Ascorbic acid

Name: Ascorbic acid

Description

Ascorbic acid (vitamin C) is a water-soluble vitamin. It occurs as a white or slightly yellow crystal or powder with a slight acidic taste. It is an antiscorbutic product. On exposure to light, it gradually darkens. In the dry state, it is reasonably stable in air, but in solution it rapidly oxidizes. Ascorbic acid (vitamin c) is freely soluble in water; sparingly soluble in alcohol; insoluble in chloroform, in ether, and in benzene. The chemical name of ascorbic acid (vitamin c) is L-ascorbic acid (vitamin c) . The empirical formula is C6H806, and the molecular weight is 176.13. The structure is as follows:

Ascorbic Acid (vitamin c) Injection is a sterile solution. Each mL contains: Ascorbic Acid (vitamin c) 250 mg and Edetate Disodium 0.025% in Water for Injection qs. Prepared with the aid of Sodium Bicarbonate. Sodium Hydroxide and/or Hydrochloric Acid may have been used to adjust pH.

Indications

Vitamin C is recommended for the prevention and treatment of scurvy. Its parenteral administration is desirable for patients with an acute deficiency or for those whose absorption of orally ingested ascorbic acid (vitamin c) is uncertain.

Symptoms of mild deficiency may include faulty bone and tooth development, gingivitis, bleeding gums, and loosened teeth. Febrile states, chronic illness, and infection (pneumonia, whooping cough, tuberculosis, diphtheria, sinusitis, rheumatic fever, etc.) increase the need for ascorbic acid (vitamin c) .

Hemovascular disorders, burns, delayed fracture and wound healing are indications for an increase in the daily intake.

Pregnancy & Lactation

Pregnancy

No adverse developmental outcomes are reported in the published literature

There are no available data on use of Ascor in pregnant women to inform a drug-associated risk of adverse developmental outcomes

Lactation

There are no data on the presence of ascorbic acid in human milk following IV dosing in lactating women

Ascorbic acid is present in human milk after maternal oral intake

Pregnancy Categories

A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA:Information not available.

What other drugs will affect ascorbic acid?

Other drugs may interact with ascorbic acid, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Introduction

An essential water-soluble vitamin; ascorbic acid is the in vivo form of vitamin C.109

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

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

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.)

Use Labeled Indications

Ascorbic acid deficiency: Treatment of symptoms of mild deficiency; use in conditions requiring an increased intake (eg, burns, wound healing)

Dietary supplement: As a dietary vitamin C supplement

Scurvy: Prevention and treatment of scurvy

Reconstitution

Prior to IV administration, dilute in a large volume parenteral solution (eg, NS, D%W). Note: Pressure may develop in the vial during storage.

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