Class: Vitamin C
ATC Class: A11GA01
VA Class: VT400
Chemical Name: l-ascorbic acid
CAS Number: 50-81-7
Brands: Cenolate, Vicks Vitamin C drops
Introduction
An essential water-soluble vitamin; ascorbic acid is the in vivo form of vitamin C.109
Uses for Ascorbic Acid
Scurvy
Prevention and treatment of scurvy.a
Dietary Requirements
Adequate intake needed to prevent scurvy and provide antioxidant protection.109
Adequate vitamin C intake can be accomplished through consumption of foodstuffs.109 Citrus fruits, tomatoes, and potatoes are the major contributors of vitamin C in the diet of US adults and children.109
Recommended Dietary Allowances (RDA) in adults based on near maximal neutrophil concentrations with minimal urinary excretion of ascorbate.109
Requirements slightly lower in women than men based on water-soluble nature of the vitamin and the larger lean body mass and total body water in males relative to females.109
Adequate intake (AI) established for infants ≤6 months of age based on observed mean vitamin C intake of infants fed principally human milk; AI for infants 7–12 months of age based on vitamin C intake from human milk and solid food.109
RDA for children 1–18 years of age based on data in adults.109
Macular Degeneration
Suggested as a component of high-dose antioxidant supplements with zinc to reduce risk of developing advanced age-related macular degeneration† in high-risk patients (i.e., those with intermediate stage age-related macular degeneration or advanced stage macular degeneration in only one eye).111 112
Methemoglobinemia
Has been used in the treatment of idiopathic methemoglobinemia†.a
Ascorbic Acid Dosage and Administration
Administration
Usually administered orally.a May be administered by IM, IV, or sub-Q injection when oral administration is not feasible or when malabsorption is suspected.a
Parenteral Administration
Preferred parenteral method of administration is IM.a
Pressure may build within the vial during storage.b Exercise care when withdrawing a dose and/or insert a vent needle (e.g., empty sterile syringe) into the vial to release the pressure.b
IV Administration
Dilution
For solution and drug compatibility, see Compatibility under Stability.
Dilute with large volume of compatible parenteral fluid to minimize adverse reactions.b Avoid rapid infusion.b
Dosage
Available as ascorbic acid, calcium ascorbate, and sodium ascorbate; dosage expressed in terms of ascorbic acid.b d
Pediatric Patients
Scurvy
Treatment
Oral or IV
100–300 mg daily for 1 month or until full recovery.a c
Dietary and Replacement Requirements
Oral
Infants ≤6 months of age: Recommended AI is 40 mg (about 6 mg/kg) daily.109
Infants 7–12 months of age: Recommended AI is 50 mg (about 6 mg/kg) daily.109
Children 1–3 years of age: RDA is 15 mg daily.109
Children 4–8 years of age: RDA is 25 mg daily.109
Children 9–13 years of age: RDA is 45 mg daily.109
Boys 14–18 years of age: RDA is 75 mg daily.109
Girls 14–18 years of age: RDA is 65 mg daily.109
Adults
Scurvy
Treatment
Oral or IV
300 mg–1 g daily for 1 month or until full recovery.b c
Dietary and Replacement Requirements
Oral
Men ≥19 years of age: RDA is 90 mg daily.109
Women ≥19 years of age: RDA is 75 mg daily.109
Macular Degeneration†
Oral
500 mg in combination with beta carotene 15 mg, vitamin E 400 units, and zinc (as zinc oxide) 80 mg, with copper (as cupric oxide) 2 mg (to prevent anemia) daily has been used.111 112
Idiopathic Methemoglobinemia†
Oral
300–600 mg daily in divided doses has been used.a
Special Populations
Pregnant Women
RDA for pregnant women 14–18 years of age is 80 mg daily.109
RDA for pregnant women 19–50 years of age is 85 mg daily.109
Requirements increased in pregnant women to ensure transfer of adequate amounts of the vitamin to the fetus.109
Lactating Women
RDA for lactating women 14–18 or 19–50 years of age is 115 or 120 mg daily, respectively.109
Requirements increased in lactating women to ensure adequate concentration of the vitamin in milk.109
Smokers
RDA increased by 35 mg daily.109
Smoking increases oxidative stress and metabolic turnover of vitamin C.109
Cautions for Ascorbic Acid
Contraindications
Manufacturer states no known contraindications.b
Warnings/Precautions
General Precautions
Sodium Content
Each 1 gram of sodium ascorbate contains approximately 5 mEq of sodium; consider sodium content in patients on sodium-restricted diets.a
Kidney Stone Formation
Kidney stone (renal calculus) formation reported in individuals with renal disease receiving large dosages of ascorbic acid; excess ascorbic acid intake not associated with kidney stone formation in healthy individuals.109
Aluminum Content
Some ascorbic acid injection preparations contain aluminum that may be toxic.b Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired.b Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.b
Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum >4–5 mcg/kg daily accumulate aluminum at levels associated with CNS and bone toxicity.b Tissue loading may occur at even lower rates of administration.b
