Ascorbic acid (Vitamin C) is a water-soluble vitamin that acts as an antioxidant and a cofactor in the synthesis of collagen, hormones, and amino acids. It is used to treat patients with the following conditions:

• Ascorbic acid deficiency:

  • For the treatment of symptoms due to vitamin C deficiency and in conditions that require an increased intake of vitamin C like burns and wound healing.

• Dietary supplement

• Scurvy (prevention and treatment)

• For Severe sepsis and septic shock as Off Label Use.

Cosmetic uses of Vitamin C:

• Vitamin C for skin whitening:

  • Ascorbic acid (Vitamin C) acts as an antioxidant and decreases the production of melanin in the skin. It also makes the skin more susceptible to the effects of glutathione resulting in skin fairness and whitening.
  • It also maintains the collagen (a protein in the skin) causing the skin firm and toned.

• Vitamin C for nails:

  • A deficiency of vitamin C results in brittle nails and slow growth of the nails. It is essential for healthy and strong nails and hair especially in combination with biotin.

• Vitamin C for pimples and acne:

  • Vitamin C removes excess oil from the pores of the skin, acts as an antioxidant, and has antiseptic properties.
  • Topical application is used as a home remedy for acne.
  • It is also used for acne scars along with vitamin A.

Ascorbic acid Dose in Adults

Use in the treatment of Ascorbic acid deficiency:

• Intramuscular, Intravenous, SubQ administration:
  • 70 - 150 mg per day.
  • Doses of 3 - 5 times the RDA or more may be required in individuals with increased requirements.

Ascorbic acid use in Burns:

• Intramuscular, Intravenous, or SubQ:
  • 1 - 2 g daily for severe burns.
  • The daily dose is determined based on the extent of tissue injury.

Use as maintenance requirement Parenteral nutrition:

• 200 mg/day intravenously

Ascorbic acid dose for the treatment of Scurvy:​​​​​​​

• Intramuscular, Intravenous, or SubQ:
  • 300 - 1,000 mg per day.
  • Treatment duration and the dose should be individualized.
  • The maximum dose of up to 6 gms may be given.

• Ascor:

  • 200 mg intravenously once a day for 7 days.
  • Patients who do not show any clinical improvement after a week maybe retreated until the resolution of the symptoms.
  • After the initial loading dose, a maintenance dose of 100 - 300 mg is given orally daily for a period of one to three months (to replenish the body stores).

Vitamin C dose as Off label use in the treatment of Severe sepsis or septic shock:

• 1500 mg intravenously over 30 - 60 minutes.
• The dose is repeated every six hourly for four days or until the patient is discharged.
• It should be administered in combination with intravenous thiamine and Intravenous hydrocortisone.

Ascorbic acid use in Wound healing: ​​​​​​​

• Intramuscular, Intravenous, SubQ:
  • 300 - 500 mg daily for 7 - 10 days prior to and after surgery.

Ascorbic acid Dose in Childrens

Ascorbic acid dose for the maintenance requirement in patients on Parenteral nutrition:

• Infants:

  • 15 - 25 mg/kg/day intravenously to a maximum daily dose of 80 mg.

• Children and Adolescents:

  • 80 mg intravenous daily

Ascorbic acid dose to treat Scurvy in children:

• Infants, Children, and Adolescents:

  • 100 - 300 mg/day orally, intramuscularly, or intravenously in divided doses for seven days initially.
  • This is followed by 100 mg/day until tissue saturation that may take 1 - 3 months.

Manufacturer's labeling: Ascor:

• Infants 5 months of age or older:

  • 50 mg intravenous once a day for seven days.

• Children less than 11 years of age:

  • 100 mg intravenous once a day for seven days.

• Children 11 years of age or older and Adolescents:

  • 200 mg intravenous once a day for seven days

Pregnancy Risk Factor C

• Pregnancy has not been tested for Vitamin C.
• Vitamin C levels in plasma decrease with pregnancy.
• Females who are pregnant may need to take higher doses than the RDA (recommended daily allowance).

Vitamin C use during breastfeeding:

• Breast milk contains Vitamin C. It is however controlled in breastmilk.
• Manufacturer suggests weighing the benefits for the mother and the potential risks to the infant

Vitmain C dose in kidney disease:

• Ascorbic acid should be administered with caution in patients with renal disease, especially in patients who are prone to develop recurrent renal calculi, an end-stage renal disease requiring hemodialysis, and those at risk of developing oxalate nephropathy.
• To avoid a potential deficiency state, 60 - 100 mg orally or intravenously once a day may be sufficient.
• Doses exceeding 100 mg per day may lead to secondary oxalosis and oxalate kidney stones.

Ascorbic acid Dose in Liver Disease:

• Vitamin C has not been studied in patients with liver disease.
• However, based on the pharmacokinetics, it seems safe in patients with liver disease. 

Common Side Effects of Ascorbic acid (Vitamin C) Include:

• Endocrine & metabolic:
  • Hyperoxaluria

Contraindication to Ascorbic acid (Vitamin C) Include:

• It has not been mentioned by the manufacturer that there are any contraindications.

