ascorbic acid (Rx, OTC)

Brand and Other Names:Ascor, Cenolate, more...Vitamin C
  • Print

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
more...

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

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
more...

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
Next:

Interactions

Interaction Checker

and ascorbic acid

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            Adverse Effects

            Frequency Not Defined

            Flushing

            Flank pain

            Faintness, headache

            Diarrhea, dyspepsia, nausea, vomiting

            Hyperoxaluria (large doses)

            Previous
            Next:

            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)
            Previous
            Next:

            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.

            more...
            Previous
            Next:

            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

            Previous
            Next:

            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

            Previous
            Next:

            Administration

            When oral administration is not feasible or when malabsorption is suspected

            IM preferred to IV

            IV Compatibility

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

            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

            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)

            Previous
            Next:

            Images

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            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.
            ST Step Therapy
            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.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous