Vitamin C: Intravenous Use by Complementary and Alternative Medicine Practitioners and Adverse Effects

Abstract

BackgroundAnecdotal information and case reports suggest that intravenously administered vitamin C is used by Complementary and Alternate Medicine (CAM) practitioners. The scale of such use in the U.S. and associated side effects are unknown.Methods and FindingsWe surveyed attendees at annual CAM Conferences in 2006 and 2008, and determined sales of intravenous vitamin C by major U.S. manufacturers/distributors. We also queried practitioners for side effects, compiled published cases, and analyzed FDA's Adverse Events Database. Of 199 survey respondents (out of 550), 172 practitioners administered IV vitamin C to 11,233 patients in 2006 and 8876 patients in 2008. Average dose was 28 grams every 4 days, with 22 total treatments per patient. Estimated yearly doses used (as 25g/50ml vials) were 318,539 in 2006 and 354,647 in 2008. Manufacturers' yearly sales were 750,000 and 855,000 vials, respectively. Common reasons for treatment included infection, cancer, and fatigue. Of 9,328 patients for whom data is available, 101 had side effects, mostly minor, including lethargy/fatigue in 59 patients, change in mental status in 21 patients and vein irritation/phlebitis in 6 patients. Publications documented serious adverse events, including 2 deaths in patients known to be at risk for IV vitamin C. Due to confounding causes, the FDA Adverse Events Database was uninformative. Total numbers of patients treated in the US with high dose vitamin C cannot be accurately estimated from this study.ConclusionsHigh dose IV vitamin C is in unexpectedly wide use by CAM practitioners. Other than the known complications of IV vitamin C in those with renal impairment or glucose 6 phosphate dehydrogenase deficiency, high dose intravenous vitamin C appears to be remarkably safe. Physicians should inquire about IV vitamin C use in patients with cancer, chronic, untreatable, or intractable conditions and be observant of unexpected harm, drug interactions, or benefit.

Evaluation of Vitamin C for Adjuvant Sepsis Therapy

“…Infection is one of the most common health problems for which complementary and alternative medicine (CAM) practitioners recommend injection of high doses of ascorbate (reduced vitamin C) (43). One possible reason for the prevalence of this practice is that infection may trigger a systemic inflammatory response that depletes endogenous ascorbate.…”

“…However, clinical trial will be necessary to determine the safety of ascorbate in sepsis. Until clinical testing is completed, large doses of ascorbate should not be given to patients with glucose-6-phosphate dehydrogenase deficiency, renal disease, renal insufficiency or renal failure, a history of oxalate nephrolithiasis, or paroxysmal nocturnal hemoglobinuria (43).…”

Parenteral vitamin C relieves chronic fatigue and pain in a patient with rheumatoid arthritis and mononeuritis multiplex secondary to CNS vasculitis

“…Parenteral vitamin C has been administered by physicians for many decades, primarily as an alternative therapy for cancer and viral infections [1] . Patients typically receive doses of ~28 g vitamin C per treatment, on average once every four days [1] .…”

“…Patients typically receive doses of ~28 g vitamin C per treatment, on average once every four days [1] . We and others have shown that parenteral vitamin C is an effective therapy for cancer-and chemotherapy-related fatigue [2] .…”

Two Grams BID Is an Oral Dosage of Vitamin C to Reduce the Risk of Recurrence of Superficial Bladder Carcinoma

“…Subsequently, the same dose had no effect on patient well-being and survival in two double-blind placebo-controlled trials, and AA was discarded as a treatment modality [6] [7]. Recent clinical evidence, however, indicates that the role of AA in cancer treatment should be examined anew [8]. The originally reported observational studies used IV and oral AA, but the subsequent doubleblind placebo-controlled studies used only oral AA.…”