ascorbic acid (Rx, OTC)

Brand and Other Names:Ascor, Cenolate, more...Vitamin C
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablets

  • 100mg
  • 250mg
  • 500mg
  • 1g

chewable, tablet

  • 100mg
  • 250mg
  • 500mg

capsule, extended release

  • 500mg

tablet, extended release

  • 500mg
  • 1000mg
  • 1500mg

crystals

  • 120g
  • 480g

granules

  • 100g
  • 500g
  • 1000g

injectable solution

  • 250mg/mL
  • 500mg/mL

oral solution

  • 100mg/mL

powder effervescent

  • 150g

powder, oral

  • 113mg
  • 120mg
  • 480mg

water, oral

  • 500mg

syrup, oral

  • 100mg/mL

RDA

Males: 90 mg/day

Females: 75 mg/day

Pregnant: 85 mg/day; not to exceed 2000 mg/day (80 mg if <18 years; not to exceed 1800 mg/day)

Nursing: 120 mg/day; not to exceed 2000 mg/day (115 mg if <18 years old; not to exceed 1800 mg/day)

Urinary Acidification

4-12 g/day PO/IV divided three or four times daily

Ascorbic Acid Deficiency (Scurvy)

Oral prevention: See recommended daily intake

Oral treatment: 250 mg PO QID x 1 week

Treatment with IV ascorbic acid

  • Indicated for short term (<1 week) treatment of scurvy in adult and children ≥5 months for whom oral administration is not possible, insufficient, or contraindicated
  • 200 mg IV qDay; recommended daily treatment should not exceed 7 days
  • If no improvement in scorbutic symptoms, retreat until resolution of scorbutic symptoms is observed
  • Also, see Administration

Charcot-Marie-Tooth Disease (Orphan)

Designated orphan indication for Charcot-Marie-Tooth disease type 1A

Orphan designated sponsor

  • Murigenetics SAS; Faculte de Medecine Timone; 13005 Marseille, France

Fragile X Syndrome (Orphan)

Orphan designation for fragile X syndrome in combination with alpha-tocopherol

Orphan sponsor

  • GenCo Pharmaceuticals LLC; 371 Lake Surprise Road; Cold Spring, New York 10516

Macular Degeneration (Off-label)

500 mg/day PO with other vitamins and minerals

Dosing Consideration

Use with caution in patients with renal impairment (see Warnings)

Limitations of use

  • Ascor is not indicated for treatment of vitamin C deficiency that is not associated with signs and symptoms of scurvy

Dosage Forms & Strengths

tablets

  • 100mg
  • 250mg
  • 500mg
  • 1g

chewable, tablet

  • 100mg
  • 250mg
  • 500mg

capsule, extended release

  • 500mg

tablet, extended release

  • 500mg1000mg1500mg

crystals

  • 120g
  • 480g

granules

  • 100g
  • 500g
  • 1000g

injectable solution

  • 250mg/mL
  • 500mg/mL

oral solution

  • 100mg/mL

powder effervescent

  • 150g

powder, oral

  • 113mg
  • 120mg
  • 480mg

water, oral

  • 500mg

syrup, oral

  • 100mg/mL

RDA

0-6 months: 40 mg/day

6-12 months: 50 mg/day

1-3 years: 15 mg/day

3-8 years: 25 mg/day

8-13 years: 45 mg/day

13-18 years: (male) 75 mg/day; (female) 65 mg/day

UL: 1-3 years: 400 mg/day; 4-8 years old: 600 mg/day; 9-13 years old: 1.2 g/day; 12-18 years old: 1.8 g/day

Urinary Acidification

500 mg/day divided PO/IV TID/QID

Ascorbic Acid Deficiency (Scurvy)

Oral prevention: See recommended daily intake

Oral treatment, infants or children: 100 mg PO TID x 1 week, then 100 mg PO qDay until resolved (typically 1-3 months)

