IV HYDRATION/VITAMIN THERAPY

What are IV hydration and vitamin therapy?

Many products on the market are labeled IV hydration or vitamin therapy for long COVID and contain various combinations of intravenous vitamins, antioxidants, and amino acids such as vitamin C, vitamin B12, vitamin D, and glutathione. For hydration, they can also contain added electrolytes and fluids. IV infusions are directly absorbed into the bloodstream, whereas oral supplements must be absorbed from the gastrointestinal system before they can reach the bloodstream. Thus, IV infusions can be more effective in supplementation than oral vitamins.

How can IV hydration/vitamin therapy help alleviate certain long COVID symptoms?

An excess release of inflammatory mediators and oxidative stress are believed to be contributing factors in long COVID that lead to a hyperinflammatory state. This oxidative stress and inflammation can lead to the progression of fatigue and neuropsychiatric symptoms, as well as disruptions in blood flow.¹ Vitamins such as vitamin C have antioxidant and anti-inflammatory properties that are believed to relieve some of these symptoms. During acute infections, the demand for vitamin C may be high due to an elevated inflammatory response and high metabolic demand; thus, COVID patients can show severe deficiencies in vitamin C. As a result, IV vitamin therapies may help with these deficiencies and reduce inflammation in the body.

What evidence supports the use of IV hydration/vitamin therapy for long COVID?

The use of IV hydration/vitamin therapy for long COVID is controversial. For commercial IV products and IV vitamin clinics marketed online, there have been no studies to demonstrate their effectiveness other than anecdotal patient stories.

The primary intravenous vitamin studied in clinical trials for fatigue is vitamin C. In a systematic review of 9 studies with 720 participants, 3 out of 4 controlled trials showed significantly decreased fatigue after IV vitamin C therapy. All except one of the observational studies also noted a decrease in fatigue scores. Other symptoms that were alleviated include sleep disturbances, difficulty concentrating, depression, and pain. However, these studies mainly focused on fatigue in cancer patients rather than long COVID patients.²

High-dose IV vitamin C has been studied for use in an acute COVID infection with mixed results. One clinical trial of 60 patients randomized to high-dose IV vitamin C or standard COVID antiviral therapy did not find significantly better outcomes in the group treated with IV vitamin C regarding the amount of oxygen saturation at discharge, length of ICU stay, or mortality.³ Another trial of 54 patients with COVID pneumonia randomized to IV vitamin C 2 grams every 6 hours for five days vs. standard treatment found a significant increase in oxygen saturation and a decrease in respiratory rate.⁴

Overall, there are proposed associations between IV vitamin therapy (specifically vitamin C) and improvement in fatigue. Still, more evidence from clinical trials needs to support its use in long-term COVID patients. In addition, patients with sufficient vitamin levels in their diet should not require additional supplementation.

What should you be aware of when using IV hydration/vitamin therapy?

Given that some IV hydration/vitamin therapies are offered in various settings, such as spas and salons that may not have medical providers administering the infusion, it is important to consult your doctor before considering one. Patients with congestive heart failure or end-stage renal disease must use caution when receiving IV fluids, as it can exacerbate their conditions. These IV therapies are also not regulated by the FDA. They could carry a risk of infection, damage to the injection site, irritation or inflammation of a vein, or air embolism from air entering the IV.⁵  In addition, these IV therapies can be fairly expensive.

References:

1)      Vollbracht C, Kraft K. Oxidative Stress and Hyper-Inflammation as Major Drivers of Severe COVID-19 and Long COVID: Implications for the Benefit of High-Dose Intravenous Vitamin C. Front Pharmacol. 2022 Apr 29;13:899198. doi: 10.3389/fphar.2022.899198

2)      Vollbracht C, Kraft K. Feasibility of Vitamin C in the Treatment of Post Viral Fatigue with Focus on Long COVID, Based on a Systematic Review of IV Vitamin C on Fatigue. Nutrients. 2021 Mar 31;13(4):1154. doi: 10.3390/nu13041154

3)      Jamali MS, Zarezade B, Koolaji S, et al. Safety and effectiveness of high-dose vitamin C in patients with COVID-19: a randomized open-label clinical trial. Eur J Med Res. 2021 Feb 11;26(1):20. doi: 10.1186/s40001-021-00490-1

4)      Tehrani S, Yadegarynia D, Abrishami A, Moradi H, Gharaei B, Rauofi M, Maghsoudi Nejad F, Sali S, Khabiri N, Abolghasemi S. An investigation into the Effects of Intravenous Vitamin C on Pulmonary CT Findings and Clinical Outcomes of Patients with COVID 19 Pneumonia A Randomized Clinical Trial. Urol J. 2022 Dec 6;19(6):460-465. doi: 10.22037/uj.v18i.6863

5)      Talk with your provider before undergoing IV vitamin therapy. UCLA Health. November 19, 2018. Accessed November 5, 2023. https://www.uclahealth.org/news/talk-with-your-provider-before-undergoing-iv-vitamin-therapy