?
Vedrop product information names ciclosporin among medicines whose intestinal absorption may increase and advises monitoring with dose adjustment if needed. It also states that interaction studies have not been performed for that labeled product. The historical TPGS research and this product warning are related evidence, not proof that every vitamin E product has been tested.
Does cyclosporine mean you need this vitamin?
No general need for tocophersolan follows from the interaction. Vedrop is used for vitamin E deficiency in a specific childhood malabsorption setting. If you already receive it, ask your team to coordinate vitamin treatment with cyclosporine levels. Product strengths may be expressed as vitamin E activity rather than total TPGS mass, so avoid converting doses yourself.
Would taking it at another time avoid the effect?
The sources do not establish a protective interval. Tocophersolan may influence how cyclosporine is absorbed, so starting, stopping or changing it can warrant a monitoring plan. The prescriber should decide any cyclosporine adjustment and continue the checks needed for its narrow treatment range, rather than relying on a fixed number of hours between doses.
Evidence and practical considerations
Absorption & effectiveness
Tocophersolan can increase oral cyclosporine exposure, and supervised dose or monitoring changes may be needed. It is a particular water-soluble vitamin E form, not interchangeable with every vitamin E supplement. Do not start it to boost cyclosporine absorption or change either prescribed dose on your own.
- Exact scope
- Oral tocophersolan, d-alpha-tocopheryl polyethylene glycol 1000 succinate or TPGS, with systemic oral cyclosporine. Historical Liqui-E and current Vedrop are identified separately. Ordinary tocopherol, tocopheryl acetate, topical vitamin E and unspecified excipient amounts are not assigned the same effect. with Cyclosporine, RxCUI 3008, IN, systemic oral use. Neoral modified microemulsion and conventional Sandimmune are distinguished; neither is automatically dose-equivalent to the other. The Neoral label identifies cyclosporine as the active ingredient and basis of strength. Intravenous reference experiments are identified separately; ophthalmic and topical use are excluded.
- Medication form and route
- oral
- Timing or duration
- Only the durations described in the sources are established; no untested persistence or dose-spacing interval is inferred.
What remains uncertain
- Small historical human studies, unresolved cyclosporine formulations in abstracts, variable response and a current product label that notes its own interaction-study gap. No general vitamin requirement or spacing interval.
Factors that may matter: tocophersolan product and dose units; malabsorption and cholestasis; cyclosporine formulation; starting or stopping TPGS; vitamin E treatment indication.
Read the supporting source summaries
Source 1: regulatory prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Patients prescribed systemic oral cyclosporine, including transplant recipients.
Requires clinical and blood-level monitoring, recognizes nephrotoxicity and hyperkalemia, cautions with potassium-containing drugs and explicitly advises avoiding grapefruit and grapefruit juice. Neoral and Sandimmune are not bioequivalent.
How this applies: Direct exact-medication identity and oral monitoring guidance. Pair-specific applicability is restricted to the named food or potassium-containing products; other supplements require their own evidence.
A regulatory label does not quantify each supplement interaction. Botanical effects and absolute event rates cannot be inferred from cyclosporine toxicity alone. Formulation-specific findings must be retained.
Source 2: primary clinical case series
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Six pediatric liver transplant recipients and one young adult with hepatobiliary graft-versus-host disease after bone marrow transplantation.
Five of seven responded; cyclosporin doses fell 40-72% within two months, and intravenous cyclosporin was stopped in two responders. Two participants did not respond.
How this applies: Direct evidence for oral d-alpha-tocopheryl polyethylene glycol 1000 succinate, not every vitamin E form or all transplant recipients.
Abstract only, uncontrolled selected malabsorption population, historical cyclosporin formulation not resolved, and no universal response. Dose reductions were supervised outcomes, not self-treatment instructions.
Source 3: primary human crossover pharmacokinetic study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Ten healthy volunteers, randomized order, seven-day washout.
Mean cyclosporine AUC increased from 3908 to 6296 ng·hour/mL; apparent oral clearance fell about 38%. Metabolite-to-parent AUC ratios did not significantly change.
How this applies: Confirms a human absorption/exposure interaction for the specified oral TPGS product outside the malabsorption case series; not a universal effect size.
Abstract only, single-dose study with marked variability, and cyclosporine formulation unresolved. Vitamin E activity units in this product are not interchangeable with total tocophersolan mass. No separation interval was tested.
