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Vitamin C

Pascorbin

for clinical vitamin C deficiencies that cannot be eliminated by diet or substituted with oral supplements

The benefits of Pascorbin® at a glance:

  • reaches the bloodstream directly and immediately supplies vitamin C
  • significantly faster availability than with vitamin C tablets
  • the no. 1 for intravenous vitamin C in Germany (in relation to packs sold - IH-Galaxy 01/2023)
  • the first and only approved branded product containing 7.5 g of vitamin C
  • without preservatives* and stabilisers
  • approved from 12 years of age

*According to the specifications of Ph. Eur. 10th edition, 5th supplement, page 831

Product information
Package sizes PZN
50 ml 00581310
Suitability: aged 12 and above (dose restriction for children)

For information for pregnant women and nursing mothers, please refer to the package insert.

Severe vitamin C deficiency may be present in the case of/following:

  • acute and chronic infections
  • unbalanced diet
  • chronic inflammatory diseases, e.g. g. arthritis
  • chronic fatigue
  • intestinal malabsorption disorders
  • surgery
  • smokers
  • reduced physical capacity
  • increased exhaustibility and irritability
  • reduced resistance to infection

Making vitamin C available faster

For vitamin C deficiency that cannot be eliminated by diet, infusions are a possible way to remedy the deficiency. In the small intestine, vitamin C is absorbed via special transport molecules and channelled into the bloodstream. The number of these transporters is limited, so only a portion of the vitamin C amount reaches the bloodstream. A lot more vitamin C can be taken up by the body by means of infusion. Such high blood levels cannot be achieved with diet and tablets.

Infusion therapy: Therapists near you

Find a practice near you. Use our therapist search at: www.naturheilkunde.de. Our website also offers fascinating information about naturopathy.

Vitamin of life - 3 facts about vitamin C

  • Vitamin C is water-soluble and, therefore, cannot be stored.
  • Most animals can produce large amounts of vitamin C through the metabolism.
  • Humans have lost this ability over the course of evolution.

Because the body is unable to produce vitamin C itself, it has to be supplied from the outside.

[*] Approved by the Bundesinstitut für Arzneimittel und Medizinprodukte [Federal Institute for Drugs and Medical Devices]

Frequently asked questions about the high-dose vitamin C infusion

1. High-dose vitamin C: What is it?
2. Why infuse vitamin C instead of just ingesting it?
3. Vitamin C infusion: How does it work?
4. How much does a vitamin C infusion cost?
5. How long does the effect of a vitamin C infusion last?
6. Does vitamin C have side effects?
7. Can too much vitamin C be harmful?
8. Where can I get a vitamin C infusion? - Practices near you
9. Where can I find scientific information as a healthcare professional?

1. High-dose vitamin C: What is it?

According to many people, tablets containing 500 to 1,000 mg of vitamin C are already high doses. This is due to the DGE’s (Deutsche Gesellschaft für Ernährung) recommendation of around 100 mg per day as a sufficient intake. Even for smokers, where there is a higher need, the DGE only recommends 155 mg per day. Nutritionists and physicians do not always consider these amounts to be sufficient. This is because the recommendations pertain only to fully healthy individuals. In the case of many diseases, the need for vitamin C increases. Unfortunately, it is not a rarity for people to have a vitamin C deficiency. They either do not ingest enough vitamin C, the body cannot absorb it sufficiently from food, or they use too much of it, for example due to a disease.

If a deficiency is present and the required amounts cannot be adequately supplied by diet or tablets, vitamin C infusions are one way to correct the deficiency. In this way, gram levels of vitamin C can be supplied directly into the bloodstream.

With the aid of a Pascorbin infusion, the amount is, for example, 7,500 mg, i.e. 7.5 g per infusion. Thus, a high-dose infusion is around 75 times the amount of vitamin C that is generally recommended for daily intake.

2. Why infuse vitamin C instead of just ingesting it?

The advantage of an infusion: The total amount of vitamin C administered as an infusion is directly available to the body. Nothing is lost in the intestine due to absorption limitations. This is called 100% bioavailability.

If vitamin C is ingested, the bioavailability is significantly lower. Even in a completely healthy individual, only part of the vitamin C, which may even be sufficiently supplied through the diet or dietary supplements, truly reaches the bloodstream.

Chronic inflammation and absorption disorders in the gastrointestinal tract may further reduce this proportion. Only vitamin C that actually reaches the bloodstream and can be distributed throughout the body, is made available to the body’s cells.

