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Pronunciation |
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(a
SKOR bik AS
id) |
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U.S. Brand
Names |
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Ascorbicap®[OTC];
C-Crystals®[OTC]; Cebid®
Timecelles®[OTC]; Cecon®[OTC]; Cevalin®[OTC];
Cevi-Bid®[OTC]; Ce-Vi-Sol®[OTC]; Dull-C®[OTC];
Flavorcee®[OTC]; N'ice® Vitamin C Drops [OTC];
Vita-C®[OTC] |
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Generic
Available |
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Yes |
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Canadian Brand
Names |
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Apo®-C; Ascorbic 500; Redoxon®;
Revitalose-C-1000® |
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Synonyms |
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Vitamin C |
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Pharmacological Index |
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Vitamin, Water Soluble |
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Use |
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Prevention and treatment of scurvy and to acidify the urine
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Pregnancy Risk
Factor |
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A/C (if dose exceeds RDA recommendation) |
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Contraindications |
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Large doses during pregnancy |
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Warnings/Precautions |
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Diabetics and patients prone to recurrent renal calculi (eg, dialysis
patients) should not take excessive doses for extended periods of
time |
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Adverse
Reactions |
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1% to 10%: Renal: Hyperoxaluria with large doses
<1%: Flushing, faintness, dizziness, headache, fatigue, nausea, vomiting,
heartburn, diarrhea, flank pain |
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Overdosage/Toxicology |
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Symptoms of overdose include renal calculi, nausea, gastritis, diarrhea
Diuresis with forced fluids may be useful following a massive ingestion
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Drug
Interactions |
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Decreased effect:
Aspirin (decreases ascorbate levels, increases aspirin)
Fluphenazine (decreases fluphenazine levels)
Warfarin (decreased effect)
Increased effect:
Iron (absorption enhanced)
Oral contraceptives (increased contraceptive effect) |
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Stability |
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Injectable form should be stored under refrigeration
(2°C to 8°C); protect oral dosage
forms from light; is rapidly oxidized when in solution in air and alkaline
media |
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Mechanism of
Action |
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Not fully understood; necessary for collagen formation and tissue repair;
involved in some oxidation-reduction reactions as well as other metabolic
pathways, such as synthesis of carnitine, steroids, and catecholamines and
conversion of folic acid to folinic acid |
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Pharmacodynamics/Kinetics |
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Absorption: Oral: Readily absorbed; an active process and is thought to be
dose-dependent
Distribution: Widely distributed
Metabolism: In the liver by oxidation and sulfation
Elimination: In urine; there is an individual specific renal threshold for
ascorbic acid; when blood levels are high, ascorbic acid is excreted in the
urine; whereas when the levels are subthreshold, very little if any ascorbic
acid is cleared into the urine |
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Usual Dosage |
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Oral, I.M., I.V., S.C.:
<6 months: 30 mg
6 months to 1 year: 35 mg
1-3 years: 15 mg; upper limit of intake should not exceed 400 mg/day
4-8 years: 25 mg; upper limit of intake should not exceed 650 mg/day
9-13 years: 45 mg; upper limit of intake should not exceed 1200 mg/day
14-18 years: Upper limit of intake should not exceed 1800 mg/day
Males: 75 mg
Females: 65 mg
Adults: Upper limit of intake should not exceed 2000 mg/day
Males: 90 mg
Females: 75 mg;
Pregnant female:
less than or equal to 18 years: 80 mg; upper limit of intake should not
exceed 1800 mg/day
19-50 years: 85 mg; upper limit of intake should not exceed 2000 mg/day
Lactating female:
less than or equal to 18 years: 15 mg; upper limit of intake should not
exceed 1800 mg/day
19-50 years: 20 mg; upper limit of intake should not exceed 2000 mg/day
Adult smoker: Add an additional 35 mg/day
Children:
Scurvy: 100-300 mg/day in divided doses for at least 2 weeks
Urinary acidification: 500 mg every 6-8 hours
Dietary supplement: 35-100 mg/day
Adults:
Scurvy: 100-250 mg 1-2 times/day for at least 2 weeks
Urinary acidification: 4-12 g/day in 3-4 divided doses
Prevention and treatment of colds: 1-3 g/day
Dietary supplement: 50-200 mg/day |
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Monitoring
Parameters |
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Monitor pH of urine when using as an acidifying agent |
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Test
Interactions |
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False-positive urinary glucose with cupric sulfate reagent, false-negative
urinary glucose with glucose oxidase method; false-negative stool occult blood
48-72 hours after ascorbic acid ingestion |
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Mental Health: Effects
on Mental Status |
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Rare reports of drowsiness; usually well tolerated |
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Mental Health:
Effects on Psychiatric
Treatment |
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May decrease fluphenazine levels; clinical significance unknown but likely
not problematic |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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No effects or complications reported |
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Patient
Information |
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Take exactly as directed; do not take more than the recommended dose. Do not
chew or crush extended release tablets. Take oral doses with 8 ounces of water.
Diabetics should use serum glucose monitoring method. Report pain on urination,
faintness, or flank pain. |
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Nursing
Implications |
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Avoid rapid I.V. injection |
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Dosage Forms |
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Capsule, timed release: 500 mg
Crystals: 4 g/teaspoonful (100 g, 500 g); 5 g/teaspoonful (180 g)
Injection: 250 mg/mL (2 mL, 30 mL); 500 mg/mL (2 mL, 50 mL)
Liquid, oral: 35 mg/0.6 mL (50 mL)
Lozenges: 60 mg
Powder: 4 g/teaspoonful (100 g, 500 g)
Solution, oral: 100 mg/mL (50 mL)
Syrup: 500 mg/5 mL (5 mL, 10 mL, 120 mL, 480 mL)
Tablet: 25 mg, 50 mg, 100 mg, 250 mg, 500 mg, 1000 mg
Tablet:
Chewable: 100 mg, 250 mg, 500 mg
Timed release: 500 mg, 1000 mg, 1500 mg |
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References |
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Ballin A, Brown EJ, Koren G, et al,
"Vitamin C-Induced Erythrocyte Damage in Premature Infants," J Pediatr,
1988, 113(1 Pt 1):114-20.
Giunta JL, "Dental Erosion Resulting From Chewable Vitamin C Tablets," J
Am Dent Assoc, 1983, 107(2):253-6.
Korallus U, Harzdorf C, and Lewalter J,
"Experimental Basis for Ascorbic Acid Therapy of Poisoning by Hexavalent Chromium Compounds,"
Int Arch Occup Environ Health, 1984, 53(3):247-56.
Lawton JM, Conway LT, Crosson JT, et al,
"Acute Oxalate Nephropathy After Massive Ascorbic Acid Administration," Arch
Intern Med, 1985, 145(5):950-1.
McAllister CJ, Scowden EB, Dewberry FL, et al,
"Renal Failure Secondary to Massive Infusion of Vitamin C," JAMA, 1984,
252(13):1684.
Myrianthopoulos M, "Dietary Treatment of Hyperlipidemia in the Elderly,"
Clin Geriatr Med, 1987, 3(2):343-59.
Pru C, Eaton J, and Kjellstrand C,
"Vitamin C Intoxication and Hyperoxalemia in Chronic Hemodialysis Patients,"
Nephron, 1985, 39(2):112-6.
Tunget CL, Clark RF, Manoguerra AS, et al,
"Iron Overdose and Detection of Gastrointestinal Bleeding With the
Hemoccult®
and Gastroccult® Assays," Ann Emerg Med, 1995,
26(1):54-7. |
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