Vitamin C: Intravenous Use by Complementary and Alternative Medicine Practitioners and Adverse Effects
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{"title"=>"Vitamin C: Intravenous use by complementary and alternative medicine practitioners and adverse effects", "type"=>"journal", "authors"=>[{"first_name"=>"Sebastian J.", "last_name"=>"Padayatty", "scopus_author_id"=>"6603053808"}, {"first_name"=>"Andrew Y.", "last_name"=>"Sun", "scopus_author_id"=>"18038702100"}, {"first_name"=>"Qi", "last_name"=>"Chen", "scopus_author_id"=>"56045500700"}, {"first_name"=>"Michael Graham", "last_name"=>"Espey", "scopus_author_id"=>"55253537300"}, {"first_name"=>"Jeanne", "last_name"=>"Drisko", "scopus_author_id"=>"7004186635"}, {"first_name"=>"Mark", "last_name"=>"Levine", "scopus_author_id"=>"7404034253"}], "year"=>2010, "source"=>"PLoS ONE", "identifiers"=>{"pmid"=>"20628650", "doi"=>"10.1371/journal.pone.0011414", "sgr"=>"77955349971", "isbn"=>"1932-6203", "scopus"=>"2-s2.0-77955349971", "issn"=>"19326203", "pui"=>"359318639"}, "id"=>"4a05bba8-5805-324a-8693-3fa36da0fa31", "abstract"=>"BACKGROUND: Anecdotal information and case reports suggest that intravenously administered vitamin C is used by Complementary and Alternate Medicine (CAM) practitioners. The scale of such use in the U.S. and associated side effects are unknown.\\n\\nMETHODS AND FINDINGS: We surveyed attendees at annual CAM Conferences in 2006 and 2008, and determined sales of intravenous vitamin C by major U.S. manufacturers/distributors. We also queried practitioners for side effects, compiled published cases, and analyzed FDA's Adverse Events Database. Of 199 survey respondents (out of 550), 172 practitioners administered IV vitamin C to 11,233 patients in 2006 and 8876 patients in 2008. Average dose was 28 grams every 4 days, with 22 total treatments per patient. Estimated yearly doses used (as 25 g/50 ml vials) were 318,539 in 2006 and 354,647 in 2008. Manufacturers' yearly sales were 750,000 and 855,000 vials, respectively. Common reasons for treatment included infection, cancer, and fatigue. Of 9,328 patients for whom data is available, 101 had side effects, mostly minor, including lethargy/fatigue in 59 patients, change in mental status in 21 patients and vein irritation/phlebitis in 6 patients. Publications documented serious adverse events, including 2 deaths in patients known to be at risk for IV vitamin C. Due to confounding causes, the FDA Adverse Events Database was uninformative. Total numbers of patients treated in the US with high dose vitamin C cannot be accurately estimated from this study.\\n\\nCONCLUSIONS: High dose IV vitamin C is in unexpectedly wide use by CAM practitioners. Other than the known complications of IV vitamin C in those with renal impairment or glucose 6 phosphate dehydrogenase deficiency, high dose intravenous vitamin C appears to be remarkably safe. Physicians should inquire about IV vitamin C use in patients with cancer, chronic, untreatable, or intractable conditions and be observant of unexpected harm, drug interactions, or benefit.", "link"=>"http://www.mendeley.com/research/vitamin-c-intravenous-complementary-alternative-medicine-practitioners-adverse-effects-4", "reader_count"=>117, "reader_count_by_academic_status"=>{"Unspecified"=>2, "Professor > Associate Professor"=>5, "Librarian"=>1, "Researcher"=>17, "Student > Doctoral Student"=>12, "Student > Ph. D. Student"=>9, "Student > Postgraduate"=>11, "Other"=>26, "Student > Master"=>7, "Student > Bachelor"=>20, "Lecturer"=>4, "Lecturer > Senior Lecturer"=>2, "Professor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>2, "Professor > Associate Professor"=>5, "Librarian"=>1, "Researcher"=>17, "Student > Doctoral Student"=>12, "Student > Ph. D. Student"=>9, "Student > Postgraduate"=>11, "Other"=>26, "Student > Master"=>7, "Student > Bachelor"=>20, "Lecturer"=>4, "Lecturer > Senior Lecturer"=>2, "Professor"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>5, "Agricultural and Biological Sciences"=>25, "Chemistry"=>1, "Computer Science"=>1, "Engineering"=>3, "Environmental Science"=>1, "Nursing and Health Professions"=>6, "Biochemistry, Genetics and Molecular Biology"=>2, "Materials Science"=>1, "Mathematics"=>1, "Medicine and Dentistry"=>63, "Neuroscience"=>2, "Sports and Recreations"=>1, "Pharmacology, Toxicology and Pharmaceutical Science"=>1, "Psychology"=>1, "Social Sciences"=>2, "Immunology and Microbiology"=>1}, "reader_count_by_subdiscipline"=>{"Materials Science"=>{"Materials Science"=>1}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>63}, "Social Sciences"=>{"Social Sciences"=>2}, "Sports and Recreations"=>{"Sports and Recreations"=>1}, "Psychology"=>{"Psychology"=>1}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>5}, "Environmental Science"=>{"Environmental