3. Vitamin C infusion: How does it work?

If you have an appointment for a high-dose vitamin C infusion of Pascorbin 7.5 g, you will receive vitamin C directly into your veins by means of an infusion system. The procedure may vary somewhat depending on your doctor or alternative practitioner.

Pascorbin is first diluted with a suitable carrier solution (usually 0.9% saline solution) and then infused directly into your veins via a so-called venepuncture cannula (e.g. butterfly) or an indwelling venous cannula (e.g. Braunüle). It usually takes about 20 to 30 minutes until an infusion is fully delivered to your veins.

It is discussed in advance whether there are any concerns about you being unable to tolerate the infusion. Specific blood levels and information on possible pre-existing conditions can provide information on this. On this, also see under the question: Can too much vitamin C be harmful?

4. How much does a vitamin C infusion cost?

This question is difficult to give a general answer to. It depends on the purchase price for Pascorbin and the other infusion accessories, which can vary a lot between pharmacies.

The medical practices also have differing prices for the services they offer: Sometimes there are flat prices for an infusion therapy; sometimes each individual item is invoiced. Therefore, it is best to speak to your practice directly about the cost in advance.

5. How long does the effect of a vitamin C infusion last?

You may have encountered the statement that there’s no point in infusing vitamin C in the gram range, because vitamin C is unable to be stored and, therefore, everything is excreted unused via the kidneys.

This statement is partly true: Vitamin C is difficult to store – this means that "too much" is excreted relatively quickly through the urine. But this limitation of therapy is also a major advantage: it makes it very safe, since overdose is practically impossible.

The high vitamin C levels in the blood, which appear immediately after an infusion, last only for a few hours. The number of hours depends on the actual, individual need and elimination via the kidneys.

Vitamin C deficiency in the blood reflects an undersupply to the tissue. The high blood levels following an infusion offer the benefit of being able to quickly offset any deficiencies in the tissues and organs. Among other things, this benefits areas of acute inflammation associated with high vitamin C consumption.

Individuals with a very severe deficiency that keeps recurring because their condition is associated with a very high consumption of vitamin C, may require several infusions.

6. Does vitamin C have side effects?

Some people think they are unable to tolerate vitamin C because they experience a hypersensitivity response, for example, to citrus fruits. However, citrus fruit allergies are not allergies to vitamin C, but to other ingredients. Since vitamin C is a vital substance, we would not be able to survive if we had an allergy to vitamin C. To date, science is also not aware of any "vitamin C intolerance".

Vitamin C in the form of an infusion is generally very well tolerated, provided that it does not contain any preservatives or similar.   Pascorbin is free of such additives.

There may be slight irritation at the injection site during infusion. Other hypersensitivity reactions (skin, breathing, circulation) are very rare, but cannot be ruled out in individual cases. Very rarely, high doses of ascorbic acid can cause complaints in the digestive tract (e.g. nausea, vomiting, diarrhoea). However, this occurs much more frequently in the case of high oral intake.

It is interesting to note that cold symptoms may initially take a temporary turn for the worse following a vitamin C infusion. This can be interpreted as a sign of a positive immune system response.

7. Can too much vitamin C be harmful?

As already stated for 5, vitamin C is very difficult to store. However, that comes with a great advantage:

The risk of “overdose” is very low. If there is “too much”, this is quickly excreted via the kidneys.

Nevertheless, there are life situations and underlying diseases where high-dose vitamin C infusions should not be used. This is primarily true in the case of too high iron levels in the blood, as seen in so-called iron storage diseases. You also should not receive vitamin C infusions if you have a propensity to kidney stone formation (oxalate stones).

Additionally, if the kidneys are not functioning properly (kidney failure), the intake of too much vitamin C should be avoided.

Some people have a genetic deficiency in a specific enzyme (G6PDH). These individuals should not take more than 500 mg daily.

Because vitamin C passes into human milk and crosses the placental barrier, pregnant women and breastfeeding women should not receive more than 500 mg daily.

Finally, interactions cannot be ruled out with some medicinal products: Therefore, always discuss with your doctor or alternative practitioner whether the vitamin C infusions are really appropriate for you.

Additionally, the following applies: Drink plenty of fluids in the hours following a high-dose vitamin C infusion!

Important note: High levels of vitamin C in the blood may interfere with the detection of certain blood readings. This applies, in particular, to glucose detection measurements in diabetics.

Therefore: Do not rely on blood levels measured within several hours after a high-dose vitamin C infusion.

8. Where can I get a vitamin C infusion? - Practices near you

There are now a whole range of alternative health practices offering vitamin C infusions. It may be that you know someone in your circle of acquaintances, who has relevant experience and can give you a recommendation.