Specific Populations
Pregnancy
Category C.b
Lactation
Distributed into milk.a Caution if parenteral preparation is used in nursing women.b
Common Adverse Effects
Relatively nontoxic; nausea, vomiting, heartburn, fatigue, flushing, headache, insomnia, sleepiness, and other GI disturbances (diarrhea, transient colic, abdominal cramps, flatulent distention) reported.a
Interactions for Ascorbic Acid
Specific Drugs and Laboratory Tests
Drug or Test | Interaction | Comments |
---|---|---|
Aspirin | Increased urinary excretion of ascorbic acid and decreased excretion of aspirin reported with concomitant administrationa | |
Fluphenazine | Decreased fluphenazine concentrationsa | |
Iron, oral | Increased GI absorption of irona | |
Tests for detection of occult blood in stool | Possible false-negative resultsb | Manufacturer of parenteral ascorbic acid recommends discontinuing vitamin C supplements 48–72 hours before testb |
Tests for glucose in urine | Possible false-positive with tests based on cupric sulfate reagent and false-negative with tests that use glucose oxidase methoda | |
Warfarin | Decreased anticoagulant effect reported; other investigators did not observe this effecta |
Ascorbic Acid Pharmacokinetics
Absorption
Bioavailability
Readily absorbed by an active process that may be limited after very large doses.a
Distribution
Extent
Widely distributed in body tissues.a
Crosses the placenta; cord blood concentration 2–4 times maternal blood concentrations.a Distributed into human milk.a
Plasma Protein Binding
About 25%.a
Elimination
Metabolism
Reversibly oxidized to dehydroascorbic acid.a
Elimination Route
Excreted in urine. a
Removed by hemodialysis.a
Stability
Storage
Oral
Capsules and Tablets
Cool dry place.d
Parenteral
Solution
Store in carton until time of use at room temperature (≤25°C).b Protect from light. b
Compatibility
For information on systemic interactions resulting from concomitant use, see Interactions.
Parenteral
Solution CompatibilityHID
Compatible |
---|
Dextran 6% in dextrose 5% |
Dextran 6% in sodium chloride 0.9% |
Dextrose-Ringer's injection combinations |
Dextrose-Ringer’s injection, lactated, combinations |
Dextrose-saline combinations |
Dextrose 2½, 5, or 10% in water |
Fructose 10% in sodium chloride 0.9% |
Fructose 10% in water |
Invert sugar 5 and 10% in sodium chloride 0.9% |
Invert sugar 5 and 10% in water |
Ionosol products |
Ringer's injection |
Ringer's injection, lactated |
Sodium chloride 0.45 or 0.9% |
Sodium lactate (1/6) M |
Variable |
Fat emulsion 10%, IV |
Drug Compatibility
Compatible |
---|
Amikacin sulfate |
Calcium chloride |
Calcium gluconate |
Chloramphenicol sodium succinate |
Chlorpromazine HCl |
Colistimethate sodium |
Cyanocobalamin |
Dimenhydrinate HCl |
Heparin sodium |
Kanamycin sulfate |
Methyldopate HCl |
Penicillin G potassium |
Polymyxin B sulfate |
Procaine HCl |
Prochlorperazine edisylate |
Promethazine HCl |
Verapamil HCl |
Incompatible |
Bleomycin sulfate |
Nafcillin sodium |
Sodium bicarbonate |
Theophylline |
Variable |
Aminophylline |
Erythromycin lactobionate |
Compatible |
---|
Warfarin sodium |
Incompatible |
Etomidate |
Thiopental sodium |
ActionsActions
An essential water-soluble vitamin present in fresh fruits and vegetables.a Vitamin C refers to both ascorbic acid and dehydroascorbic acid (DHA); both compounds exhibit antiscorbutic activity.109
An antioxidant and a cofactor in enzymatic and metabolic processes.109
Required for collagen formation and tissue repair.b
Advice to Patients
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses.a
Importance of proper dietary habits, including taking appropriate AI or RDA of vitamin C.a
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.a
Importance of informing patients of other important precautionary information.a (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
---|---|---|---|---|
Bulk | Powder* | |||
Oral | Capsules, extended-release | 250 mg* | ||
500 mg* | ||||
Lozenges | 60 mg* | |||
Solution | 25 mg/drop | Vicks Vitamin C Drops | Procter & Gamble | |
100 mg/mL | ||||
500 mg/5 mL* | ||||
Tablets | 100 mg* | |||
250 mg* | ||||
500 mg* | ||||
1 g* | ||||
Tablets, chewable | 100 mg* | |||
250 mg* | ||||
500 mg* | ||||
1 g* | ||||
Tablets, extended-release | 500 mg* | |||
1 g* | ||||
1.5 g* | ||||
Parenteral | Injection | 222 mg/mL* | ||
250 mg/mL* | ||||
500 mg/mL* | Cenolate | Hospira |
Ascorbic acid and sodium ascorbate are also commercially available in combination with other vitamins, minerals, amino acids, analgesic-antipyretics, antihistamines, anti-inflammatory agents, cough suppressants, expectorants, infant formulas, protein supplements, and herbal supplements. For IV infusion, ascorbic acid or sodium ascorbate is also commercially available in combination with other vitamins in caloric and electrolyte solutions.a
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
---|---|---|---|---|
Bulk | Powder* | |||
Oral | Tablets | 610 mg (500 mg of ascorbic acid)* |
Calcium ascorbate is also commercially available in combination with other vitamins.
