Should Vitamin C/Ascorbic Acid infusion be used in the treatment of COVID-19?

Abstract

KEY FINDINGS
 There is no direct evidence available as of this point for efficacy of intravenous vitamin C as an adjunctive treatment in preventing mortality or shortening disease course among adults suspected of, or positive for COVID-19.
 • Vitamin C is currently not mentioned in the treatment guidelines for COVID.
 • Currently, there are 3 ongoing trials registered in clinicaltrials.gov studying intravenous vitamin C in COVID-19. No other ongoing or planned trials were registered in the other trial registries.
 • Most of the available data are from studies on disease populations which may be considered as COVID-19 suspects:
  Conflicting results on mortality from indirect evidence among patients with sepsis with or without ARDS with significant reduction in mortality found in only a small subset of patients (n-40) with severe sepsis given high dose Vitamin C infusion.
  Strong evidence supporting no mortality benefit from 5 meta-analyses on critically ill patients due to conditions other than or in combination with sepsis who were given Vit C infusion alone or in combinations with other medications. One meta-analysis showed benefit in decreasing duration of ICU stay and mechanical ventilation but sample size is small. Most showed no benefit on and other key endpoints such as acute kidney injury, duration of hospital stay/ ICU stay/ duration of vasopressor use or duration of mechanical ventilation.
 • The use of Vit C infusion is not mentioned in the treatment guidelines for COVID-19 or ARDS.
 • The risks or adverse events with short term use of Vitamin C infusion in the general population is negligible or minimal. It should be avoided in patients with G6PD insufficiency. The dose should be carefully adjusted for patients with renal insufficiency.