Ascorbic Acid (Vitamin C) (ascorbic acid)
Vitamin C Oral Tablet, Extended Release
Last reviewed · Source: First Databank (FDB) drug data
Overview
Ascorbic acid is the functional and principal in vivo form of vitamin C, an essential water-soluble vitamin.
USES: Ascorbic acid (vitamin C) is used to prevent or treat low levels of vitamin C in people who do not get enough of the vitamin from their diets. Most people who eat a normal diet do not need extra ascorbic acid. Low levels of vitamin C can result in a condition called scurvy.
Scurvy may cause symptoms such as rash, muscle weakness, joint pain, tiredness, or tooth loss. Vitamin C plays an important role in the body. It is needed to maintain the health of skin, cartilage, teeth, bone, and blood vessels.
It is also used to protect your body's cells from damage. It is known as an antioxidant.
Generic name: ascorbic acid
Pronunciation: (as-KORE-bik AS-id)
Drug class: Vitamin C
Therapeutic class: Electrolyte Balance-Nutritional Products
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Ascorbic Acid (Vitamin C)
Indications
The following indications are listed for Ascorbic Acid (Vitamin C):
- Vitamin C Deficiency
Also known as: Ascorbic Acid Deficiency, Scurvy.
Dosing
No dosing information is available for this tab.
Ascorbic acid is usually administered orally. When oral administration is not feasible or when malabsorption is suspected, the drug may be administered IM, IV, or subcutaneously. When given parenterally, utilization of the vitamin reportedly is best after IM administration and that is the preferred parenteral route.
No dosing information is available for this tab.
No dosing information is available for this tab.
Drug interactions
Concurrent administration of more than 200 mg of ascorbic acid per 30 mg of elemental iron increases absorption of iron from the GI tract; however, most individuals are able to absorb orally ingested iron adequately without concurrent administration of ascorbic acid.
Increased urinary excretion of ascorbic acid and decreased excretion of aspirin occur when the drugs are administered concurrently.
Salicylates inhibit uptake of ascorbic acid by leukocytes and platelets. As a result, leukocyte and plasma concentrations of ascorbic acid are decreased to concentrations slightly higher than those associated with tissue depletion of the vitamin; however, there is no evidence to date that salicylate therapy precipitates ascorbic acid deficiency. Although concomitant administration of ascorbic acid supplements in patients receiving salicylates increases plasma ascorbic acid concentrations, leukocyte ascorbic acid concentrations are not increased and tissue stores of the vitamin may not be increased. Therefore, routine administration of ascorbic acid supplements to patients receiving salicylates is not warranted; however, patients receiving high dosages of salicylates who exhibit any signs or symptoms of ascorbic acid deficiency should be evaluated for such a deficiency.
Ascorbic acid has reportedly decreased the anticoagulant effect of warfarin; however, other investigators have failed to show this effect. Concurrent administration of ascorbic acid and fluphenazine reportedly resulted in decreased fluphenazine plasma concentration. Acidification of the urine following administration of ascorbic acid may result in altered excretion of other drugs.
There are no contraindication interactions for this drug.
Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
Ascorbic Acid (Vitamin C)/Bortezomib
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Vitamin C can form a complex with the boronic acid moiety of the bortezomib molecule, preventing its absorption into cells.(1-4) This may protect normal tissue in the body, which may have higher levels of Vitamin C.(5)
CLINICAL EFFECTS: Concurrent administration of Vitamin C may result in decreased bortezomib activity.(1-4)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Instruct patients receiving bortezomib therapy not to begin taking vitamin C supplements without consulting their oncologist first. Patients who are instructed to take vitamin C should follow their oncologist's instructions on how to separate dosages and should be carefully monitored for bortezomib efficacy.
DISCUSSION: An in vitro study with human plasma and multiple myeloma cells found that high levels of vitamin C (following 1 gram/day of ascorbic acid for 4 days) decreased bortezomib effectiveness by 26%. An in vivo study in mice found that vitamin C administration with bortezomib completely blocked the response of bortezomib.(6) An in vitro study in rat Schwann cells and myeloma cells(4) and an in vivo study in mice(7) found that delayed administration of vitamin C had no effect on bortezomib effects. In an in vivo study in multiple myeloma patients, concurrent ascorbic acid, arsenic trioxide, bortezomib, and high-dose melphalan in which ascorbic acid was administered close to bortezomib, the combination was safe and well tolerated, but produced no changes in response rates.(8) In another in vivo study in multiple myeloma patients, a regimen of ascorbic acid, bortezomib, and melphalan in which bortezomib was administered in the morning and ascorbic acid in the evening was found to be safe and efficacious, with 74% of patients responding to therapy.(9)
Moderate Interaction: Assess the risk to the patient and take action as needed.
Ascorbic Acid (Vitamin C)/Deferoxamine
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: It is believed that ascorbic acid increases the iron available for chelation from an labile intracellular iron pool. Ascorbic acid may then facilitate iron-induced oxidative tissue damage.(1)
CLINICAL EFFECTS: Dietary ascorbic acid may increase the absorption of dietary iron. Supplemental ascorbic acid therapy given during chelation therapy may improve iron output;(1-9) however, excessive dosages may result in cardiac toxicity from iron-induced oxidative tissue damage.(1,2,11-13)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Ascorbic acid intake is often restricted in patients with iron overload; however, it has been used in conjunction with deferoxamine to increase iron excretion.(2) Supplemental ascorbic acid therapy should only be initiated after one month of deferoxamine therapy. Ascorbic acid therapy should only be given in patients receiving deferoxamine regularly and the dose should be given after the infusion has started. The dosage of ascorbic acid should be limited to 50 mg daily in children under 10 years of age; 100 mg daily in older children; and 200 mg daily, in divided doses, in adults.(2) Cardiac function should be monitored in patients receiving concurrent therapy. Discontinue ascorbic acid therapy in patients who develop cardiac dysfunction.(2)
DISCUSSION: Supplemental ascorbic acid therapy given during chelation therapy has been shown to improve iron output,(1-9) possibly by increasing iron available for chelation from an labile intracellular iron pool.(1) However, dosages in excess of 500 mg daily have been associated with cardiac dysfunction.(1,2,11-13)
Contraindications
There is no enhanced messaging for this drug.
- Hemolytic anemia from pyruvate kinase and g6PD deficiencies
- Calcium oxalate renal calculi
- Glucose-6-phosphate dehydrogenase (g6Pd) deficiency
- Hyperoxaluria
- Hemochromatosis
- Kidney disease with reduction in glomerular filtration rate (GFr)
- Sickle cell disease
Adverse reactions
There is no enhanced messaging for this drug.
There are no severe adverse reactions for this drug.
Rare or Very Rare
- Abdominal pain with cramps
- Diarrhea
- Drowsy
- Fatigue
- Flushing
- Headache disorder
- Heartburn
- Hyperoxaluria
- Increased urinary frequency
- Insomnia
- Nausea
- Vomiting
Precautions
No enhanced messaging available.
No enhanced messaging available.
No enhanced messaging available.
No enhanced messaging available.
No enhanced messaging available.
ICD codes
| Code | Type | Description |
|---|---|---|
| Vitamin C deficiency | ||
| E54 | ICD10CM | Ascorbic acid deficiency |
ICD code information from First Databank (FDB).
Formulary status
Search health-plan coverage for this drug by ZIP code.
Choose the first character of a health plan name.
Last reviewed · Source: First Databank (FDB) drug data
On this page
Actions
Sign in to save favorites
Saving this drug requires a free Physicians Office Resource account.