Terapia con dosis masivas de vitamina C endovenosa: revisión de mecanismos moleculares, evidencia clínica y perfil de seguridad

Reynaldo Ortiz

Resumen


La distinción farmacocinética fundamental entre la administración oral e intravenosa ha permitido redescubrir al ácido ascórbico (vitamina C) no solo como un nutriente esencial, sino como un fármaco pro-oxidante selectivo con potentes efectos pleiotrópicos. En concentraciones farmacológicas milimolares, inalcanzables por vía oral, el ascorbato induce citotoxicidad selectiva en células cancerosas a través de la generación extracelular de peróxido de hidrógeno, modula el epigenoma restaurando la función de las enzimas TET, en neoplasias hematológicas y actúa como un "caballo de Troya" metabólico en tumores con mutaciones KRAS/BRAF. Clínicamente, la evidencia más sólida y prometedora ha emergido en el campo de la oncología. Ensayos recientes han documentado una duplicación de la supervivencia global en cáncer de páncreas metastásico y beneficios significativos en glioblastoma multiforme, con un perfil de toxicidad favorable. En el ámbito de los cuidados críticos, específicamente en sepsis y COVID 19, el panorama es complejo y polarizado; aunque se observan beneficios en la reducción de la duración de vasopresores y mejora de la oxigenación, grandes ensayos recientes han arrojado señales de alerta sobre la mortalidad y disfunción orgánica que obligan a reevaluar los protocolos de dosificación y selección de pacientes. En este trabajo se presentan algunos hallazgos que pueden proporcionar una referencia para la práctica clínica basada en evidencia y la dirección futura de la investigación biomédica.

Recibido: 15-04-2026
Aceptado: 18-05-2026


Palabras clave


Vitamina C intravenosa; Dosis masiva; Oncología; Estrés oxidativo; Farmacocinética; Citotoxicidad selectiva; Ácido ascórbico endovenoso; Reacción de Fenton, Mutaciones KRAS

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Referencias


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