The short answer
Review supplemental vitamin E with the prescriber, particularly before procedures or when other bleeding-risk medicines are used. A fluoxetine co-use case exists, but several stronger competing explanations prevent isolating vitamin E.
What this answer covers
Supplemental vitamin E with fluoxetine; the reported case used a multivitamin containing 50 IU, not a high-dose isolated vitamin E regimen.
- Supplement or preparation
- Vitamin E
- Medication ingredient
- fluoxetine
Both dose and other medicines matter
Fluoxetine carries a bleeding warning. ODS notes that large vitamin E supplement doses can affect clotting, but the dose producing clinically significant effects is uncertain.
The case was a complex procedural event
A patient taking fluoxetine, fish oil and a multivitamin developed a spinal hematoma after an epidural procedure and ketorolac administration. The authors proposed multiple contributors.
Do not mislabel the vitamin exposure
The multivitamin contained 50 IU of vitamin E. This was not proof that isolated high-dose vitamin E caused the event, nor that a particular lower dose guarantees safety.
Make a procedure plan with the team
Disclose the vitamin amount, fish oil and all pain medicines before a procedure. Report unusual bleeding promptly; do not copy an automatic stopping interval or stop fluoxetine independently.
Evidence and practical considerations
Side effects & toxicity
Conditional bleeding review with strongly confounded exact coexposure evidence; no automatic restriction of dietary vitamin E.
- Exact scope
- Supplemental vitamin E with fluoxetine; the reported case used a multivitamin containing 50 IU, not a high-dose isolated vitamin E regimen. with Exact oral fluoxetine hydrochloride capsules. RxNorm IN 4493/PIN 227224 hydrochloride capsules. Active norfluoxetine and prolonged elimination matter. Not the combined olanzapine product.
- Medication form and route
- oral
- Timing or duration
- Source-specific single-dose, repeated-dose and observational exposures distinguished.
What remains uncertain
- One procedural case with ketorolac, fish oil, renal disease and spinal disease; no causal allocation or safe-dose threshold.
Factors that may matter: preparation and plant part; clinical indication; dose; other medicines; baseline alertness.
Read the supporting source summaries
Source 1: current product label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: People prescribed oral fluoxetine.
Exact label names tryptophan and St John’s wort in serotonin warnings, warns about bleeding and mania, and describes long elimination of fluoxetine and norfluoxetine.
How this applies: RxNorm IN 4493/PIN 227224 hydrochloride capsules. Active norfluoxetine and prolonged elimination matter. Not the combined olanzapine product.
No universal supplement interval, event rate or preparation equivalence established. Original label distinguishes warnings from measured pair-specific results.
Source 2: official nutrient guidance
ods.od.nih.gov · Source check Sep 10, 2026
Population: People using vitamin E.
Large supplemental amounts may affect platelets/clotting and increase bleeding with anticoagulant or antiplatelet treatment.
How this applies: General nutrient bleeding context with actual dose and formulation required.
Clinically significant dose threshold unknown; proposed amounts above 400 IU/day are not a guaranteed safety boundary. No exact fluoxetine event rate.
Source 3: original case report
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: One 66-year-old with renal impairment and spinal disease undergoing cervical epidural injection.
Spinal epidural hematoma occurred; authors proposed multiple contributors to impaired hemostasis.
How this applies: Only the named drug, preparation, route and measured endpoints apply.
Procedure, ketorolac, fish oil and comorbidities strongly confound causality. Vitamin E was a multivitamin dose, not isolated high-dose supplementation; no pair-specific incidence or universal stopping rule.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Current exact available claims adjudicated using original captures and explicit identity and comparator limits. | |
| Research summary published |
Article revision: 81a1818bd1f7e3da
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.