How to safely inject high dose vitamin C?

1. SAFETY PROTOCOL IN
VITAMIN C INJECTION
Peter Nugraha Soekmadji
Department of Dermatovenereology
Faculty of Medicine
Maranatha Christian University
Bandung

2. Conflict of Interest Statement
• NO support or commercial funding for this
presentation or for any products mentioned
here

3. Water-
soluble
Potent
antioxidant
Various
biologic roles
VITAMIN C

4. ANTIOXIDANT

6. Farris PK. Topical vitamin C: a useful agent for treating photoaging and other dermatologic conditions. Dermatol Surg. 2005
Jul;31(7 Pt 2):814-7; discussion 818.
FUNCTION

7. Padayatty SJ, Sun H, Wang Y, Riordan HD, Hewitt SM, Katz A, Wesley RA, Levine M. Vitamin C pharmacokinetics: implications for
oral and intravenous use. Ann Intern Med. 2004 Apr 6;140(7):533-7.
BIOAVAILABILITY

8. Parrow NL, Leshin JA, Levine M. Parenteral ascorbate as a cancer therapeutic: a reassessment based on pharmacokinetics.
Antioxid Redox Signal. 2013 Dec 10;19(17):2141-56. doi: 10.1089/ars.2013.5372.

9. What is the
roles of intravenous vitamin C
in medicine?

11. Parrow NL, Leshin JA, Levine M. Parenteral ascorbate as a cancer therapeutic: a reassessment based on pharmacokinetics.
Antioxid Redox Signal. 2013 Dec 10;19(17):2141-56. doi: 10.1089/ars.2013.5372.

12. What is the safety issues of
high-dose VITAMIN C ?

13. ADVERSE EFFECTS
• Hemolytic anemia: check G6PD level!
• Electrolyte imbalances (Na+ ↑, K+ ↓, Ca2+ ↓):
observe for physical signs of it!
• Urinary stones: inappropriate use for patients
with renal insufficiency
• Minor effects: hyperglycemia, LFT ↑

14. BASELINE WORKUP
• Informed consent
• G6PD level
• Electrolytes
• Renal function

15. TREATMENT PROTOCOLS
• Continuous infusion is better than intermittent
injection
• Do a test dose first
• Increase dose gradually to desired plasma levels
• Mix with Ringer Lactate solution (< 25 g vit. C) or
sterile water (larger amounts)
• If you want to do intermittent injection, do it slowly
over 5 minutes
• The injection interval should be shorter than 10 days
• After intravenous treatments, continue with high-dose
oral vit. C to prevent rebound scurvy

16. What is the
roles of INTRAVENOUS VITAMIN C
in cosmetic dermatology?

17. Lee GS. Intravenous vitamin C in the treatment of post-laser hyperpigmentation for melasma: a short report. J Cosmet Laser Ther.
2008 Dec;10(4):234-6. doi: 10.1080/14764170802187193.

18. Kliegman formula +
Vitamin C iontophoresis 7 sessions: xerosis
PROTOCOLS

19. 11x monthly QS NdYAG
1064 nm, 7mm, 2,1 J/cm2
3x 7g IV vitamin C
+ 12th QS NdYAG
PROTOCOLS

22. Vitamin C 2 g (10ml) + glutathione 600 mg
Injected slowly over 5 min., 1x/7-10 d,ays
Total 6x
PROTOCOLS

23. Optimal dose
Best interval
for injections
Best cocktail
FUTURE
DIRECTIONS for
anti-aging effects