Ascorbic Acid (Dosing, Interaction, Side Effect, Administration, Etc..)

CLASS:
Nutritive Agent

Parenteral Vitamin

Vitamin C

(class)

Vitamin Combination

Vitamin Combination, Adult Formula

DOSING:
Adult Dose:
Important Note:
Orphan drug designation:
Treatment of Charcot-Marie-Tooth disease type 1A

Treatment of scurvy Ascorbic Acidbic acid deficiency:

200 mg IV infusion

at 33 mg/min once daily for a maximum of 7 days;

Maximum dose 200 mg

. May retreat until symptoms resolved (

FDA dosage

)
1 to 2 g orally for the first 2 days then

500 mg daily

for a week (off-label

dosage

)

Burn (Severe):
200 to 500 mg/day up to 1 to 2 g/day IM/IV/SC or ORALLY until healing or completion of grafting

Pediatric Dose:
Important Note:
Orphan drug designation:
Treatment of Charcot-Marie-Tooth disease type 1A
Treatment of scurvy

Ascorbic Acidbic acid deficiency:
(11 years or older)

200 mg IV

infusion at 33 mg/min once daily for a maximum of 7 days; Maximum dose, 200 mg. May retreat until symptoms resolved

(1 to less than 11 years)

100 mg

IV infusion at 3.3 mg/min once daily for a maximum of 7 days; retreatment not recommended

(5 to less than 12 months)

50 mg

IV infusion at 1.3 mg/min once daily for a maximum of 7 days; retreatment not recommended

INDICATIONS:
FDA-LABELED INDICATIONS:
Ascorbic Acidbic acid deficiency

NON-FDA LABELED INDICATIONS:
AIDS virus infection associated with pregnancy
Anemia of chronic renal failure
Burn (Severe)
Hypertension
Iron supplement therapy; Adjunct
Multiple organ failure; Prophylaxis
Radiographic contrast agent nephropathy; Prophylaxis





MECHANISM OF ACTION:
Ascorbic Acidbic acid restores the body pool of Ascorbic Acidbic acid in patients with scurvy.

ADVERSE EFFECT:
Common:
Dermatologic:

Injection

site pain
Swelling at injection site

Serious:
Hematologic:
Hemolysis

Renal:
Oxalate nephropathy

CONTRAINDICATION:
Specific contraindications have not been determined

DRUG INTERACTION:
Antibiotics:
Ascorbic Acidbic acid may decrease activities of erythromycin, kanamycin, streptomycin, doxycycline, and lincomycin. Bleomycin is inactivated in vitro by Ascorbic Acidbic acid. If the antibiotic efficacy is suspected to be decreased by concomitant

administration of ascorbic acid

, discontinue

ascorbic acid

administration.
Amphetamine & Other Drugs Affected by Urine Acidification:
Ascorbic Acidbic acid may acidify the urine and lower serum concentrations of amphetamine by increasing renal excretion (as reflected by changes in amphetamine urine recovery rates). In case of decreased amphetamine efficacy discontinue

ascorbic acid administration

. Standard monitoring of therapy is warranted. In addition, acidification of urine by Ascorbic Acidbic acid will alter the excretion of certain drugs affected by the pH of the urine (e.g. fluphenazine) when administered concurrently. It has been reported that concurrent administration of Ascorbic Acidbic acid and fluphenazine has resulted in decreased fluphenazine plasma concentrations. Standard monitoring of therapy is warranted.

Warfarin:
Limited case reports have suggested interference of Ascorbic Acidbic acid with the anticoagulation effects of warfarin, however, patients on warfarin therapy treated with Ascorbic Acidbic acid doses up to 1000 mg/day (5 times the largest recommended single dose) for 2 weeks (twice the maximum recommended duration), no effect was observed. Standard monitoring for anti-coagulation therapy should continue during Ascorbic Acidbic acid treatment, as per standard of care.