Treatment with IV ascorbic acid

  • Indicated for short term (<1 week) treatment of scurvy in children and adolescents ≥5 months for whom oral administration is not possible, insufficient or contraindicated
  • <5 months: Safety and efficacy not established
  • 5 months to <12 months: 50 mg IV qDay
  • 1 year to <11 years: 100 mg IV qDay
  • ≥11 years: 200 mg IV qDay; recommended daily treatment should not exceed 7 days
  • If no improvement in scorbutic symptoms, retreat until resolution of scorbutic symptoms is observed
  • Repeat dosing is not recommended in children and adolescents <11 years
  • Also, see Administration

Charcot-Marie-Tooth Disease (Orphan)

Designated orphan indication for Charcot-Marie-Tooth disease type 1A

Orphan designated sponsor

  • Murigenetics SAS; Faculte de Medecine Timone; 13005 Marseille, France

Cystic Fibrosis (Orphan)

Orphan designation for cystic fibrosis

Orphan sponsor

  • Renovion, Inc; 112 South Duke St; Durham, North Carolina 27701
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Interactions

Interaction Checker

and ascorbic acid

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      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (0)

              Serious - Use Alternative (0)

                Monitor Closely (6)

                • deferasirox

                  deferasirox, ascorbic acid. unknown mechanism. Use Caution/Monitor. Coadministration of deferasirox and ascorbic acid has not been formally studied. Doses up to ascorbic acid 200 mg per day have not been associated with adverse consequences.

                • deferoxamine

                  deferoxamine, ascorbic acid. Other (see comment). Use Caution/Monitor. Comment: Ascorbic acid increases the availability of iron for chelation with deferoxamine. Ascorbic acid should be avoided in pts. with cardiac failure undergoing deferoxamine Tx. Clinical cardiac monitoring recommended for pts. supplemented with ascorbic acid.

                • dextroamphetamine transdermal

                  ascorbic acid will decrease the level or effect of dextroamphetamine transdermal by Other (see comment). Modify Therapy/Monitor Closely. Urinary acidifying agents can lower blood levels and efficacy of amphetamines. Increase dose of dextroamphetamine transdermal based on clinical response.

                • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

                  ascorbic acid increases levels of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by decreasing hepatic clearance. Use Caution/Monitor. Coadministration of ascorbic acid and certain combined hormonal contraceptives (CHCs) containing EE may increase plasma EE concentrations, possibly by inhibition of conjugation.

                • omadacycline

                  ascorbic acid will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

                • wheat germ extract

                  ascorbic acid decreases effects of wheat germ extract by unknown mechanism. Use Caution/Monitor. Mfr. recommends separating by 2 hrs.

                Minor (19)

                • aluminum hydroxide

                  ascorbic acid increases levels of aluminum hydroxide by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • aspirin

                  ascorbic acid will increase the level or effect of aspirin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

                  aspirin decreases levels of ascorbic acid by increasing renal clearance. Minor/Significance Unknown.

                  ascorbic acid increases levels of aspirin by decreasing renal clearance. Minor/Significance Unknown.

                • aspirin rectal

                  ascorbic acid will increase the level or effect of aspirin rectal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

                  ascorbic acid increases levels of aspirin rectal by decreasing renal clearance. Minor/Significance Unknown.

                  aspirin rectal decreases levels of ascorbic acid by increasing renal clearance. Minor/Significance Unknown.

                • aspirin/citric acid/sodium bicarbonate

                  aspirin/citric acid/sodium bicarbonate decreases levels of ascorbic acid by increasing renal clearance. Minor/Significance Unknown.

                  ascorbic acid will increase the level or effect of aspirin/citric acid/sodium bicarbonate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

                  ascorbic acid increases levels of aspirin/citric acid/sodium bicarbonate by decreasing renal clearance. Minor/Significance Unknown.

                • balsalazide

                  balsalazide decreases levels of ascorbic acid by increasing renal clearance. Minor/Significance Unknown.

                • bazedoxifene/conjugated estrogens

                  bazedoxifene/conjugated estrogens decreases levels of ascorbic acid by increasing elimination. Minor/Significance Unknown.

                • butabarbital

                  butabarbital decreases levels of ascorbic acid by increasing elimination. Minor/Significance Unknown.

                • butalbital

                  butalbital decreases levels of ascorbic acid by increasing elimination. Minor/Significance Unknown.

