Name /bks_53161_deglins_md_disk/ascorbicacid 02/11/2014 09:01AM Plate # 0-Composite pg 1 # 1

1 Use Cautiously in: Recurrent kidney stones; OB: Avoid chronic use of large doses
in pregnant women.
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ascorbic acid (as-kor-bik a-sid) Adverse Reactions/Side Effects
Apo-C, Ascorbicap, Cebid, Cecon, Cecore-500, Cemill, Cenolate, Cetane, Cevalin, CNS: drowsiness, fatigue, headache, insomnia. GI: cramps, diarrhea, heartburn,
Cevi-Bid, Flavorcee, Mega-C/A Plus, Ortho/CS, Sunkist nausea, vomiting. GU: kidney stones. Derm: flushing. Hemat: deep vein thrombo-
Classification sis, hemolysis (in G6PD deficiency), sickle cell crisis. Local: pain at subcut or IM
Therapeutic: vitamins sites.
Pharmacologic: water soluble vitamins Interactions
Pregnancy Category C Drug-Drug: If urinary acidification occurs, mayqexcretion andpeffects of mexi-
letine, amphetamine, or tricyclic antidepressants. Large doses (⬎10 g/day)
maypresponse to warfarin.qiron toxicity when given concurrently with deferox-
Indications amine.
Treatment and prevention of vitamin C deficiency (scurvy) with dietary supplementa-
tion. Supplemental therapy in some GI diseases during long-term parenteral nutrition Route/Dosage
or chronic hemodialysis. States of increased requirements such as: Pregnancy, Lacta- PO (Adults): Scurvy— 500 mg/day for at least 14 days. Prevention of defi-
tion, Stress, Hyperthyroidism, Trauma, Burns, Infancy. Unlabeled Use: Prevention ciency— 50– 100 mg/day.
of the common cold. PO (Children): Scurvy— 100– 300 mg/day for at least 14 days. Prevention of de-
ficiency— 30– 45 mg/day.
Action IM (Adults): Scurvy— 100– 500 mg/day for at least 14 days.
Necessary for collagen formation and tissue repair. Involved in oxidation reduction IM (Children): Scurvy— 100– 300 mg/day for at least 14 days.
reactions; tyrosine, folic acid, iron, and carbohydrate metabolism; lipid and protein IV (Adults and Children): Prevention of deficiency— determined by need.
synthesis; cellular respiration; and resistance to infection. Therapeutic Effects:
Replacement in deficiency states. Supplementation during increased requirements. NURSING IMPLICATIONS
Assessment
Pharmacokinetics ● Vitamin C Deficiency: Assess for signs of vitamin C deficiency (faulty bone and
Absorption: Actively absorbed after oral administration by a saturable process. tooth development, gingivitis, bleeding gums, loosened teeth) before and during
Distribution: Widely distributed. Crosses the placenta; enters breast milk. therapy.
Metabolism and Excretion: Converted to compounds that are excreted by the ● Lab Test Considerations: Megadoses of ascorbic acid (⬎10 times the RDA re-
kidneys. quirement) may cause false-negative results for occult blood in the stool.
Half-life: Unknown. ● May causepserum bilirubin andqurine oxalate, urate, and cysteine levels.
TIME/ACTION PROFILE (response to skeletal and hemorrhagic changes in scurvy) Potential Nursing Diagnoses
ROUTE ONSET PEAK DURATION Imbalanced nutrition: less than body requirements (Indications)
PO, IM, IV, subcut 2 days–3 wk unknown unknown
Deficient knowledge, related to diet and medication regimen (Patient/Family Teach-
ing)
Contraindications/Precautions Implementation
Contraindicated in: Tartrazine hypersensitivity (some products contain tartra- ● Often ordered as a part of multivitamin supplementation, because inadequate diet
zine— FDC yellow dye #5). often results in multiple-vitamin deficiency.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/ascorbicacid 02/11/2014 09:01AM
2 ● Additive Compatibility: amikacin, calcium chloride, calcium gluconate, chlor-
● Pressure in ampules may be increased at room temperature; wrap with protective
cover before breaking.
