|ASCORBIC ACID (VITAMIN C)
Apo-C , Ascorbicap, Cecon, Cetane, Cevalin, CeVi-Sol , Flavorcee, Redoxon , Schiff Effervescent Vitamin C, Vita-C
Classifications: vitamin; Therapeutic: vitamin supplement
Pregnancy Category: C
25 mg, 50 mg, 100 mg, 250 mg, 500 mg, 1000 mg tablets; 500 mg/mL injection
Water-soluble vitamin essential for synthesis and maintenance of collagen and intercellular ground substance of body tissue
cells, blood vessels, cartilage, bones, teeth, skin, and tendons. Unlike most mammals, humans are unable to synthesize ascorbic
acid in the body; therefore it must be consumed daily.
Increases protective mechanism of the immune system, thus supporting wound healing. Necessary for wound healing and resistance
Prophylaxis and treatment of scurvy and as a dietary supplement.
To acidify urine; to prevent and treat cancer; to treat idiopathic methemoglobinemia; as adjuvant during deferoxamine therapy
for iron toxicity; in megadoses will possibly reduce severity and duration of common cold. Widely used as an antioxidant
in formulations of parenteral tetracycline and other drugs.
Use of sodium ascorbate in patients on sodium restriction; use of calcium ascorbate in patients receiving digitalis; pregnancy
Excessive doses in patients with G6PD deficiency; hemochromatosis, thalassemia, sideroblastic anemia, sickle cell anemia;
patients prone to gout or renal calculi.
Route & Dosage
Adult: PO/IV/IM/SC 150500 mg/d in 12 doses
Child: PO/IV/IM/SC 100300 mg/d in divided doses
Adult: PO/IV/IM/SC 4560 mg/d
Child: PO/IV/IM/SC 3060 mg/d
Adult: PO/IV/IM/SC 412 g/d in divided doses
Child: PO/IV/IM/SC 500 mg q68h
- Give oral solutions mixed with food.
- Dissolve effervescent tablet in a glass of water immediately before ingestion.
- Open ampules with caution. After prolonged storage, decomposition may occur with release of carbon dioxide and resulting
increase in pressure within ampule.
- Be aware that ascorbic acid injection may gradually darken on exposure to light; slight coloration reportedly does not affect
its therapeutic action.
Verify correct IV concentration and rate of infusion for children with physician.
PREPARE: Direct/Continuous/Intermittent: ??Give undiluted or diluted (preferred) in solutions such as NS, D5W, D5/NS, RL.??Be aware that parenteral vitamin C is incompatible with many drugs. ??Consult pharmacist for compatibility information.
ADMINISTER: Direct: Give undiluted at a rate of 100 mg or a fraction thereof over 1 min. Continuous/Intermittent (preferred): Give at ordered rate determined by volume of solution to be infused.
INCOMPATIBILITIES Solution/additive: Aminophylline, bleomycin, erythromycin, nafcillin, sodium bicarbonate, theophylline. Y-site: Etomidate, thiopental.
- Store in airtight, light-resistant, nonmetallic containers, away from heat and sunlight, preferably at 15°30°
C (59°86° F), unless otherwise specified by manufacturer.
Adverse Effects (≥1%) GI:
Nausea, vomiting, heartburn, diarrhea
, or abdominal cramps (high doses). Hematologic:
Acute hemolytic anemia
(patients with deficiency of G6PD); sickle cell crisis. CNS:
Headache or insomnia
(high doses). Urogenital:
Urethritis, dysuria, crystalluria, hyperoxaluria, or hyperuricemia (high doses). Other:
Mild soreness at injection site; dizziness and temporary faintness with rapid IV administration
Diagnostic Test Interference
High doses of ascorbic acid can produce false-negative results for urine glucose with glucose oxidase methods (e.g., Clinitest, TesTape, Diastix); false-positive results with copper reduction methods (e.g., Benedict's solution, Clinitest); and false increases in serum uric acid determinations (by enzymatic methods). Interferes with urinary steroid (17-OHCS) determinations (by modified Reddy, Jenkins, Thorn procedure), decreases in serum bilirubin, and may cause increases in serum cholesterol, creatinine, and uric acid (methodologic inferences). May produce false-negative tests for occult blood in stools if taken within 4872 h of test.
Large doses may attenuate hypoprothrombinemic effects of oral anticoagulants
may inhibit ascorbic acid uptake by leukocytes
and tissues, and ascorbic acid may decrease elimination of salicylates
; chronic high doses of ascorbic acid may diminish the effects of disulfiram.
Readily absorbed PO; however, absorption may be limited with large doses. Distribution:
Widely distributed to body tissues; crosses placenta; distributed into breast milk. Metabolism:
In liver. Elimination:
Rapidly in urine when plasma
level exceeds renal
threshold of 1.4 mg/dL.
Assessment & Drug Effects
- Lab tests: Periodic Hct & Hgb, serum electrolytes.
- Monitor for S&S of acute hemolytic anemia, sickle cell crisis.
Patient & Family Education
- High doses of vitamin C are not recommended during pregnancy.
- Take large doses of vitamin C in divided amounts because the body uses only what is needed at a particular time and excretes
the rest in urine.
- Megadoses can interfere with absorption of vitamin B12.
- Note: Vitamin C increases the absorption of iron when taken at the same time as iron-rich foods.