Otherwise, you can use our therapist search. This can be found at: www.naturheilkunde.de. There you can search for physicians and alternative practitioners in your postal code area. If you also look under the criterion “infusion therapy” under “therapies”, you will see a selection of practices that offer the appropriate therapy. You will usually also receive an immediate link to the respective practice website, so you can take a look.

The website www.naturheilkunde.de offers fascinating information about naturopathy and further information on vitamin C infusion therapy.

9. Where can I find scientific information as a healthcare professional?

As a healthcare professional, you can register to the specialist pages of www.pascoe.de (top right) with a Pascoe login or DocCheck password.

There, you’ll find further information on medical and scientific questions about vitamin C.

Tip: While you’re there, you can also sign up for the specialist newsletter! Once a month, you’ll receive 3-6 concise articles on important vitamin C and other naturopathy or Pascoe topics.

Dosage

50 ml injection vial:
For a short peripheral venous infusion, 50 ml of Pascorbin should be diluted with at least 100 ml of a suitable carrier solution (e.g. isotonic saline) and infused slowly.

Vitamin C substitution in parenteral nutrition:
 for prophylaxis of vitamin C deficiency, with prolonged parenteral nutrition

  • Adults receive 100 to 500 mg ascorbic acid intravenously per day
  • (equivalent to 0.7 ml to 3.3 ml of Pascorbin).
  • Children receive 5 to 7 mg ascorbic acid/kg BW intravenously per day.

Methemoglobinaemia in childhood:
500 to 1,000 mg of ascorbic acid (equivalent to 3.3 ml to 6.6 ml Pascorbin®) are injected intravenously once. If necessary, the administration must be repeated with the same dosage. A dose of 100 mg/kg BW per day should not be exceeded.

Do not self-treat with injections. The injection therapy should be administered by a doctor or alternative practitioner.

How is a high-dose vitamin C infusion of Pascorbin 7.5 g administered?

The ascorbic acid in Pascorbin 7.5 g is highly concentrated. Therefore, the Pascorbin 7.5 g must be diluted with a suitable carrier solution.

A suitable carrier solution is, e.g. 0.9% saline solution. A minimum of 100 ml of this saline solution is required to infuse 50 ml of Pascorbin 7.5 g. The finished solution for infusion is then administered with an infusion set and a butterfly needle (or Braunüle = peripheral venous catheter).

Such an infusion lasts approx. 20-30 min.

1 ml solution for injection contains 150 mg ascorbic acid.
Excipients: Sodium hydrogen carbonate, water for injection.

1 injection vial with 50 ml solution for injection contains:

Active substance
Ascorbic acid 7.5 g

You will always find the most current package leaflet on our page.
This leaflet was last revised in May 2020.

Package leaflet: Information for the user

Pascorbin®

Active substance: Ascorbic acid 150 mg per ml solution for injection

For use in adults and children.

Read all of this leaflet carefully before you start using this medicine, because it contains important information for you.
Always use this medicine exactly as described in this leaflet or or as your doctor or pharmacist has told you.
- Keep this leaflet. You may need to read it again.
- Ask your pharmacist if you need more information or advice.
- If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See Section 4.
- You must talk to a doctor if you do not feel better or if you feel worse.

What is in this leaflet:
1. What Pascorbin® is and what it is used for
2. What you need to know before you take Pascorbin®
3. How to use Pascorbin®
4. Possible side effects
5. How to store Pascorbin®
6. Contents of the pack and other information

1. What Pascorbin® is and what it is used for
Ascorbic acid (vitamin C) is a water-soluble vitamin.
Pascorbin® is used
- for the treatment of clinical vitamin C deficiency conditions that cannot be eliminated by diet or substituted with oral supplements
- for methemoglobinaemia in childhood.

