LTC Pharmacy Services Update: Vitamin C and Zinc in Wound Healing

At Grane Rx, we’re committed to providing the highest-quality LTC pharmacy services. As part of that commitment, we share an ongoing series of pharmacy updates from our Chief Clinical Officer, designed to keep you in the know on clinical topics related to longterm care pharmacy and PACE pharmacy. At times, residents are ordered the combination of vitamin C and zinc for wound prevention and healing. The idea of using vitamin C as a supplement in wound healing has been discussed since 1937 when two Harvard medical school surgeons published an article concerning its use for this purpose. Since then, there have been some additional studies and opinion articles written on the topic, but there have been no well-powered, randomized, controlled trials (RCTs) evaluating whether the use of vitamin C (and also zinc) is efficient in helping wounds heal. This bears the question: is using this vitamin and mineral supplement combination for wound healing potentially beneficial?

Considerations for the Use of Vitamin C in LTC Pharmacy Services

When residents are experiencing vitamin C deficiency, they have impaired collagen cross-linking, reduced wound tensile strength and increased wound dehiscence (rupture along a surgical incision). The elderly are at the highest risk due to poor dietary intake and malnutrition. According to the Hospital of the University of Pennsylvania, a resident is indicated for vitamin C supplementation when there is a deficiency. However, the level of deficiency is difficult to determine—and thus, the appropriate dosing is also difficult to determine. Supplement dosing needs to also take into consideration whether a resident is taking a multivitamin, as this may already provide some vitamin C supplementation. While vitamin C is essential in wound healing, vitamin C supplements may interact with other medications, such as chemotherapy drugs and warfarin, which are both common among residents needing LTC pharmacy services. Vitamin C total intake should not exceed 2 grams per day, as there is no added benefit from higher doses. In fact, high doses of vitamin C have been associated with many serious adverse effects, such as blood clotting, kidney stones, digestive system problems and red blood cell destruction.

Considerations for the Use of Zinc in LTC Pharmacy Services

When residents are experiencing a zinc deficiency, they have reduced wound strength, decreased collagen synthesis and decreased immunity. Some risk factors for deficiency are wound vac drainage, diarrhea and malabsorption. According to the Hospital of the University of Pennsylvania, zinc supplementation is indicated when zinc is deficient; but, as with vitamin C, this is difficult to determine. In comparison to vitamin C, zinc is not essential to wound healing, it simply stimulates it. If zinc supplementation is used long term, it is possible that a copper supplement may also be needed. It has also been found that high doses of zinc can suppress the immune system and have even been linked to an increased risk of some cancers. [Tweet “In this #LTCpharmacyservices update, learn about how supplements affect wound healing”]

The Bottom Line: Vitamin C and Zinc in LTC Pharmacy Services

Taking into consideration all of the information available, the routine use of vitamin C and zinc supplementation for wound healing is not recommended. Vitamin C and zinc supplementation may be considered on a case-by-case basis, but it’s important to look at the whole picture of the resident to determine if supplementation is actually appropriate. When well-powered RCTs and more information on the topic become available, a re-evaluation of this recommendation will need to occur.       Our post acute care pharmacy team stays up to date with the latest clinical information—and utilizes that information to the benefit of SNF residents. Get started today by calling (866) 824-MEDS (6337).]]>

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