Laboratory Test Interference:
Because Ascorbic Acidbic acid is a strong reducing agent, it can interfere with numerous laboratory tests based on oxidation-reduction reactions (e.g. glucose, nitrite and bilirubin levels, leukocyte count, etc.). Chemical detecting methods based on colorimetric reactions are generally those tests affected. Ascorbic Acidbic acid may lead to inaccurate results (false negatives) obtained for checking blood or urinary glucose levels, nitrite, bilirubin, and leukocytes if tested during or within 24 hours after infusion

Major:
Amygdalin (probable)
Bisacodyl (theoretical)
Bleomycin (theoretical)
Deferoxamine (probable)
Doxycycline (theoretical)
Erythromycin (theoretical)
Kanamycin (theoretical)
Lincomycin (theoretical)
Senna (theoretical)
Sodium Picosulfate (theoretical)
Streptomycin (theoretical)

Moderate:
Indinavir (probable)

PHARMACOKINETICS:
Absorption:
Time for Maximum Plasma Concentration (Tmax):
IV: 30 minutes.
Oral: 2 to 3 hours.

Metabolism:
DehydroAscorbic Acidbic acid: Active

Excretion:
Renal excretion: Primary
Dialyzable: Yes (hemodialysis), 40%; Yes (peritoneal dialysis).

Elimination:
7.4 hours

PRECAUTION:
Administration:
Not intended for

long term use

Hematologic:
Hemolysis has been reported in patients with glucose-6-phosphate dehydrogenase deficiency.

Reduced dosage

and monitoring recommended; discontinuation may be necessary

Laboratory:
Interference in laboratory testing, including blood and urine glucose testing, nitrite and bilirubin levels, and leucocyte count testing, may occur; delay tests based on oxidation-reduction reaction until 24 hours after infusion

Renal:
Acute and chronic oxalate nephropathy have been reported with long-term administration of high doses; increased risk in patients with renal
disease including renal impairment, history of oxalate kidney stones, geriatric patients, and pediatric patients less than 2 years of age. Monitoring recommended and discontinuation may be necessary
Acidification of urine may occur and lead to precipitation of cysteine, urate, or oxalate stones

PREGNANCY CATEGORY:
Fetal risk cannot be ruled out.

BREAST FEEDING:
Infant risk cannot be ruled out.

MONITORING:
Improvement in the signs and symptoms of scurvy is indicative of efficacy (IV route).
Renal function: In patients at increased risk of oxalate nephropathy or nephrolithiasis (renal disease, including renal impairment, history of oxalate kidney stones, pediatric patients aged less than 2 years, and geriatric patients) (IV route).
Hemoglobin and blood counts for signs of hemolysis: In patients with glucose-6-phosphate dehydrogenase deficiency (IV route).

HOW TO TAKE OR ADMINISTRATION:
Intravenous:
Provided in multi-dose vials of

25,000 mg ascorbic acid

; do not administer entire contents of vial to a single patient.
Do not administer undiluted.
Pressure may develop within vial during storage.
Penetrate each vial only 1 time with a sterile transfer device or dispensing set
Once vial is opened, complete all dispensing from the vial within 4 hours and

use

each dose immediately; discard unused portion.
Dilute one daily dose in compatible infusion solution (D5W or

sterile water for injection

) then add appropriate solutes to create an isotonic solution (undiluted has an osmolarity of approximately 5900 milliosmole/L).
Do not mix with solutions containing elemental compounds that can be reduced (eg, copper).
Final concentration of admixture solution for infusion is in the range of 1 to

25 mg ascorbic acid

per mL.
Administer diluted solution immediately as a slow IV infusion at a rate according to age as follows: 5 months to less than 12 months, 1.3 mg/min; 1 year to less than 11 years, 3.3 mg/min; 11 years or older, 33 mg/min.

Oral:
Preferable to take with a meal

DOSAGE FORM:
Intravenous Solution:
500 MG/1 ML

Oral

Tablet

, Extended Release:
500 MG

Oral Tablet

, Extended Release:
1500 MG

Mucous Membrane Lozenge/Troche:
60 MG

Injection Solution:
500 MG/1 ML

Oral Wafer:
500 MG

PATIENT COUNSELING OR CLINICAL TEACHING:
Side effects may include pain and swelling at the infusion site.




Disclaimer:
For the Registered Medical Practitioner Only. We are not recommended for self medication. self medication is may harmful for health. We are only Provide information about medicine.