Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Adverse Effects
Frequency Not Defined
Flushing
Flank pain
Faintness, headache
Diarrhea, dyspepsia, nausea, vomiting
Hyperoxaluria (large doses)
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)
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.
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
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
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)
Images
Patient Handout
Formulary
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