• Treatment of ascorbic acid deficiency.
• Supplemental therapy in some GI diseases during long-term parenteral nutrition or chronic hemodialysis.
• Treatment and prevention of scurvy.

Contraindicated in:

• Tartrazine hypersensitivity (some oral products contain tartrazine — FDC yellow dye #5).

Use Cautiously in:

• Renal impairment (↑ risk for nephrolithiasis)
• Recurrent kidney stones (↑ risk for nephrolithiasis)
• Glucose 6–phosphate dehydrogenase deficiency (↑ risk for hemolysis; avoid exceeding US recommended daily allowance)
• OB: Lactation: Avoid exceeding US recommended daily allowance
• Pedi: Children <2 yr (↑ risk for nephrolithiasis); children <5 mo (safety and effectiveness of IV formulation not established)
• Geri: ↑risk for nephrolithiasis.

Derm: flushing.

GI: vomiting, cramps, diarrhea, heartburn, nausea.

GU: nephrolithiasis, oxalate nephropathy.

Hemat: hemolysis (in G6PD deficiency), deep vein thrombosis.

Local: pain at SUBQ, IM, or IV sites.

Neuro: fatigue, drowsiness, headache, insomnia.

Drug-Drug:

• If urinary acidification occurs, may ↑ excretion and ↓ effects of mexiletine,amphetamine, fluphenazine, or tricyclic antidepressants.
• Large doses (>10 g/day) may ↓ response to warfarin.
• ↑iron toxicity when given concurrently with deferoxamine.
• May ↓ effects of erythromycin, streptomycin, doxycycline, and bleomycin.

(Generic available)

• Chewable tablets: 60 mg^OTC; 100 mg^OTC; 250 mg^OTC; 500 mg^OTC; 1 g^OTC;
• Extended-release capsules: 500 mg^OTC;
• Extended-release tablets: 500 mg^OTC; 1 g^OTC; 1.5 g^OTC;
• Oral solution: 50 mg/0.6 mL^OTC; 100 mg/mL^OTC;
• Syrup: 250 mg/5 mL^OTC;
• Solution for injection: 222 mg/mL; 250 mg/mL; 500 mg/mL ;
• Tablets: 25 mg^OTC; 50 mg^OTC; 100 mg^OTC; 125 mg^OTC; 250 mg^OTC; 500 mg^OTC; 1 g^OTC; 1.5 g^OTC;
• In combination with: other vitamins and minerals in multivitamin preparations.

• PO (Adults): Scurvy: 500 mg/day for at least 14 days. Prevention of deficiency: 50–100 mg/day.
• PO (Children): Scurvy: 100–300 mg/day for at least 14 days. Prevention of deficiency: 30–45 mg/day.
• IM (Adults): Scurvy: 100–500 mg/day for at least 14 days.
• IM (Children): Scurvy: 100–300 mg/day for at least 14 days.
• IV (Adults and Children 11 yr): Scurvy (treatment): 200 mg once daily for up to 7 days; if no improvement in symptoms, retreat until symptoms resolve.
• IV (Children 1–10 yr): 100 mg once daily for up to 7 days. Retreatment is not recommended.
• IV (Children 5 mo-<1 yr): 50 mg once daily for up to 7 days. Retreatment is not recommended.

Ascor, Ascorbicap, Cebid, Cecon, Cecore-500, Cemill, Cenolate, Cetane, Cevalin, Cevi-Bid, Flavorcee, Mega-C/A Plus, Ortho/CS, Sunkist

• Necessary for collagen formation and tissue repair.
• Involved in oxidation reduction reactions; tyrosine, folic acid, iron, and carbohydrate metabolism; lipid and protein synthesis; cellular respiration; and resistance to infection.

• Replacement in deficiency states.
• Supplementation during increased requirements.

Therapeutic Classification: vitamins

Pharmacologic Classification: water soluble vitamins

Absorption: Actively absorbed after oral administration by a saturable process. IV administration results in complete bioavailability.

Distribution: Widely distributed. Crosses the placenta; enters breast milk.

Metabolism/Excretion: Converted to compounds that are excreted by the kidneys.

Half-life: 7.4 hr.

Apo-C

(response to skeletal and hemorrhagic changes in scurvy)

• Advise patient to take medication as directed and not to exceed dose prescribed. Excess doses may lead to diarrhea and urinary stone formation. If a dose is missed, skip dose and return to dose schedule.
• Vitamin C Deficiency: Encourage patient to comply with diet recommendations of health care professional. Explain that the best source of vitamins is a well-balanced diet.
  • Foods high in ascorbic acid include citrus fruits, tomatoes, strawberries, cantaloupe, and raw peppers. Gradual loss of ascorbic acid occurs when fresh food is stored, but not when it is frozen. Rapid loss is caused by drying, salting, and cooking.
  • Patients self-medicating with vitamin supplements should be cautioned not to exceed RDA. The effectiveness of megadoses of vitamins for treatment of various medical conditions is unproven and may cause side effects. Abrupt withdrawal of megadoses of ascorbic acid may cause rebound deficiency.

as-KOR-bik A-sid