Vitamin C + Vitamin E

Approved and Clinically Accepted Uses:

• Nutritional Supplementation:
• Prevention and treatment of combined Vitamin C and E deficiency due to malnutrition, restrictive diets, or chronic illness.
• Supplementation in pregnancy, lactation, and elderly individuals.
• Skin and Dermatologic Conditions:
• Adjunctive therapy in hyperpigmentation, photoaging, melasma, and acne-induced post-inflammatory erythema.
• Promotes wound healing and reduces oxidative damage to the skin.
• Cardiovascular Health:
• Antioxidant support in individuals with cardiovascular risk factors to reduce LDL oxidation and vascular inflammation.
• Immune Support:
• Enhances immune response in viral infections, chronic inflammatory diseases, and during recovery from illness.
• Eye Disorders:
• Supportive treatment in age-related macular degeneration (AMD) and cataract prevention as part of the AREDS/AREDS2 formulations.
• Oxidative Stress and Chronic Illness:
• Adjunctive therapy in diabetes, neurodegenerative conditions (e.g., Alzheimer’s disease), and chronic kidney disease where oxidative stress is high.

Adults:

• General Supplementation:
• Vitamin C: 500 mg once or twice daily
• Vitamin E: 200–400 IU once daily
• Therapeutic Use in Oxidative Stress or Skin Disorders:
• Vitamin C: 1000 mg/day in divided doses
• Vitamin E: 400–800 IU/day, depending on clinical condition

Pediatrics:

• Only under physician supervision.
• Vitamin C: 100–250 mg/day
• Vitamin E: 50–200 IU/day (age-dependent)

Elderly:

• Same as adult dosing; monitor renal and hepatic function.

Renal Impairment:

• Use with caution; reduce dose of Vitamin C to ≤500 mg/day to minimize oxalate accumulation.

Hepatic Impairment:

• No specific adjustment required; monitor liver function in chronic use.

Administration Route:

• Oral: Tablets or capsules, preferably after meals with water.

Duration:

• Varies by indication: 2–4 weeks for deficiency; longer duration for chronic supplementation.

Vitamin C (Ascorbic Acid) acts as a potent water-soluble antioxidant by donating electrons to neutralize reactive oxygen species (ROS). It is a cofactor in collagen synthesis, carnitine production, and neurotransmitter metabolism. It enhances non-heme iron absorption and modulates immune responses.

Vitamin E (α-Tocopherol) is a lipid-soluble antioxidant that protects polyunsaturated fatty acids in cell membranes from peroxidation. It stabilizes membranes, modulates signal transduction pathways, and exhibits anti-inflammatory properties by inhibiting protein kinase C and inflammatory cytokine release.

Combined, they synergistically protect tissues against oxidative damage by acting in both aqueous and lipid compartments of cells.

Vitamin C:

• Absorption: Rapidly absorbed in the small intestine via active transport (SVCT1 & SVCT2)
• Bioavailability: Decreases with higher doses (≥1 g/day); saturable kinetics
• Peak Plasma Concentration: 2–3 hours post-dose
• Metabolism: Hepatic metabolism to dehydroascorbic acid
• Elimination: Renal excretion (as oxalate and ascorbate); half-life: ~8–40 minutes depending on dose

Vitamin E:

• Absorption: Fat-soluble; absorbed with dietary fats via lymphatics
• Bioavailability: Enhanced with food; interindividual variability
• Distribution: Stored in adipose tissue and liver; binds to lipoproteins
• Metabolism: Hepatic metabolism to tocopherol quinone
• Elimination: Bile and feces (major); urine (minor); half-life: ~44 hours

• Vitamin C:
• Generally considered safe during pregnancy and lactation at recommended dietary intake levels.
• High doses (>2000 mg/day) may pose risks of oxaluria or rebound scurvy in neonates.
• Vitamin E:
• Also considered safe in pregnancy up to 400 IU/day.
• High doses may increase bleeding risk due to its antiplatelet effect.

Lactation:

• Both vitamins are excreted in breast milk in small amounts.
• No adverse effects reported in breastfed infants at recommended doses.

Caution: Use therapeutic doses only under medical supervision during pregnancy or lactation.

• Primary Class: Antioxidant & Nutritional Supplement
• Subclass:
• Vitamin C: Water-soluble vitamin
• Vitamin E: Fat-soluble vitamin (α-Tocopherol)

• Known hypersensitivity to Vitamin C, Vitamin E, or formulation excipients
• Hemochromatosis or hemosiderosis (Vitamin C may increase iron absorption)
• History of oxalate nephrolithiasis (Vitamin C in high doses)
• Severe hepatic insufficiency (for high-dose Vitamin E)
• Hypervitaminosis E

• Use cautiously in patients with:
• Renal impairment or kidney stones
• Bleeding disorders or concurrent anticoagulant therapy (Vitamin E)
• Glucose-6-phosphate dehydrogenase (G6PD) deficiency
• Prolonged high-dose Vitamin E may increase hemorrhagic stroke risk
• Monitor for gastrointestinal upset or diarrhea with high Vitamin C doses
• Monitor vitamin levels in long-term supplementation

Common:

• Gastrointestinal: Nausea, abdominal cramps, diarrhea (Vitamin C); mild GI upset (Vitamin E)
• Dermatologic: Skin rash, flushing (Vitamin E)

Rare but Serious:

• Oxalate nephropathy or nephrolithiasis (Vitamin C)
• Increased bleeding tendency or bruising (Vitamin E at high doses)
• Fatigue, headache, or blurred vision (Vitamin E >800 IU/day)

Dose-Dependent Effects:
More likely with doses exceeding the tolerable upper intake levels (Vitamin C: 2000 mg/day; Vitamin E: 1000 mg/day)

• Vitamin C:
• Increases absorption of iron and aluminum (care in renal impairment)
• May reduce efficacy of anticoagulants (warfarin)
• May affect blood glucose readings (interferes with lab tests)
• Vitamin E:
• Potentiates the effect of anticoagulants (e.g., warfarin) and antiplatelets
• Reduces absorption when taken with bile acid sequestrants (e.g., cholestyramine)
• Potential additive effect with other antioxidants

Enzyme Systems:
Minimal CYP450 involvement; mostly non-enzymatic interactions.

• WHO and NIH continue to support use of vitamins C and E in daily recommended amounts for general health.
• No new warnings added recently; high-dose antioxidant therapy remains under evaluation in chronic diseases.
• Clinical studies suggest possible adjunctive roles in COVID-19 recovery, but not for treatment or prevention.

• Store in a cool, dry place below 25°C.
• Protect from light and moisture.
• Keep container tightly closed.
• Avoid freezing.
• Do not use beyond expiration date.
• For chewable or effervescent forms: Use immediately after reconstitution.