Cautions
Contraindications
- Manufacturer states no known contraindications.
Warnings/Precautions
General Precautions
Sodium Content
Each 1 gram of sodium ascorbate contains approximately 5 mEq of sodium; consider sodium content in patients on sodium-restricted diets.
Kidney Stone Formation
Kidney stone (renal calculus) formation reported in individuals with renal disease receiving large dosages of ascorbic acid; excess ascorbic acid intake not associated with kidney stone formation in healthy individuals.
Aluminum Content
Some ascorbic acid injection preparations contain aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.
Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum >4–5 mcg/kg daily accumulate aluminum at levels associated with CNS and bone toxicity. Tissue loading may occur at even lower rates of administration.
Specific Populations
Pregnancy
Category C.
Lactation
Distributed into milk. Caution if parenteral preparation is used in nursing women.
Common Adverse Effects
Relatively nontoxic; nausea, vomiting, heartburn, fatigue, flushing, headache, insomnia, sleepiness, and other GI disturbances (diarrhea, transient colic, abdominal cramps, flatulent distention) reported.
Drug Interactions
Specific Drugs and Laboratory Tests
| Drug or Test |
Interaction |
Comments |
| Aspirin |
Increased urinary excretion of ascorbic acid and decreased excretion of aspirin reported with concomitant administration |
|
| Fluphenazine |
Decreased fluphenazine concentrations |
|
| Iron, oral |
Increased GI absorption of iron |
|
| Tests for detection of occult blood in stool |
Possible false-negative results |
Manufacturer of parenteral ascorbic acid recommends discontinuing vitamin C supplements 48–72 hours before test |
| Tests for glucose in urine |
Possible false-positive with tests based on cupric sulfate reagent and false-negative with tests that use glucose oxidase method |
|
| Warfarin |
Decreased anticoagulant effect reported; other investigators did not observe this effect |
|
Pharmacokinetics
Absorption
Bioavailability
Readily absorbed by an active process that may be limited after very large doses.
Distribution
Extent
Widely distributed in body tissues.
Crosses the placenta; cord blood concentration 2–4 times maternal blood concentrations. Distributed into human milk.
Plasma Protein Binding
About 25%.
Elimination
Metabolism
Reversibly oxidized to dehydroascorbic acid.
Elimination Route
Excreted in urine.
Removed by hemodialysis.
Stability
Storage
Oral
Capsules and Tablets
Cool dry place.
Parenteral
Solution
Store in carton until time of use at room temperature (≤25°C). Protect from light.
Compatibility
Parenteral
Solution Compatibility
| Compatible |
| Dextran 6% in dextrose 5% |
| Dextran 6% in sodium chloride 0.9% |
| Dextrose-Ringer's injection combinations |
| Dextrose-Ringer’s injection, lactated, combinations |
| Dextrose-saline combinations |
| Dextrose 2½, 5, or 10% in water |
| Fructose 10% in sodium chloride 0.9% |
| Fructose 10% in water |
| Invert sugar 5 and 10% in sodium chloride 0.9% |
| Invert sugar 5 and 10% in water |
| Ionosol products |
| Ringer's injection |
| Ringer's injection, lactated |
| Sodium chloride 0.45 or 0.9% |
| Sodium lactate (1/6) M |
| Variable |
| Fat emulsion 10%, IV |
Drug Compatibility
Y-Site Compatibility
| Compatible |
| Warfarin sodium |
| Incompatible |
| Etomidate |
| Thiopental sodium |
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