Warnings and precautions​​​​​​​

• Oxalate nephropathy/nephrolithiasis:

  • The precipitation of urate and cysteine crystals can be caused by ascorbic acid acid acid acidifying the urine.
  • Chronic or acute oxalate renal disease may be caused by prolonged and excessive intravenous drug use.
  • Patients at high risk for developing oxalate renal disease should have their renal functions monitored. These patients are at high risk include:
    • Patients with dementia
    • Children, especially children younger than 2 years old
    • Patients with underlying kidney disease
    • Individuals who have a history of using oxalate stone.

• Diabetes:

  • Patients with diabetes should not consume too much vitamin C over a longer time.

• Glucose-6-phosphatase dehydrogenase deficiency:

  • Patients with G6PD (glucose-6-phosphatase dehydrogenase) deficiency may develop hemolytic crisis.
  • These patients are at risk of hemolysis and should be given a lower dose. Patients should also be closely monitored.
  • The patient must stop receiving therapy if hemolysis is observed during treatment.

• Hemochromatosis:

  • Iron toxicity can develop in conditions that are predisposed to iron overload, including primary and secondary hemochromatosis.

• Renal impairment

  • Monitor renal function and watch for signs of acute renal impairment.
  • Patients with oxalate kidney stone sensitivity are more likely to develop chronic or acute oxalate renal disease.

Vitamin C (ascorbic acid): Drug Interaction

Monitor:

• Monitor Renal functions, hemoglobin, and blood counts.
• Ascorbic acid may result in oxalate kidney stones. It may also result in hemolysis in patients who are G6PD deficient. 

How to administer Ascorbic acid (Vitamin C)?

• It should be administered orally.
• When parenteral administration is given because of malabsorption or due to short-bowel, the intramuscular route is preferred.
• Oral vitamin C is preferably given with meals.
• The intramuscular, intravenous, and subcutaneous injections should not be administered rapidly as it may cause the person to faint and become dizzy.
• Ascor is for intravenous use only.
• It should be diluted in 5% dextrose water or sterile water for infusion and administered by a slow intravenous infusion at a rate of 33 mg/minute.

Mechanism of action of Ascorbic acid (Vitamin C):

• It is a water-soluble vitamin which acts as an antioxidant. It converts dietary Iron from the ferric (Fe+3) to the ferrous form (Fe+2), making it more absorbable.
• It is required for collagen synthesis, as well as acting as an electron donor for collagen, carnitine and hormones, and amino acids biosynthesis.

It isIt is easily absorbedIn the intestine. Vitamin C absorption depends on the amount consumed (30 to 180 mg/day). It is saturable. In 2 to 3 weeks, it reverses the effects of scurvy.

TheVitamin C bioavailabilityIt is close to 100% in doses below 200 mg and it decreases as you take more. It isdistributedIt is found in the adrenal and pituitary glands. It isMetabolizedReversible oxidation to DHA (dehydroascorbic Acid). Both ascorbic acid (DHA) and ascorbic acid (Ascorbic Acid) are active.

Unabsorbed vitamin c is broken down in the intestine. It has been ahalf-life eliminationA half-life of between 8 and 40 days. ExcretionIt is mostly via urine, especially if the plasma levels are high.

Vitamin C (Ascorbic acid) International brands:

• Acerola C 500
• Asco-Tabs-1000
• Ascocid
• Ascocid-ISO-pH
• Ascor
• BProtected
• Vitamin C
• C-500
• C-Time
• Cemill SR
• Cemill
• Chew-C
• Fruit C 500
• Fruit C
• Fruity C
• Mega-C/A Plus
• Ortho-CS 250
• Vita-C
• VitaChew
• Vit C Citrus Burst
• Ascor L 500
• Mega C Acid
• Mega-C-Sodium
• Addivita
• Amovit-C
• Appeton Activ-C
• Ascofer
• Asconvita
• Ascorbin
• Ascorvit
• Askorbin
• Askorbinsyre “Dak”
• Biferce
• Biovital Vitamin C
• C Vitamin Pharmavit
• C-Dose
• C-Tabs
• C-Vimin
• C-Vital
• C-Will
• Ce-Vi-Sol
• Cebion
• Cecai
• Cecap
• CeCe
• Cecon
• Cecon Drops
• Ceelin
• Ceevit
• Celaskon
• Celin
• Celon
• Cetamine
• Cetebe
• Cetrinets
• Cevalin
• Cevarol
• Cevidrops
• Cevitil
• Cevitol
• Cewin
• Chewette C
• Citravite
• Femiprim
• Fit-C
• Flavettes
• Hicee
• Larce
• Leder C
• Limcee
• Nutravit C
• Nutricee
• Ophtavit C
• Plivit C
• Pro-C
• Redoxon C
• Redoxon Forte
• Scorbex
• Scorbi-100
• Sicovit C
• Sweetcee
• Tanvimil-C
• Teddy-C
• Tropicee
• Upha C
• Upsa-C
• Vamcee
• Vicef
• Vit'C
• Vita-C
• Vita-Cedol Orange
• Vitac
• Vitamine C Lambo
• Vitamine C OJG
• Vitamine C Repha
• Vitamine C
• Roter
• Vitamine-C-Qualiphar
• Vitascorbol
• Vitonic
• Vorange
• Xon-ce
• Ácido ascórbico

Vitamin C (Ascorbic acid) brands and supplements in Pakistan: