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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                Monitor Closely (5)

                • 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.

                • 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 (20)

                • 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.

                • warfarin

                  ascorbic acid decreases effects of warfarin by pharmacodynamic antagonism. Minor/Significance Unknown. Dose >10 g/day vitamin C.

                • 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
                ascorbic acid (vitamin C) oral
                -
                1,000 mg tablet
                ascorbic acid (vitamin C) oral
                -
                500 mg tablet
                ascorbic acid (vitamin C) oral
                -
                500 mg tablet
                ascorbic acid (vitamin C) oral
                -
                500 mg capsule
                ascorbic acid (vitamin C) oral
                -
                250 mg tablet
                Special C oral
                -
                500-10-10-200 mg tablet
                Ascor intravenous
                -
                500 mg/mL vial
                Ascor intravenous
                -
                500 mg/mL vial
                ascorbic acid (vitamin C) injection
                -
                500 mg/mL vial
                Vitamin C oral
                -
                250 mg chewable tablet
                Vitamin C oral
                -
                500 mg chewable tablet
                Vitamin C oral
                -
                500 mg chewable 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
                -
                125 mg chewable tablet
                Vitamin C oral
                -
                250 mg tablet
                Vitamin C oral
                -
                1,000 mg tablet
                Vitamin C oral
                -
                500 mg tablet
                Vitamin C With Rose Hips oral
                -
                1,000 mg tablet

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

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                Patient Education
                ascorbic acid (vitamin C) oral

                ASCORBIC ACID - ORAL

                (as-KORE-bik AS-id)

                COMMON BRAND NAME(S): Cecon, Vitamin C

                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.

                HOW TO USE: Take this vitamin by mouth with or without food, usually 1 to 2 times daily. Follow all directions on the product package, or take as directed by your doctor.If you are taking the extended-release capsules, swallow them whole. Do not crush or chew extended-release capsules or tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing. Take this product with a full glass of water (8 ounces/240 milliliters) unless your doctor directs you otherwise.If you are taking the wafers or chewable tablets, chew them thoroughly and then swallow. If you are taking the lozenges, place the lozenge in your mouth and allow it to slowly dissolve.If you are taking the powder, mix it thoroughly in the proper amount of liquid or soft food and stir well. Take all of the mixture right away. Do not prepare a supply for future use. If you are using the liquid form of this vitamin, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.Dosage is based on your medical condition and response to treatment.Use this vitamin regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.If you think you may have a serious medical problem, seek immediate medical attention.

                SIDE EFFECTS: Diarrhea, nausea, vomiting, abdominal cramps/pain, or heartburn may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.If your doctor has directed you to use this medication, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if any of these rare but very serious side effects occur: painful urination, pink/bloody urine.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or 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: Before taking ascorbic acid, tell your doctor or pharmacist if you have any allergies. This product may contain inactive ingredients (such as peanut/soy), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this vitamin, tell your doctor or pharmacist your medical history, especially of: kidney disease (such as kidney stones), a certain enzyme deficiency (G6PD deficiency).During pregnancy, this vitamin has been found to be safe when used in recommended doses. Higher doses should be used during pregnancy only if clearly needed. Discuss the risks and benefits with your doctor.This vitamin passes into breast milk and is considered to be safe during breast-feeding when used in recommended doses. Consult your doctor for more information.

                DRUG INTERACTIONS: The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.This vitamin may interfere with certain laboratory tests (including certain urine glucose tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.Keep a list of all the products you use. Share the list with your doctor and pharmacist to reduce your risk for serious medication problems.

                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: Keep all regular medical and laboratory appointments.This product is not a substitute for a proper diet. It is best to get your vitamins from healthy foods. Ascorbic acid is commonly found in citrus fruit (such as oranges), tomatoes, brussels sprouts, cauliflower, and broccoli, among others. Consult your doctor, pharmacist, or nutritionist for more details.

                MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

                STORAGE: Different brands of this vitamin have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Keep all medications away from children and pets.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 2021. Copyright(c) 2021 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

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                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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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.