Comparative Pricing
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 05/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
Vitamin C 1000MG Tablets (IVAX PHARMACEUTICALS INC.): 100/$15.99 or 200/$19.97
Vitamin C 500MG Tablets (MAJOR PHARMACEUTICALS): 100/$28.53 or 200/$30.71
Disclaimer
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.
AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions September 01, 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
† Use is not currently included in the labeling approved by the US Food and Drug Administration.
References
73. Nienhuis A, Delea C, Aamodt R et al. Potential role for desferrioxamine and ascorbic acid in the treatment of chronic iron overload. Blood. 1975. 46:1026. Abstract. (IDIS 64329)
74. Hussain MAM, Flynn DM, Green N et al. Effect of dose, time, and ascorbate on iron excretion after subcutaneous desferrioxamine. Lancet. 1977; 1:977-9. [IDIS 76597] [PubMed 67469]
75. Modell B. Total management of thalassemia major. Arch Dis Child. 1977; 52:489-500. [IDIS 86686] [PubMed 879834]
100. Wolfe L, Olivieri N, Sallan D et al. Prevention of cardiac disease by subcutaneous deferoxamine in patients with thalassemia major. N Engl J Med. 1985; 312:1600-3. [IDIS 200851] [PubMed 4000198]
101. Marcus RE, Davies SC, Bantock HM et al. Desferrioxamine to improve cardiac function in iron-overloaded patients with thalassaemia major. Lancet. 1984; 1:392-3. [IDIS 181610] [PubMed 6141447]
102. Borgna-Pignatti C, De Stefano P, Broglia AM. Visual loss in patient on high-dose subcutaneous desferrioxamine. Lancet. 1984; 1:681. [IDIS 183172] [PubMed 6142370]
103. Olivieri NF, Buncic R, Chew E et al. Visual and auditory neurotoxicity in patients receiving subcutaneous deferoxamine infusions. N Engl J Med. 1986; 314:869-73. [IDIS 213050] [PubMed 3485251]
104. Nienhuis AW, Benz EJ, Propper R et al. Thalassemia major: molecular and clinical aspects. Ann Intern Med. 1979; 91:883-97. [IDIS 106721] [PubMed 391118]
105. Nienhuis AW. Vitamin C and iron. N Engl J Med. 1981; 304:170-1. [IDIS 126294] [PubMed 7442737]
106. Pippard MJ, Callender ST, Finch CA. Ferrioxamine excretion in iron-loaded man. Blood. 1982; 60:288-94. [IDIS 156244] [PubMed 7093519]
107. Modell B, Petrou M. Management of thalassaemia major. Arch Dis Child. 1983; 58:1026-30. [IDIS 180974] [PubMed 6660889]
108. National Research Council Food and Nutrition Board Subcommittee on the Tenth Edition of the RDAs. Recommended dietary allowances. 10th ed. Washington, DC: National Academy Press; 1989:115-24.
109. Committee on the Scientific Evaluation of Dietary Reference Intakes of the Food and Nutrition Board, Institute of Medicine, National Academy of Sciences. Dietary reference intakes for Vitamin C, Vitamin E, selenium, and carotenoids. Washington, DC: National Academy Press; 2000.
110. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes of the Food and Nutrition Board, Institute of Medicine, National Academy of Sciences. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington, DC: National Academy Press; 1997. (Uncorrected proofs.)
111. Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss. Arch Ophthalmol. 2001; 119:1417-36. [PubMed 11594942]
112. Jampol LM. Antioxidants, zinc, and age-related macular degeneration. Arch Ophthalmol. 2001;119:1533-4. Editorial.
a. AHFS drug information 2007. McEvoy GK, ed. Ascorbic Acid. Bethesda, MD: American Society of Health-Systems Pharmacists; 2007: 3631-4.
b. Luitpold Pharmaceuticals, Inc. Ascorbic Acid Injection prescribing information. Shirley, NY; 2000 Jun.
c. Weinstein, M, Babyn P, Zlotkin S. An orange a day keeps the doctor away: scurvy in the year 2000. Pediatrics. 2001; 108:e55.
d. GNC A-Z vitamin C 500 mg tablets package information. From ). Accessed 24 May 2007.
HID. Trissel LA. Handbook on injectable drugs. 14th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2007:171-6.
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Compare Ascorbic Acid with other medications
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