C-Vitera

Approved Indications:

• Treatment and prevention of scurvy (Vitamin C deficiency)
• Dietary supplementation in individuals with inadequate intake
• Supportive therapy in wound healing, burns, trauma, and postoperative recovery
• Enhancement of iron absorption in iron-deficiency anemia
• Supplementation in pregnancy and lactation when dietary intake is insufficient

Clinically Accepted Off-label Uses:

• Adjunctive use in common cold and upper respiratory infections (to reduce duration and severity)
• Supportive antioxidant therapy in infections, sepsis, and COVID-19
• Supportive use in cancer care (as antioxidant adjunct, not as curative therapy)
• Immune support in chronic fatigue or immunocompromised states
• Reduction of oxidative stress in chronic diseases (e.g., diabetes, atherosclerosis)

Route of Administration: Oral (tablet, syrup, chewable, effervescent), Parenteral (IV/IM injection)

Adults:

• Prevention (RDA): 75 mg/day (female), 90 mg/day (male)
• Smokers: Additional 35 mg/day
• Treatment of deficiency/scurvy: 250–500 mg orally 1–2 times daily for at least 2 weeks
• Wound healing, antioxidant support: 500–1000 mg/day
• Parenteral (IV in critical care): 500–1500 mg every 6–8 hours (as per clinician's discretion)

Pediatric:

• RDA by age:
• 1–3 years: 15 mg/day
• 4–8 years: 25 mg/day
• 9–13 years: 45 mg/day
• 14–18 years: 65–75 mg/day
• Scurvy treatment: 100–300 mg/day in divided oral doses for 2 weeks

Geriatric:

• Same as adult doses; monitor renal function with high-dose or long-term use

Pregnancy & Lactation:

• RDA:
• Pregnancy: 85 mg/day
• Lactation: 120 mg/day
• Higher doses (up to 1000 mg/day) used if clinically indicated

Renal/Hepatic Impairment:

• Caution in chronic kidney disease due to risk of hyperoxaluria and renal stones
• No hepatic adjustment generally required

Ascorbic acid functions as a cofactor in various enzymatic hydroxylation reactions, particularly in collagen biosynthesis by supporting proline and lysine hydroxylation. It acts as a potent antioxidant by scavenging free radicals and reactive oxygen species, regenerating other antioxidants such as vitamin E. Vitamin C enhances the absorption of non-heme iron by reducing ferric (Fe³⁺) to ferrous (Fe²⁺) iron in the gut. It also plays a role in immune cell function, promotes leukocyte chemotaxis and proliferation, and modulates cytokine production to support immune defense.

• Absorption: Rapidly absorbed in the small intestine via active transport; saturation occurs above 200 mg.
• Bioavailability: High at low doses; decreases with doses >500 mg (excess excreted).
• Distribution: Widely distributed; highest concentrations in leukocytes, adrenal glands, and eyes.
• Metabolism: Metabolized in the liver to dehydroascorbic acid and further to oxalic acid and other metabolites.
• Half-life: Dose-dependent (8–40 minutes at physiological levels; longer at high doses).
• Excretion: Primarily renal; excess excreted as unchanged ascorbate or oxalate.
• Onset: Typically within a few hours for deficiency symptoms.

• Pregnancy: No FDA-assigned letter; generally considered safe at recommended intakes. High doses (>1000 mg/day) are not recommended due to insufficient safety data.
• Lactation: Excreted in breast milk; safe at nutritional doses. Monitor infant for diarrhea if mother uses high doses.
• Recommendation: Stay within daily recommended ranges unless higher doses are prescribed by a physician.

• Primary Class: Water-Soluble Vitamin
• Subclassification: Nutritional Supplement; Antioxidant Agent

• Known hypersensitivity to ascorbic acid or formulation components
• History of oxalate kidney stones
• Hemochromatosis or other iron overload conditions
• Severe renal impairment or dialysis patients (risk of oxalate accumulation)

• Renal Risk: High doses may lead to oxalate nephropathy and kidney stones
• Iron Overload: Use caution in patients with thalassemia or hemochromatosis
• G6PD Deficiency: IV megadoses may cause hemolysis
• Monitoring: Renal function should be monitored in long-term or high-dose use
• Parenteral Use: IV administration should be slow and diluted to prevent hypotension or vein irritation

Common:

• Gastrointestinal: Nausea, diarrhea, abdominal cramps (dose-dependent)
• CNS: Headache, dizziness

Less Common:

• Skin: Rash, flushing
• Renal: Hyperoxaluria, urinary frequency

Serious (Rare):

• Hemolysis in G6PD-deficient patients (especially with IV or >4 g/day)
• Renal stones with long-term high doses

Typical Onset: GI effects appear within hours of ingestion; renal effects with prolonged high-dose exposure

• Iron supplements: Enhances absorption—beneficial in iron deficiency
• Aluminum-containing antacids: May increase systemic aluminum absorption
• Aspirin and salicylates: May increase urinary excretion of Vitamin C
• Oral anticoagulants (e.g., warfarin): High doses may affect coagulation profile
• Chemotherapy agents: Potential reduction in cytotoxic effect of some agents (inconclusive)
• Enzyme System Involvement: Not significantly metabolized via CYP450 pathways

• COVID-19 studies: High-dose IV Vitamin C studied in critical care patients; results are mixed and not officially guideline-approved
• WHO and NICE: No updates in indication; remains a supportive nutrient, not curative therapy
• Recent trials: Continue to explore roles in sepsis, cancer, and immunomodulation

• Oral Tablets/Chewables/Syrup: Store below 25°C in a dry place; protect from light and moisture
• Effervescent Tablets: Keep tightly closed; avoid exposure to humidity
• Injections:
• Store between 20°C and 25°C
• Protect from light
• Do not freeze
• Use immediately after opening vial