Vitamin C

Last Review Performed on: April 10th, 2020

Vitamin C, an essential micronutrient, is a potent antioxidant and a cofactor for a family of biosynthetic and gene regulatory enzymes. It contributes to immune defense by supporting various cellular functions of both the innate and adaptive immune system. Vitamin C accumulates in leukocytes, and its concentration rapidly declines during infections and stress. Vitamin C supplementation has shown to improve the ability to resist infection by improving the activities of the immune system, such as antimicrobial and natural killer cell activities, lymphocyte proliferation, chemotaxis, and delayed-type hypersensitivity (2). Vitamin C also works at maintaining the redox integrity of cells and thereby protects them against the reactive oxygen species generated during respiratory burst and the inflammatory response (2).

The CITRIS-ALI trial did not show benefit of a 96-hour infusion of Vitamin C (50 mg/kg Actual Body Weight q6h) compared to placebo on primary outcome of change in SOFA score from baseline - No COVID patients (3)

  • (9.8 to 6.8 in the vitamin C group (3 pts) and from 10.3 to 6.8 in the placebo group (3.5 pts); difference -0.10 95% CI, -1.23 to 1.03; p=0.86)

The VITAMINS trial did not show benefit of combination of Vitamin C, hydrocortisone, and thiamine compared to hydrocortisone alone in patients with septic shock on the outcomes of duration of time alive and free of vasopressor administration over 7 days - No COVID patients (4)

  • Vitamin C dose: 1.5g q6h.

Ongoing clinical trials studying Vitamin C:

  1. Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia: a Prospective Randomized Clinical Trial (China): NCT04264533

    • Study Type: Interventional (Clinical Trial)

    • Estimated enrollment: 140 participants

    • Actual Study Start Date: February 14, 2020

    • Estimated Study Completion Date: September 30, 2020

    • Intervention/treatment: 12g Vitamin C will be infused in the experimental group twice a day for 7 days by the infusion pump with a speed of 12ml/h

    • Drug: Sterile Water for Injection: 50ml sterile water for injection will be infused in the placebo comparator group twice a day for 7 days by the infusion pump with a speed of 12ml/h.

  2. Use of Ascorbic Acid in Patients With COVID 19 (Italy): NCT04323514

    • Study Type: Interventional (Clinical Trial)

    • Estimated Enrollment: 500 participants

    • Actual Study Start Date: March 13, 2020

    • Estimated Study Completion Date: March 13, 2021

    • Intervention/treatment: Dietary Supplement: Vitamin C

    • 10 g of vitamin C intravenously in addition to conventional therapy.

Reference

  1. Carr, A and Maggini, S . “Vitamin C and Immune system” Nutrients 2017, 9, 1211

  2. Wintergerst, E.S, Maggini, S and Hornig, D.H., “Immune enhancing role of Vitamin C and zinc and effect on clinical conditions,” Annals of Nutrition and Metabolism, 2006 : 50, no. 2, pp. 85–94

  3. Fowler, A.A., Truwit, J. D., Hite, R.D et al., Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial. JAMA. 2019 Oct 1;322(13):1261-1270

  4. Fujii T, Luethi N, Young PJ, Frei DR, Eastwood GM, French CJ, Deane AM, Shehabi Y, Hajjar LA, Oliveira G, Udy AA. Effect of vitamin C, hydrocortisone, and thiamine vs hydrocortisone alone on time alive and free of vasopressor support among patients with septic shock: the VITAMINS randomized clinical trial. JAMA. 2020 Feb 4;323(5):423-31.DOI: 10.1001/jama.2019.22176