2. What you need to know before you take Pascorbin®
Do not use Pascorbin®:
The following describes when Pascorbin® may only be used under certain conditions and with particular caution. Please ask your doctor about this. This also applies if this information was previously applicable to you.
Pascorbin® may only be used after consultation with your doctor in case of kidney stones from oxalate, and certain diseases in which too much iron is stored in the body (thalassaemia, haemochromatosis, sideroblastic anaemia).
Warnings and precautions:
Special note for diabetics: After parenteral administration of ascorbic acid, the detection reaction of glucose in the blood is impaired. Intravenous injection of high doses of Pascorbin® can lead to acute renal failure caused by kidney stones, due to precipitation of calcium oxalate crystals in the kidney. This has already been observed at doses of 1.5 – 2.5 g. Patients with pre-existing impairment of the renal function (renal insufficiency) are particularly at risk. Ensure adequate hydration (approx. 1½ to 2 l per day). In patients with recurrent kidney stone formation, the daily vitamin C dose should not exceed 100 to 200 mg. Patients with high-grade or end-stage renal disease (dialysis patients) should not receive more than 50 to 100 mg daily. In patients with erythrocyte glucose-6-phosphate-dehydrogenase deficiency (serious impairment of the metabolism of the red blood cells), severe haemolysis (dissolution of red blood cells) was observed under high doses of vitamin C (more than 4 g daily) in isolated cases. Therefore, the dosage of ascorbic acid must not exceed 100 – 500 mg daily. In patients with known respiratory problems (especially due to impaired respiratory function, such as in asthma, chronic bronchitis or smoker’s cough), acute respiratory distress may occur in individual cases during treatment with high doses (from 7.5 g) of Pascorbin®. It is therefore recommended to start treatment with lower doses in these patients. Pascorbin® must not be mixed with medicinal products whose effect is reduced by chemical reduction.

Children:
- In children under 12 years of age, an IV administration of 5-7 mg ascorbic acid/kg BW per day should not be exceeded in the context of parenteral nutrition.
- As part of the treatment of methemoglobinaemia in childhood, an amount of 100 mg ascorbic acid/kg BW daily should not be exceeded.
Elderly:
Ensure adequate hydration (approx. 1½ to 2 l per day).
Notes:
After administration of gram doses, the ascorbic acid concentration in urine may increase to such an extent that the measurement of various clinical-chemical parameters (glucose, uric acid, creatinine, inorganic phosphate) is impaired and falsified.
Other medicines and Pascorbin®:
The effect of the following medicines or product groups may be affected with concomitant treatment with Pascorbin®.
Pascorbin® can chemically change other medicines (due to the high redox potential). Tolerability with other medicines must, therefore, be checked in individual cases when administered concomitantly.
Ascorbic acid may influence the effect of anticoagulants.
Concomitant use of ascorbic acid and fluphenazine leads to decreased plasma concentrations of fluphenazine. The concomitant use of ascorbic acid and acetylsalicylic acid leads to decreased excretion of acetylsalicylic acid and increased urinary excretion of ascorbic acid. Salicylates inhibit ascorbic acid uptake into leukocytes (white blood cells) and thrombocytes (platelets).
If a patient is also receiving chemotherapy, the administration of higher doses of vitamin C should take place on an offset timetable (depending on the half-life of the chemotherapeutic agent 1 to 3 days), because clinical data on possible interactions are lacking.
Tell your doctor or pharmacist if you are taking/using, have recently taken/used, or might take/use any other medicines, even if these are over-the-counter medicines.
Pascorbin® with food and drink:
No special precautions are required.
Pregnancy and breastfeeding:
Pregnancy
During pregnancy, an amount of 100 to 500 mg ascorbic acid daily should not be exceeded.
Breastfeeding
During breastfeeding, an amount of 100 to 500 mg ascorbic acid daily should not be exceeded.
Driving and using machines
No special precautions are required.
Pascorbi ® contains sodium:
One ampoule with 5 ml solution for injection contains 4.2 mmol (97.2 mg) sodium, and one injection vial with 50 ml solution for injection contains 42.3 mmol (972 mg) sodium. This should be taken into account for patients on a low-sodium diet.

3. How to use Pascorbin®
Always use Pascorbin® exactly as described in this leaflet. Check with your doctor or pharmacist if you are not sure.
Pascorbin® is generally used by a doctor.
Unless otherwise prescribed by the doctor, the usual dose is:
Pascorbin® is intended for peripheral venous injection.
Unless otherwise prescribed, inject 5 ml intravenously every day slowly, up to 50 ml solution for injection as an adjunct to the infusion.
Adults are given 100 to 500 mg of ascorbic acid per day (equivalent to 0.7 ml to 3.3 ml Pascorbin ®) intravenously to prevent vitamin C deficiency in prolonged artificial (parenteral) nutrition.
Children intravenously 5 to 7 mg ascorbic acid/kg BW per day.
Methemoglobinaemia in childhood:
500 to 1,000 mg of ascorbic acid (equivalent to 3.3 ml to 6.6 ml Pascorbin®) are injected intravenously once.
If necessary, the administration must be repeated with the same dosage.
A dose of 100 mg/kg BW per day should not be exceeded.
Method of administration:
Pascorbin® will be slowly injected intravenously (into the veins) by your doctor or other medical staff.
Duration of use:
Your doctor will decide on the duration of the use, based on the course of the disease and the blood counts.
If you use more Pascorbin® than you should:
Use of Pascorbin® is interrupted. Other measures are generally not necessary, except in case of the occurrence of haemolysis or kidney stones (see section “Precautions for use and warnings”).
In case of pain in the renal area or difficulty urinating after a high dose of Pascorbin®, a doctor should be informed immediately.

