Citravit (Tablets) Instructions for Use

ATC Code

A11GA01 (Ascorbic acid (vitamin C))

Active Substance

Ascorbic acid (Rec.INN registered by WHO)

Clinical-Pharmacological Group

Vitamin preparation

Pharmacotherapeutic Group

Vitamin

Pharmacological Action

Vitamin C. Ascorbic acid is necessary for the formation of intracellular collagen and is required to strengthen the structure of teeth, bones, and capillary walls.

It participates in redox reactions, tyrosine metabolism, the conversion of folic acid to folinic acid, carbohydrate metabolism, the synthesis of lipids and proteins, iron metabolism, cellular respiration processes, and activates the synthesis of steroid hormones.

It reduces the need for vitamins B₁, B₂, A, E, folic acid, pantothenic acid, promotes increased body resistance to infections; improves iron absorption, promoting its deposition in the reduced form.

It has antioxidant properties.

Pharmacokinetics

After oral administration, Ascorbic acid is completely absorbed from the gastrointestinal tract. It is widely distributed in body tissues.

The concentration of ascorbic acid in blood plasma is normally approximately 10-20 µg/ml.

The concentration of ascorbic acid in leukocytes and platelets is higher than in erythrocytes and plasma. In deficiency states, the concentration in leukocytes decreases later and more slowly and is considered a better criterion for assessing deficiency than plasma concentration.

Binding to plasma proteins is about 25%.

Ascorbic acid is reversibly oxidized to form dehydroascorbic acid; a part is metabolized to form ascorbate-2-sulfate, which is inactive, and oxalic acid, which is excreted in the urine.

Ascorbic acid taken in excessive amounts is rapidly excreted unchanged in the urine; this usually occurs when the daily dose exceeds 200 mg.

Indications

For systemic use: prevention and treatment of hypo- and avitaminosis of vitamin C; meeting the increased body demand for vitamin C during periods of growth, pregnancy, lactation, during heavy exertion, fatigue, during convalescence after prolonged serious illnesses; in the winter period, with an increased risk of developing infectious diseases.

ICD codes

Dosage Regimen

Administer Citravit orally, intramuscularly, or intravenously as directed.

Determine the specific dose based on the indication, patient age, route of administration, and the dosage form used.

For the prevention of vitamin C deficiency, typical adult oral doses range from 50 mg to 100 mg once daily.

For the treatment of established deficiency, administer up to 250 mg twice daily until symptoms resolve.

During periods of increased requirement such as pregnancy, lactation, growth, or convalescence, administer 100 mg to 200 mg daily.

For pediatric patients, adjust the dose based on age and body weight; do not exceed adult dosages.

When administering parenterally, use only clear solutions and adhere to strict aseptic technique.

For intramuscular or intravenous use, dissolve the tablet contents in a suitable sterile solvent before administration.

In patients with renal impairment, a history of urolithiasis, or hemochromatosis, use the minimum effective dose.

Monitor patients on long-term, high-dose therapy for potential adverse effects.

Discontinue therapy and consult a physician if signs of hypersensitivity or severe adverse reactions occur.

Adverse Reactions

From the central nervous system: headache, feeling of tiredness, insomnia.

From the digestive system: stomach cramps, nausea and vomiting.

Allergic reactions: isolated cases of skin reactions and manifestations from the respiratory system have been described.

From the urinary system: when used in high doses – hyperoxaluria and the formation of renal stones from calcium oxalate.

Other: sensation of heat.

Contraindications

Hypersensitivity to ascorbic acid.

Use in Pregnancy and Lactation

The minimum daily requirement for ascorbic acid during the second and third trimesters of pregnancy is about 60 mg.

Ascorbic acid crosses the placental barrier. It should be borne in mind that the fetus can adapt to high doses of ascorbic acid taken by the pregnant woman, and then the newborn may develop ascorbic acid deficiency as a withdrawal reaction. Therefore, during pregnancy, ascorbic acid should not be taken in increased doses, except when the expected benefit outweighs the potential risk.

The minimum daily requirement during lactation (breastfeeding) is 80 mg. Ascorbic acid is excreted in breast milk. A maternal diet containing an adequate amount of ascorbic acid is sufficient to prevent deficiency in the infant. It is not known whether the use of high doses of ascorbic acid by the mother is dangerous for the child. Theoretically, this is possible. Therefore, it is recommended that nursing mothers do not exceed the maximum daily requirement for ascorbic acid, except when the expected benefit outweighs the potential risk.

Use in Renal Impairment

Use with caution in patients with hyperoxaluria, impaired renal function, or a history of urolithiasis.

Pediatric Use

Approved for use in children and adolescents under 18 years of age in appropriate doses.

Geriatric Use

Approved for use in elderly patients.

Special Precautions

Use with caution in patients with hyperoxaluria, impaired renal function, or a history of urolithiasis.

Since Ascorbic acid increases iron absorption, its use in high doses can be dangerous in patients with hemochromatosis, thalassemia, polycythemia, leukemia, and sideroblastic anemia.

In patients with a high iron content in the body, ascorbic acid should be used in minimal doses.

Use with caution in patients with glucose-6-phosphate dehydrogenase deficiency.

The use of ascorbic acid in high doses can cause exacerbation of sickle cell anemia.

Data on the diabetogenic effect of ascorbic acid are contradictory. However, with long-term use of ascorbic acid, blood glucose levels should be periodically monitored.

It is believed that the use of ascorbic acid in patients with rapidly proliferating and widely disseminated tumors may exacerbate the course of the process. Therefore, ascorbic acid should be used with caution in patients with progressive cancer.

The absorption of ascorbic acid is reduced with the simultaneous consumption of fresh fruit or vegetable juices, alkaline drinks.

Drug Interactions

With simultaneous use with barbiturates, primidone, the excretion of ascorbic acid in the urine increases.

With simultaneous use of oral contraceptives, the concentration of ascorbic acid in blood plasma decreases.

With simultaneous use with iron preparations, Ascorbic acid, due to its reducing properties, converts ferric iron to ferrous iron, which improves its absorption.

Ascorbic acid in high doses can decrease urine pH, which, with simultaneous use, reduces the tubular reabsorption of amphetamine and tricyclic antidepressants.

With simultaneous use, acetylsalicylic acid reduces the absorption of ascorbic acid by about one third.

With simultaneous use with warfarin, a decrease in the effects of warfarin is possible.

With simultaneous use, Ascorbic acid increases iron excretion in patients receiving deferoxamine. When using ascorbic acid at a dose of 500 mg/day, impaired left ventricular function is possible.

With simultaneous use with tetracycline, the excretion of ascorbic acid in the urine increases.

A case of decreased plasma concentration of fluphenazine in a patient taking ascorbic acid 500 mg twice daily has been described.

An increase in the plasma concentration of ethinyl estradiol is possible with its simultaneous use as part of oral contraceptives.

Storage Conditions

Store at 2°C (36°F) to 25°C (77°F). Keep in original packaging, protected from light. Keep out of reach of children.

Dispensing Status

Over-the-Counter

Important Safety Information

This information is for educational purposes only and does not replace professional medical advice. Always consult your doctor before use. Dosage and side effects may vary. Use only as prescribed.