Science"=>1}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}, "Engineering"=>{"Engineering"=>3}, "Chemistry"=>{"Chemistry"=>1}, "Neuroscience"=>{"Neuroscience"=>2}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>25}, "Computer Science"=>{"Computer Science"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>6}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>2}}, "reader_count_by_country"=>{"Canada"=>3, "Colombia"=>1, "United States"=>6, "Egypt"=>1, "Denmark"=>1, "United Kingdom"=>2, "Australia"=>2, "Portugal"=>2}, "group_count"=>9}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/841499"], "description"=>"<p>Vitamin C is supplied in 50 ml bottles containing 25grams. Estimated total number of doses (bottles) used each year was calculated as the cumulative sum of each practitioners' number of patients×that practitioners' average dose in bottles×that practitioner's average number of doses per patient.</p>", "links"=>[], "tags"=>["iv", "respondents", "years", "2006"], "article_id"=>511952, "categories"=>["Medicine", "Cancer", "Virology", "Pharmacology"], "users"=>["Sebastian J. Padayatty", "Andrew Y. Sun", "Qi Chen", "Michael Graham Espey", "Jeanne Drisko", "Mark Levine"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0011414.t001", "stats"=>{"downloads"=>1, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Details_of_high_dose_IV_vitamin_C_use_by_survey_respondents_for_the_years_2006_and_2008_/511952", "title"=>"Details of high dose IV vitamin C use by survey respondents for the years 2006 and 2008.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-07-07 00:32:32"}
  • {"files"=>["https://ndownloader.figshare.com/files/841363"], "description"=>"<p>X axis shows the number of practitioners who used intravenous vitamin C to treat each of the conditions listed on the Y axis. Blue bars denote infections, red bars denote cancers, and green bars denote other indications. Data for 2006 (solid bars) and 2008 (hatched bars) show that intravenous vitamin C was most often used to treat infections and cancer. Indications for which less than four practitioners used high dose intravenous vitamin C are listed in <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0011414#pone.0011414.s001\" target=\"_blank\">Table S1</a>.</p>", "links"=>[], "tags"=>["practitioners", "intravenous"], "article_id"=>511820, "categories"=>["Medicine", "Cancer", "Virology", "Pharmacology"], "users"=>["Sebastian J. Padayatty", "Andrew Y. Sun", "Qi Chen", "Michael Graham Espey", "Jeanne Drisko", "Mark Levine"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0011414.g002", "stats"=>{"downloads"=>1, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Number_of_practitioners_who_used_intravenous_vitamin_C_for_various_conditions_/511820", "title"=>"Number of practitioners who used intravenous vitamin C for various conditions.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-07-07 00:30:20"}
  • {"files"=>["https://ndownloader.figshare.com/files/841435"], "description"=>"<p>Data included in the table represent only those practitioners who reported exact patient numbers.</p><p>*Described as “not confirmed (possible). Patient had partial renal failure and cancer metastases to kidneys.”</p><p>Data on practitioners who reported adverse events but did not report the number of patients affected are detailed below as: side effect (with the number of practitioners who reported each side effect in parenthesis).</p><p><i>For the year 2006:</i> lethargy/fatigue (9), local vein irritation (3), nausea/vomiting (2), hypoglycemia (2), allergy (2), phlebitis (1), cellulitis (1), hematuria (1), dry mouth (1), Herxheimer reaction (1), localized thrombosis (1), and syncope (1).</p><p><i>For the year 2008</i>: lethargy/fatigue (9), nausea/vomiting (6), local vein irritation (4), headache (3), phlebitis (3), heartburn (1), dizziness (1), venosclerosis (1), mild palpitation (1), and cold (1), dizziness (1), “initiation of mem occasionally” (1), and other (1).</p>", "links"=>[], "tags"=>["events", "reported", "iv", "years", "2006"], "article_id"=>511887, "categories"=>["Medicine", "Cancer", "Virology", "Pharmacology"], "users"=>["Sebastian J. Padayatty", "Andrew Y. Sun", "Qi Chen", "Michael Graham Espey", "Jeanne Drisko", "Mark Levine"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0011414.t003", "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Adverse_events_reported_with_IV_vitamin_C_use_in_the_survey_for_the_years_2006_and_2008_/511887", "title"=>"Adverse events reported with IV vitamin C use in the survey for the years 2006 and 2008.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-07-07 00:31:27"}