                • choline magnesium trisalicylate

                  ascorbic acid will increase the level or effect of choline magnesium trisalicylate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

                  ascorbic acid increases levels of choline magnesium trisalicylate by decreasing renal clearance. Minor/Significance Unknown.

                  choline magnesium trisalicylate decreases levels of ascorbic acid by increasing renal clearance. Minor/Significance Unknown.

                • conjugated estrogens

                  conjugated estrogens decreases levels of ascorbic acid by increasing elimination. Minor/Significance Unknown.

                • conjugated estrogens, vaginal

                  conjugated estrogens, vaginal decreases levels of ascorbic acid by increasing elimination. Minor/Significance Unknown.

                • copper

                  ascorbic acid decreases levels of copper by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • diflunisal

                  diflunisal decreases levels of ascorbic acid by increasing renal clearance. Minor/Significance Unknown.

                • lornoxicam

                  ascorbic acid will increase the level or effect of lornoxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

                • metolazone

                  ascorbic acid will increase the level or effect of metolazone by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

                • oxytetracycline

                  oxytetracycline decreases levels of ascorbic acid by increasing elimination. Minor/Significance Unknown.

                • phenobarbital

                  phenobarbital decreases levels of ascorbic acid by increasing elimination. Minor/Significance Unknown.

                • rose hips

                  ascorbic acid will increase the level or effect of rose hips by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

                • willow bark

                  ascorbic acid will increase the level or effect of willow bark by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

                  willow bark decreases levels of ascorbic acid by increasing renal clearance. Minor/Significance Unknown.

                  ascorbic acid increases levels of willow bark by decreasing renal clearance. Minor/Significance Unknown.

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                Adverse Effects

                Frequency Not Defined

                Flushing

                Flank pain

                Faintness, headache

                Diarrhea, dyspepsia, nausea, vomiting

                Hyperoxaluria (large doses)

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                Warnings

                Contraindications

                Hypersensitivity

                Cautions

                Hemolysis has been reported with ascorbic acid in patients with glucose-6-phosphate dehydrogenase deficiency; discontinue treatment if hemolysis is suspected and treat as needed

                Ascorbic acid may interfere with laboratory tests based on oxidation-reduction reactions (eg, blood and urine glucose testing, nitrite and bilirubin levels, and leucocyte count testing); delay laboratory tests until 24 hours after ascorbic acid infusion if possible

                Oxalate nephropathy and nephrolithiasis

                • Acute and chronic oxalate nephropathy reported with prolonged administration of high doses of ascorbic acid
                • Increased risk for oxalate nephropathy in patients with renal disease, renal impairment, history of oxalate kidney stones, and geriatric patients
                • Monitor renal function; discontinue treatment if oxalate nephropathy develops and treat any suspected oxalate nephropathy accordingly

                Drug interactions overview

                • Ascorbic acid may decrease effects of erythromycin, kanamycin, streptomycin, doxycycline, and lincomycin; if antibiotic efficacy is suspected, discontinue ascorbic acid
                • Limited case reports have suggested interference of ascorbic acid with anticoagulation effects of warfarin; monitor
                • Amphetamine and other drugs affected by urine pH
                  • Ascorbic acid may acidify urine
                  • Lowers amphetamines levels by increasing renal excretion
                  • May alter excretion of certain drugs affected by urine pH (eg, fluphenazine)
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                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.

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                Nutrition

                Sources: Citrus fruits, peppers, cabbage, papaya, orange juice, broccoli, guava, carambola, radishes

                Function: Required for collagen biosythesis

                Deficiency: Scurvy; fatigue, depression, easy bruising & bleeding, weakened cartilage, coiled hairs, difficulty wound healing, thickened skin, abnormal bone growth in infants

                Toxicity: Potential for kidney stones, withdrawal from high doses can lead to scurvy, even with "normal" intake

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                Pharmacology

                Mechanism of Action

                Necessary for collagen formation and tissue repair; plays a role in oxidation/reduction reactions as well as other metabolic pathways including synthesis of catecholamines, carnitine, and steroids; also plays a role in conversion of folic acid to folinic acid

