No evidence to support intravenous high-dose vitamin C in the management of COVID-19

The TGA is aware of a report that intravenous high-dose vitamin C may be beneficial in the management of a COVID-19 infection.

We have investigated this report and found there is no robust scientific evidence to support the usage of this vitamin in the management of COVID-19.

No published peer reviewed studies in the medical literature were found to support the usage of this vitamin for COVID-19.  We are aware of some studies underway in certain countries and should these be positive, the TGA would welcome the submission of an application for vitamin C in treating COVID-19, accompanied and supported by appropriate research.

Two recently published open-label studies relating to the use of vitamin C in other types of infections, associated with septic shock and acute respiratory distress syndrome (ARDS), were identified and reviewed. In both of these studies, where vitamin C was used as monotherapy (used alone) or in combination with other products, there was no clear evidence of benefit.  It cannot be concluded that intravenous vitamin C is an effective treatment of ARDS (resulting from COVID-19, or otherwise).

More research is needed before any recommendation for the use of intravenous vitamin C in the treatment of COVID-19 can be made. 

The public should be reassured that there are many organised, scientific research studies being fast-tracked on therapy for COVID-19, both locally and internationally. Obtaining good evidence in the management of the current COVID-19 pandemic is essential in ensuring public safety.

Known benefits of vitamin C

All vitamins, including vitamin C, are micronutrients, which are contained in various foods and form an essential part of the human diet. However, the quantities required for daily intake are small and these can usually be reliably obtained from the consumption of a balanced daily intake of wholesome foods.

Vitamins can play an important role in the health of some people, particularly those who have deficiencies.  However, vitamin C deficiency is rare in Australia. Vitamin C may have a number of health benefits, but the only well-established evidence for its use is in the treatment of scurvy.

Reviewed studies and references

• Fowler AA, Truwit JD, Hite RD, et al. 2019. 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 322(13):1261-1270.
• Fujii T, Luethi N, Young PJ, et al. 2020. 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 doi: 10.1001/jama.2019.22176
• Matthay MA, Aldrich JM, Gotts JE 2020. Treatment for severe acute respiratory distress syndrome from COVID-19. Lancet Respir Med doi: 10.1016/S2213-2600(20)30127-2
• Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected (Interim guidance 13 March 2020 ): https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
• Information for Clinicians on Therapeutic Options for COVID-19 Patients: https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html