The short answer
The added bleeding risk from vitamin E supplements with diflunisal is uncertain. Review the exact supplement with your prescriber, especially if you have ulcer or bleeding risk factors.
What this answer covers
Oral vitamin E supplements products with prescription oral diflunisal. Exact preparation, dose and duration matter; other drugs and food exposures are not interchangeable.
- Supplement or preparation
- Vitamin E
- Medication ingredient
- diflunisal
What the human evidence shows
A small randomized study in warfarin users found no significant INR change with vitamin E. That is counterevidence to assuming every supplement exposure worsens anticoagulation, but INR does not measure every platelet effect and the study did not test diflunisal.
Diflunisal differs from aspirin
The diflunisal label describes a reversible, dose-dependent platelet effect. In short studies, 250 mg twice daily had no measurable effect and 500 mg twice daily had a slight effect. These findings do not remove its serious GI bleeding warning or make aspirin studies a direct test of this combination.
Review the exact product
NIH guidance cautions that large supplemental doses can increase bleeding concerns with medicines affecting clotting. Bring the dose in mg or IU and the formulation to your pharmacist. No exact dose has been validated as safe with diflunisal, and the supplement warning does not require avoiding foods containing vitamin E.
Recognize the medicine’s own warning signs
Diflunisal can cause serious stomach or intestinal bleeding even without a supplement. Seek urgent care for vomiting blood or black, tarry stools, and report persistent stomach pain or unusual bleeding. A few hours of separation has not been shown to prevent a combined bleeding effect. Tell your prescriber about other pain relievers, aspirin and anticoagulants.
Evidence and practical considerations
Side effects & toxicity
An increased bleeding or gastrointestinal-injury rate specifically from vitamin E supplements with diflunisal has not been established.
- Exact scope
- Oral vitamin E supplements products with prescription oral diflunisal. Exact preparation, dose and duration matter; other drugs and food exposures are not interchangeable. with Exact diflunisal RxCUI 3393 IN, confirmed by current RxNorm. Prescription oral tablets; not aspirin, and not a class-average NSAID effect.
- Medication form and route
- Oral
What remains uncertain
- Small, short or other-drug studies do not establish this exact combination’s risk or rule out rare serious bleeding.
Factors that may matter: Exact preparation and dose; Fasting versus fed dosing; Bleeding and ulcer history; Other medicines.
Read the supporting source summaries
Source 1: Current prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Prescription oral diflunisal users and healthy-volunteer pharmacology studies.
Diflunisal has dose-dependent reversible platelet effects. At 500 mg twice daily effects were slight; 250 mg twice daily had no measurable effect in a short study. Serious GI bleeding and ulcers remain labeled risks. Antacids may lower levels, especially with continuous use.
How this applies: Exact current drug label. Exact diflunisal RxCUI 3393 IN, confirmed by current RxNorm. Prescription oral tablets; not aspirin, and not a class-average NSAID effect.
Not proof of each supplement combination. Short healthy-volunteer fecal blood-loss findings do not establish long-term GI safety. Aspirin has different platelet pharmacology. No universal antacid separation interval.
Source 2: Original clinical research
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: 21 patients receiving chronic warfarin.
No significant INR change was found.
How this applies: Exact drug where specified; other-drug and supplement-only findings remain indirect.
Abstract-only, dose not specified in inspected abstract. INR is a surrogate; warfarin is not diflunisal, and null INR does not exclude platelet-mediated bleeding.
Source 3: Medication terminology
rxnav.nlm.nih.gov · Source check Sep 10, 2026
Population: Terminology record.
Diflunisal, IN.
How this applies: Exact identity.
No clinical evidence.
Research assessment: · Open full citations ↗
Side effects & toxicity
High-dose vitamin E supplements warrant individualized review because diflunisal has dose-dependent platelet effects.
- Exact scope
- Oral vitamin E supplements products with prescription oral diflunisal. Exact preparation, dose and duration matter; other drugs and food exposures are not interchangeable. with Exact diflunisal RxCUI 3393 IN, confirmed by current RxNorm. Prescription oral tablets; not aspirin, and not a class-average NSAID effect.
- Medication form and route
- Oral
What remains uncertain
- A precaution based on defined supplement evidence and the exact drug label, not a measured combination event rate.
Factors that may matter: Exact preparation and dose; Fasting versus fed dosing; Bleeding and ulcer history; Other medicines.
Read the supporting source summaries
Source 1: Current prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Prescription oral diflunisal users and healthy-volunteer pharmacology studies.
Diflunisal has dose-dependent reversible platelet effects. At 500 mg twice daily effects were slight; 250 mg twice daily had no measurable effect in a short study. Serious GI bleeding and ulcers remain labeled risks. Antacids may lower levels, especially with continuous use.
How this applies: Exact current drug label. Exact diflunisal RxCUI 3393 IN, confirmed by current RxNorm. Prescription oral tablets; not aspirin, and not a class-average NSAID effect.
Not proof of each supplement combination. Short healthy-volunteer fecal blood-loss findings do not establish long-term GI safety. Aspirin has different platelet pharmacology. No universal antacid separation interval.
Source 2: Government nutrient guidance
ods.od.nih.gov · Source check Sep 10, 2026
Population: Users of vitamin E supplements.
Large supplemental doses may impair clotting or platelet function and increase bleeding concern with antiplatelet or anticoagulant treatment.
How this applies: General guidance cautiously linked to exact drug platelet pharmacology.
No exact diflunisal combination estimate or validated safe threshold. Direct HTTP fetch failed; relevant original guidance body read through web open and preserved.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Sources checked and article drafted. | |
| Research summary published |
Article revision: 3bbd610627b25dca
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?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.