                Pharmacokinetics

                Distribution: Large

                Metabolism: Liver

                Absorption: Rapidly absorbed

                Excretion: Urine

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                Administration

                IV Compatibility

                Compatible w/ most common diluents (eg, dextrose solns, NS, LR, Ringer's, ½NS, dextrose-saline, dextrose-LR)

                IV Preparation

                Dilute with large volume of compatible fluid to minimize adverse reactions

                IV ascorbic acid (Ascor) is supplied as a pharmacy bulk package (PBP)

                Intended for dispensing of single doses to multiple patients in a pharmacy admixture program and is restricted to the preparation of admixtures for infusion

                Use only in a suitable ISO Class 5 work area such as a laminar flow hood (or an equivalent clean air compounding area)

                Open vials are to be used within 4 hr

                Prior to administration, the final diluted solution for infusion must be isotonic (undiluted the osmolarity is ~5,900 mOsmol/L)

                Calculate the osmolarity of the intended admixture for infusion

                Add daily dose directly to an appropriate volume of a suitable infusion solution (eg, 5% Dextrose Injection)

                Do not mix with solutions containing elemental compounds that cause reduction (eg, copper)

                Final concentration of ascorbic acid admixture solution for infusion: 1-25 mg/mL

                Visually inspect for particulate matter and discoloration prior to administration; solution should appear colorless to pale yellow

                Immediately use as a slow IV infusion

                IV Administration

                Consider IV or IM administration when PO is not feasible

                Avoid rapid infusion

                Infusion rate of diluted Ascor solution

                • 5 months-12 months: 1.3 mg/minute
                • 1-11 years: 3.3 mg/minute
                • >11 years: 33 mg/minute

                Oral Administration

                Take with or without meals

                Storage

                Unopened IV vials: Store in refrigerator at 2-8°C (36-46°F); protect from light; contains no preservatives

                Opened IV vials: Use within 4 hr of vial entry; discard remaining portion

                Tablets: Store at room temperature at 15-30°C (59-86°F)

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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                Vitamin C With Rose Hips oral
                -
                1,000 mg tablet
                ascorbic acid (vitamin C) injection
                -
                500 mg/mL vial
                ascorbic acid (vitamin C) oral
                -
                250 mg tablet
                ascorbic acid (vitamin C) oral
                -
                125 mg chewable tablet
                ascorbic acid (vitamin C) oral
                -
                1,000 mg tablet
                ascorbic acid (vitamin C) oral
                -
                500 mg capsule
                ascorbic acid (vitamin C) oral
                -
                500 mg chewable tablet
                ascorbic acid (vitamin C) oral
                -
                500 mg tablet
                ascorbic acid (vitamin C) oral
                -
                500 mg tablet
                Special C oral
                -
                500-10-10-200 mg tablet
                Vitamin C oral
                -
                125 mg chewable tablet
                Vitamin C oral
                -
                500 mg tablet
                Vitamin C oral
                -
                500 mg tablet
                Vitamin C oral
                -
                500 mg tablet
                Vitamin C oral
                -
                1,000 mg tablet
                Vitamin C oral
                -
                500 mg tablet
                Vitamin C oral
                -
                125 mg chewable tablet
                Vitamin C oral
                -
                500 mg tablet
                Vitamin C oral
                -
                250 mg tablet
                Vitamin C oral
                -
                1,000 mg tablet
                Vitamin C oral
                -
                250 mg tablet

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

                Select a drug:
                Patient Education
                ascorbic acid (vitamin C) injection

                NO MONOGRAPH AVAILABLE AT THIS TIME

                USES: Consult your pharmacist.

                HOW TO USE: Consult your pharmacist.

                SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                PRECAUTIONS: Consult your pharmacist.

                DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

                OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

                NOTES: No monograph available at this time.

                MISSED DOSE: Consult your pharmacist.

                STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

                Information last revised July 2016. Copyright(c) 2022 First Databank, Inc.

                IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                Formulary

                FormularyPatient Discounts

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                The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                NC NOT COVERED – Drugs that are not covered by the plan.
                Code Definition
                PA Prior Authorization
                Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                QL Quantity Limits
                Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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                Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                OR Other Restrictions
                Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.