<p>Caution should be exercised when administering this multivitamin formulation to patients on warfarin sodium-type anticoagulant therapy as it contains Vitamin K. Larger doses or supplementation with oral or parenteral vitamin E are not recommended because elevated blood levels of vitamin E may result. Additional vitamin A supplementation may be required, especially in low birth weight infants. Polysorbates have been associated with the E-Ferol syndrome (thrombocytopenia, renal dysfunction, hepatomegaly, cholestasis, ascites, hypotension, and metabolic acidosis) in low birth weight infants. This product contains aluminum. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature.</p>