  • {"files"=>["https://ndownloader.figshare.com/files/841270"], "description"=>"<p>Practitioners were grouped according to the number of patients whom they treated with IV vitamin C in the preceding twelve months. For ease of display, number of patients were divided into arbitrary ranges which are shown on the X axis. The number of practitioners who treated the specified number of patients are shown on the Y axis. Patients were unevenly distributed among survey respondents. In 2006, out of 106 practitioners who responded to the survey, 13 did not use high dose IV vitamin C, 30 respondents treated more than 100 patients each, and 3 treated 1000 or more patients (Fig 1A). For 2008, the corresponding numbers were 93, 14, 18 and 2 respectively (Fig 1B). Cumulative total of patients treated by all practitioners are shown as line diagrams (scaled to Y axis on right).</p>", "links"=>[], "tags"=>["patients", "treated"], "article_id"=>511728, "categories"=>["Medicine", "Cancer", "Virology", "Pharmacology"], "users"=>["Sebastian J. Padayatty", "Andrew Y. Sun", "Qi Chen", "Michael Graham Espey", "Jeanne Drisko", "Mark Levine"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0011414.g001", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cumulative_total_and_the_distribution_of_patients_treated_among_the_survey_respondents_/511728", "title"=>"Cumulative total and the distribution of patients treated among the survey respondents.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2010-07-07 00:28:48"}
  • {"files"=>["https://ndownloader.figshare.com/files/841563"], "description"=>"<p>Normal ranges and units of measurement for laboratory values are: Serum creatinine - mg/dl (normal range 0.6–1.5mg/dl). Hemoglobin g/dl (normal range: male 13–18g/dl, female 12–16g/dl). Reticulocyte count in % (normal range 0.5–2.5% red cells). Plasma bilirubin- mg/dl (normal range <1mg/dl). Plasma vitamin C - mg/dl (normal range 0.6–2 mg/dl).</p>", "links"=>[], "tags"=>["reported"], "article_id"=>512018, "categories"=>["Medicine", "Cancer", "Virology", "Pharmacology"], "users"=>["Sebastian J. Padayatty", "Andrew Y. Sun", "Qi Chen", "Michael Graham Espey", "Jeanne Drisko", "Mark Levine"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0011414.t005", "stats"=>{"downloads"=>6, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Adverse_effects_of_vitamin_C_reported_in_the_literature_/512018", "title"=>"Adverse effects of vitamin C reported in the literature.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-07-07 00:33:38"}
  • {"files"=>["https://ndownloader.figshare.com/files/841467"], "description"=>"<p>Some respondents did not list the number of patients treated for each of the conditions for which they used intravenous vitamin C treatment. Therefore, the data do not provide indications for treatment for all patients who received IV vitamin C.</p>", "links"=>[], "tags"=>["iv"], "article_id"=>511924, "categories"=>["Medicine", "Cancer", "Virology", "Pharmacology"], "users"=>["Sebastian J. Padayatty", "Andrew Y. Sun", "Qi Chen", "Michael Graham Espey", "Jeanne Drisko", "Mark Levine"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0011414.t002", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Indications_for_treatment_with_high_dose_IV_vitamin_C_/511924", "title"=>"Indications for treatment with high dose IV vitamin C.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-07-07 00:32:04"}
  • {"files"=>["https://ndownloader.figshare.com/files/841533"], "description"=>"<p>*Other includes an academic medical center and a tribal medical center.</p>", "links"=>[], "tags"=>["treating", "practitioners"], "article_id"=>511993, "categories"=>["Medicine", "Cancer", "Virology", "Pharmacology"], "users"=>["Sebastian J. Padayatty", "Andrew Y. Sun", "Qi Chen", "Michael Graham Espey", "Jeanne Drisko", "Mark Levine"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0011414.t006", "stats"=>{"downloads"=>0, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Details_of_treating_practitioners_and_institutions_/511993", "title"=>"Details of treating practitioners and institutions.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-07-07 00:33:13"}
  • {"files"=>["https://ndownloader.figshare.com/files/419008", "https://ndownloader.figshare.com/files/419080", "https://ndownloader.figshare.com/files/419132", "https://ndownloader.figshare.com/files/419236", "https://ndownloader.figshare.com/files/419282"], "description"=>"<div><h3>Background</h3><p>Anecdotal information and case reports suggest that intravenously administered vitamin C is used by Complementary and Alternate Medicine (CAM) practitioners. The scale of such use in the U.S. and associated side effects are unknown.