● PO: Extended-release tablets and capsules should be swallowed whole without
crushing, breaking, or chewing; contents of capsules may be mixed with jelly or
jam. Chewable tablets should be chewed well or crushed before swallowing. Oral
solution may be taken directly by mouth or mixed with fruit juice, cereal, or other
food.
● IM: IM is usually the preferred parenteral route.
IV Administration
● pH: 5.5– 7.0.
● Continuous Infusion: Diluent: Dilute dose in 1000 mL D5W, D10W, 0.9%
NaCl, 0.45% NaCl, LR or Ringer’s solution, dextrose/saline or dextrose/Ringer’s
combinations. Rate: Infuse slowly.
● Y-Site Compatibility: alfentanil, amikacin, atracurium, atropine, aztreonam,
bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate,
cefazolin, cefoperazone, cefotaxime, cefotetan, cefoxitin, cefuroxime, chlorprom-
azine, cimetidine, clindamycin, cyanocobalamin, cyclosporine, dexamethasone,
digoxin, diphenhydramine, dobutamine, dopamine, doxycycline, enalaprilat,
ephedrine, epinephrine, epoetin alfa, esmolol, famotidine, fentanyl, fluconazole,
folic acid, furosemide, gentamicin, glycopyrrolate, heparin, hydrocortisone, imi-
penem/cilastatin, indomethacin, insulin, isoproterenol, ketorolac, labetalol, lid-
ocaine, magnesium sulfate, mannitol, meperidine, metaraminol, methoxamine,
methyldoapte, methylprednisolone, metoclopramide, metoprolol, morphine,
multivitamins, nafcillin, nalbuphine, naloxone, nitroglycerin, norepinephrine, on-
dansetron, oxacillin, oxytocin, penicillin G, pentazocine, phenobarbital, phentol-
amine, phenylephrine, phytonadione, potassium chloride, procainamide, pro-
chlorperazine, promethazine, propranolol, protamine, pyridoxime, rantidine,
sodium bicarbinate, streptokinase, succinylcholine, sufentanil, theophylline, thi-
amine, ticarcillin/clavulanate, tobramycin, tolazoline, trimetaphan, vancomycin,
vasopressin, verapamil, warfarin.
● Y-Site Incompatibility: aminophylline, azathioprine, ceftazidime, ceftriaxone,
chloramphenicol, diazepam, diazoxide, erythromycin, etomidate, ganciclovir, hy-
dralazine, hydroxycobalamin, midazolam, nitroprusside, papaverine, pentami-
dine, pentobarbital, phenytoin, thiopental, trimethoprim/sulfamethoxazole.
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promazine, colistimethate, cyanocobalamin, diphenhydramine, heparin, levoflox-
acin, methyldopate, penicillin G potassium, polymyxin B, procaine, prochlorper- PDF Page #2
azine, promethazine, verapamil.
● Additive Incompatibility: bleomycin, nafcillin, sodium bicarbonate, theophyl-
line.
Patient/Family Teaching
● Advise patient to take medication as directed and not to exceed dose prescribed.
Excess doses may lead to diarrhea and urinary stone formation. If a dose is
missed, skip dose and return to dose schedule.
● Vitamin C Deficiency: Encourage patient to comply with diet recommendations
of health care professional. Explain that the best source of vitamins is a well-bal-
anced diet.
● Foods high in ascorbic acid include citrus fruits, tomatoes, strawberries, canta-
loupe, and raw peppers. Gradual loss of ascorbic acid occurs when fresh food is
stored, but not when it is frozen. Rapid loss is caused by drying, salting, and cook-
ing.
● Patients self-medicating with vitamin supplements should be cautioned not to ex-
ceed RDA. The effectiveness of megadoses of vitamins for treatment of various
medical conditions is unproven and may cause side effects. Abrupt withdrawal of
megadoses of ascorbic acid may cause rebound deficiency.
Evaluation/Desired Outcomes
● Decrease in the symptoms of ascorbic acid deficiency.
Why was this drug prescribed for your patient?
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