Source 4: regulatory product information
ema.europa.eu · Source check Sep 10, 2026
Population: Children with vitamin E deficiency from digestive malabsorption in congenital or hereditary chronic cholestasis; not premature neonates.
Warns that tocophersolan can enhance intestinal absorption of lipophilic medicines including ciclosporin, with monitoring and dose adjustment if necessary. Section 4.5 also states that interaction studies have not been performed for the labeled product.
How this applies: Direct tocophersolan identity and explicit ciclosporin caution. Does not generalize to ordinary tocopherol, acetate esters, topical vitamin E or every excipient amount.
Product-specific regulatory guidance, not itself a controlled cyclosporine interaction study. Its indication does not mean cyclosporine users generally need vitamin E. Different TPGS products and vitamin E units require care.
Research assessment: · Open full citations ↗
Timing & monitoring
Tocophersolan use may require closer cyclosporine monitoring and a supervised dose adjustment, but cyclosporine does not create a general need for this vitamin form or a proven dose-spacing rule.
- Exact scope
- Oral tocophersolan, d-alpha-tocopheryl polyethylene glycol 1000 succinate or TPGS, with systemic oral cyclosporine. Historical Liqui-E and current Vedrop are identified separately. Ordinary tocopherol, tocopheryl acetate, topical vitamin E and unspecified excipient amounts are not assigned the same effect. with Cyclosporine, RxCUI 3008, IN, systemic oral use. Neoral modified microemulsion and conventional Sandimmune are distinguished; neither is automatically dose-equivalent to the other. The Neoral label identifies cyclosporine as the active ingredient and basis of strength. Intravenous reference experiments are identified separately; ophthalmic and topical use are excluded.
- Medication form and route
- oral
What remains uncertain
- Label guidance and selected studies support monitoring; they do not establish universal supplementation or a protective separation interval.
Factors that may matter: tocophersolan product and dose units; malabsorption and cholestasis; cyclosporine formulation; starting or stopping TPGS; vitamin E treatment indication.
Read the supporting source summaries
Source 1: regulatory product information
ema.europa.eu · Source check Sep 10, 2026
Population: Children with vitamin E deficiency from digestive malabsorption in congenital or hereditary chronic cholestasis; not premature neonates.
Warns that tocophersolan can enhance intestinal absorption of lipophilic medicines including ciclosporin, with monitoring and dose adjustment if necessary. Section 4.5 also states that interaction studies have not been performed for the labeled product.
How this applies: Direct tocophersolan identity and explicit ciclosporin caution. Does not generalize to ordinary tocopherol, acetate esters, topical vitamin E or every excipient amount.
Product-specific regulatory guidance, not itself a controlled cyclosporine interaction study. Its indication does not mean cyclosporine users generally need vitamin E. Different TPGS products and vitamin E units require care.
Source 2: primary human crossover pharmacokinetic study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Ten healthy volunteers, randomized order, seven-day washout.
Mean cyclosporine AUC increased from 3908 to 6296 ng·hour/mL; apparent oral clearance fell about 38%. Metabolite-to-parent AUC ratios did not significantly change.
How this applies: Confirms a human absorption/exposure interaction for the specified oral TPGS product outside the malabsorption case series; not a universal effect size.
Abstract only, single-dose study with marked variability, and cyclosporine formulation unresolved. Vitamin E activity units in this product are not interchangeable with total tocophersolan mass. No separation interval was tested.
Source 3: primary clinical case series
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Six pediatric liver transplant recipients and one young adult with hepatobiliary graft-versus-host disease after bone marrow transplantation.
Five of seven responded; cyclosporin doses fell 40-72% within two months, and intravenous cyclosporin was stopped in two responders. Two participants did not respond.
How this applies: Direct evidence for oral d-alpha-tocopheryl polyethylene glycol 1000 succinate, not every vitamin E form or all transplant recipients.
Abstract only, uncontrolled selected malabsorption population, historical cyclosporin formulation not resolved, and no universal response. Dose reductions were supervised outcomes, not self-treatment instructions.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Original studies and regulatory sources checked; a new article prepared with exact formulation and access limits. No independent clinical review is recorded. | |
| Research summary published |
Article revision: a4799ec9587bed19
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
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Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.