</p><h3>Methods and Findings</h3><p>We surveyed attendees at annual CAM Conferences in 2006 and 2008, and determined sales of intravenous vitamin C by major U.S. manufacturers/distributors. We also queried practitioners for side effects, compiled published cases, and analyzed FDA's Adverse Events Database. Of 199 survey respondents (out of 550), 172 practitioners administered IV vitamin C to 11,233 patients in 2006 and 8876 patients in 2008. Average dose was 28 grams every 4 days, with 22 total treatments per patient. Estimated yearly doses used (as 25g/50ml vials) were 318,539 in 2006 and 354,647 in 2008. Manufacturers' yearly sales were 750,000 and 855,000 vials, respectively. Common reasons for treatment included infection, cancer, and fatigue. Of 9,328 patients for whom data is available, 101 had side effects, mostly minor, including lethargy/fatigue in 59 patients, change in mental status in 21 patients and vein irritation/phlebitis in 6 patients. Publications documented serious adverse events, including 2 deaths in patients known to be at risk for IV vitamin C. Due to confounding causes, the FDA Adverse Events Database was uninformative. Total numbers of patients treated in the US with high dose vitamin C cannot be accurately estimated from this study.</p><h3>Conclusions</h3><p>High dose IV vitamin C is in unexpectedly wide use by CAM practitioners. Other than the known complications of IV vitamin C in those with renal impairment or glucose 6 phosphate dehydrogenase deficiency, high dose intravenous vitamin C appears to be remarkably safe. Physicians should inquire about IV vitamin C use in patients with cancer, chronic, untreatable, or intractable conditions and be observant of unexpected harm, drug interactions, or benefit.</p></div>", "links"=>[], "tags"=>["intravenous", "complementary", "practitioners", "adverse", "effects"], "article_id"=>142749, "categories"=>["Medicine", "Cancer", "Pharmacology"], "users"=>["Sebastian J. Padayatty", "Andrew Y. Sun", "Qi Chen", "Michael Graham Espey", "Jeanne Drisko", "Mark Levine"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0011414.s001", "https://dx.doi.org/10.1371/journal.pone.0011414.s002", "https://dx.doi.org/10.1371/journal.pone.0011414.s003", "https://dx.doi.org/10.1371/journal.pone.0011414.s004", "https://dx.doi.org/10.1371/journal.pone.0011414.s005"], "stats"=>{"downloads"=>8, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Vitamin_C_Intravenous_Use_by_Complementary_and_Alternative_Medicine_Practitioners_and_Adverse_Effects/142749", "title"=>"Vitamin C: Intravenous Use by Complementary and Alternative Medicine Practitioners and Adverse Effects", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2010-07-07 00:45:49"}
  • {"files"=>["https://ndownloader.figshare.com/files/841600"], "description"=>"<p>When the vitamin C dose was provided as ml, the dose was converted to mg on the basis that vitamin C is supplied as 0.5gram/ml solution. Some practitioners did not mention the dose of vitamin C used. The format of the FDA adverse events database did not permit identification of specific patients, so that the same patient may have been reported multiple times in the same quarter or in several quarters, inflating the number of patients with adverse events.</p>", "links"=>[], "tags"=>["reported", "patients", "treated", "iv"], "article_id"=>512052, "categories"=>["Medicine", "Cancer", "Virology", "Pharmacology"], "users"=>["Sebastian J. Padayatty", "Andrew Y. Sun", "Qi Chen", "Michael Graham Espey", "Jeanne Drisko", "Mark Levine"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0011414.t004", "stats"=>{"downloads"=>1, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Adverse_effects_reported_to_the_Food_and_Drug_Administration_FDA_in_patients_treated_with_IV_vitamin_C_/512052", "title"=>"Adverse effects reported to the Food and Drug Administration (FDA) in patients treated with IV vitamin C.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-07-07 00:34:12"}

PMC Usage Stats | Further Information

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  • {"unique-ip"=>"134", "full-text"=>"136", "pdf"=>"24", "abstract"=>"8", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"30", "supp-data"=>"2", "cited-by"=>"0", "year"=>"2013", "month"=>"4"}
  • {"unique-ip"=>"123", "full-text"=>"132", "pdf"=>"38", "abstract"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"15", "supp-data"=>"3", "cited-by"=>"0", "year"=>"2012", "month"=>"11"}
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  • {"unique-ip"=>"127", "full-text"=>"143", "pdf"=>"48", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"23", "supp-data"=>"1", "cited-by"=>"0", "year"=>"2013", "month"=>"6"}
  • {"unique-ip"=>"117", "full-text"=>"121", "pdf"=>"21", "abstract"=>"4", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"24", "supp-data"=>"7", "cited-by"=>"0", "year"=>"2013", "month"=>"7"}
  • {"unique-ip"=>"118", "full-text"=>"131", "pdf"=>"24", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"4", "supp-data"=>"5", "cited-by"=>"0", "year"=>"2013", "month"=>"8"}
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