4. Possible side effects
Like all medicines, Pascorbin® can cause side effects, although not everybody gets them.
The following categories are used to give information on the frequency of side effects:

Very common: more than 1 in 10 people
Common: 1 to 10 in 100 people
Uncommon: 1 to 10 in 1,000 people
Rare: 1 to 10 in 10,000 people
Very rare: less than 1 in 10,000 people
Not known: Frequency cannot be estimated from the available data


Possible side effects: Hypersensitivity reactions (e.g. difficulty breathing, allergic skin reactions) have been observed very rarely. Very rarely, high doses of ascorbic acid can cause gastrointestinal disorders (e.g. nausea, vomiting, diarrhoea). In individual cases, short-term circulatory disorders (e.g. dizziness, nausea, visual disturbances) may occur. Very rarely, reactions such as chills and a temperature increase have been observed in acute infections.

Countermeasures: Immediate discontinuation of the injection or infusion.

Reporting of side effects: If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Bundesinstitut für Arzneimittel und Medizinprodukte [Federal Institute for Drugs and Medical Devices], Abt. Pharmakovigilanz [Pharmacovigilance Dept.], Kurt-Georg-Kiesinger-Allee 3, D-53175 Bonn, Website: http://www.bfarm.de. By reporting side effects, you can help provide more information about the safety of this medicine.

5. How to store Pascorbin®
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the carton and the container after “Verwendbar
bis“ or “Verw. bis” [Expiry date].
The expiry date refers to the last day of that month.
Storage conditions:
Ampoules resp. vial: Do not store above 25°C.
Ampoules resp. vial: Store protected from light.
Reference to shelf life after opening or preparation:
The preservative-free solution for injection is intended for single use only. The product must be used immediately after opening the ampoule or the injection vial. Unused residues must be discarded.

6. Contents of the pack and other information
What Pascorbin® contains:
- The active substance is: Ascorbic acid.
1 ml solution for injection contains 150 mg ascorbic acid.
- The other ingredients are:
Sodium hydrogen carbonate, water for injection.
What Pascorbin® looks like and contents of the pack:
Brown ampoules or brown glass bottle with clear, yellowish liquid.
Pascorbin® is available as a pack with 5 ampoules/5 ml, 10 ampoules/5 ml, as hospital packs with 100 ampoules/5 ml, 1,000 ampoules/5 ml, as well as a vial of 50 ml, and as a bundle pack with 20 vials of 50 ml and 60 vials of 50 ml.
Not all pack sizes may be marketed.
Marketing Authorisation Holder and Manufacturer:
Pascoe pharmazeutische Präparate GmbH, Schiffenberger Weg 55 D-35394 Giessen or Großempfängerpostleitzahl [bulk recipient postal code] D-35383 Giessen, Tel.: +49 (0)641/7960-0, Fax: +49 (0)641/7960-109, e-mail: info(at)pascoe.de.
Manufacturer: Pascoe pharmazeutische Präparate GmbH · Europastraße 2 · D-35394 Giessen.

Other information:
Fresh fruit and vegetables have a needs-based high vitamin C content. However, prolonged storage, particularly of potatoes and vegetables, causes vitamin C losses to a varying extent.
In general, we absorb this vitamin sufficiently in Central Europe. It is primarily older people who are more likely to be inadequately supplied, due to changes in dietary habits. Infants who are fed cow's milk also need additional vitamin C.
Vitamin C deficiency can occur in severe physical disorders besides malnutrition.
A rare, very severe form of vitamin C deficiency is scurvy, which is associated with weakness and bleeding throughout the body and is treated medicinally with vitamin C.

Pascorbin Package leaflet

Pascorbin®
Active substance: Ascorbic acid 150 mg per ml solution for injection
For therapy of clinical vitamin C deficiencies which cannot be corrected by dietary means or substituted orally. Methemoglobinemia in infancy. Contains sodium hydrogen carbonate.
For risks and side effects read the package insert and ask your doctor or at your pharmacy.
Pascoe pharmazeutische Präparate GmbH, D-35383 Giessen

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