Version May 2024
Note: 1 mL oral solution contains 2 mEq of potassium and the equivalent of 2 mEq of bicarbonate; 1 packet of crystals (powder for oral solution) contains 30 mEq of potassium and the equivalent of 30 mEq of bicarbonate. Individualize dose based on disease state and patient response.
Gout (adjuvant):
Powder: Oral: One packet dissolved in cool water or juice 4 times daily; adjust dose to urinary pH.
Solution: Oral: 10 to 30 mL 4 times daily; adjust dose based on urinary pH.
Renal tubular acidosis:
Powder: Oral: One packet dissolved in cool water or juice 4 times daily; adjust dose based on response.
Solution: Oral: 10 to 30 mL 4 times daily; adjust dose based on response.
Urine alkalinizer:
Powder: Oral: One packet dissolved in cool water or juice 4 times daily; adjust dose to urinary pH.
Solution: Oral: 10 to 30 mL 4 times daily; adjust dose based on urinary pH.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in manufacturer's labeling. Use is contraindicated in patients with anuria or severe renal impairment with oliguria or azotemia.
There are no dosage adjustments provided in manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Potassium citrate and citric acid (powder or solution): Pediatric drug information")
Note: Dosing presented as mEq bicarbonate and may be presented per dose or per day. Concentration or strength of product formulations may vary. Use caution. For US products, oral solution contains 2 mEq of potassium and the equivalent of 2 mEq of bicarbonate per 1 mL; crystals (powder for oral solution) contain 30 mEq of potassium and the equivalent of 30 mEq of bicarbonate per packet. Individualize dose based on disease state and patient response.
Ketogenic diet; adjunct therapy: Limited data available (Kossoff 2018): Children and Adolescents: Oral: 1 mEq bicarbonate/kg/dose twice daily; potassium citrate/citric acid has been shown to decrease the incidence of nephrolithiasis based on trial experience in 313 patients (McNally 2009); a smaller trial in 22 subjects reported potassium citrate prevented metabolic acidosis without loss of ketogenic diet efficacy (Bjurulf 2020).
Renal tubular acidosis (RTA), distal; type 1: Limited data available: Note: Adjust doses to achieve target bicarbonate levels.
Infants:
Note: Required doses are highly individualized and will decrease over time as growth rates change; monitor frequently. Doses may need to be divided more frequently than presented (eg, every feed) for tolerability and sustained metabolic control (ERKNet/ESPN [Trepiccione 2021]).
Normal serum bicarbonate (identified via screening): Oral: Initial: 1 to 2 mEq/kg/day in at least 4 divided doses (ERKNet/ESPN [Trepiccione 2021]).
Low serum bicarbonate: Oral: Initial: 3 to 5 mEq bicarbonate/kg/day in at least 4 divided doses; initiate therapy on the higher end of the range in patients with marked acidosis; titrate based on target serum bicarbonate; a range of ~2 to 10 mEq bicarbonate/kg/day has been reported, although some patients may require higher daily doses with close monitoring (ERKNet/ESPN [Trepiccione 2021]; Lopez-Garcia 2019; Rodríguez Soriano 2002; Santos 1986).
Children and Adolescents: Oral: Initial: 2 to 4 mEq bicarbonate/kg/day in 3 to 4 divided doses. Younger patients (ie, <6 years of age) may require higher doses to achieve targets (eg, up to 10 mEq bicarbonate/kg/day) (ERKNet/ESPN [Trepiccione 2021]; Giglio 2021; Lopez-Garcia 2019; Rodríguez Soriano 2002; Santos 1986; Soleimani 2016).
Systemic alkalinization; chronic: Limited data available: Infants, Children, and Adolescents: Oral: 2 to 3 mEq bicarbonate/kg/day in 3 to 4 divided doses; adjust dose to targeted serum bicarbonate levels; typical adult doses do not exceed 60 mEq/dose (Gal 2007).
Urine alkalinization, urolithiasis (cystinuria, uricosuria, hypocitraturia):
Fixed dosing: Children and Adolescents: Oral: 10 to 30 mEq bicarbonate/dose after meals and at bedtime; typical adult doses do not exceed 60 mEq bicarbonate/dose (manufacturer's labeling).
Weight-directed dosing: Limited data available: Infants, Children, and Adolescents: Oral: Reported range: 0.5 to 4 mEq bicarbonate/kg/day in 4 divided doses; titrate to target pH (dependent on stone composition) (Copelovitch 2012; Elder 2020; Penido 2015; Santos-Victoriano 1998). Per the manufacturer, in adults, when used for urine alkalinization, doses of 20 to 30 mEq bicarbonate administered 4 times daily typically maintain urinary pH 7 to 7.6.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in manufacturer's labeling. Use is contraindicated in patients with anuria or severe renal impairment with oliguria or azotemia.
There are no dosage adjustments provided in manufacturer's labeling.
See Potassium Citrate monograph.
Hypersensitivity to any ingredient of the formulation, severe renal insufficiency with oliguria or azotemia; untreated Addison disease; adynamia episodica hereditaria; acute dehydration; heat cramps; anuria; severe myocardial damage; hyperkalemia.
Concerns related to adverse effects:
• GI effects: May cause GI upset (eg, nausea, vomiting, diarrhea, abdominal pain, discomfort) and lead to GI ulceration, bleeding, perforation and/or obstruction requiring surgical intervention. Some fatal cases have been reported. Discontinue immediately if abdominal pain, distension, nausea, vomiting or GI bleeding occurs.
• Hyperkalemia: Close monitoring of serum potassium concentrations is needed to avoid hyperkalemia; severe hyperkalemia may lead to muscle weakness/paralysis and cardiac conduction abnormalities (eg, heart block, ventricular arrhythmias, asystole).
Disease-related concerns:
• Acid/base disorders: Use with caution in patients with acid/base alterations; changes in serum potassium concentrations can occur during acid/base correction, monitor closely.
• Cardiovascular disease: Use with caution in patients with cardiovascular disease (eg, heart failure, cardiac arrhythmias); patients may be more susceptible to life-threatening cardiac effects associated with hyper/hypokalemia.
• Hepatic impairment: Citrate is converted to bicarbonate in the liver; this conversion may be impaired in patients in hepatic failure.
• Potassium-altering conditions/disorders: Use with caution in patients with disorders or conditions likely to contribute to altered serum potassium and hyperkalemia.
• Renal impairment: Use with caution in patients with renal impairment; monitor serum potassium concentrations closely. Contraindicated in severe renal impairment with oliguria or azotemia.
• Severely ill: Citrate is converted to bicarbonate in the liver; this conversion may be impaired in patients who are severely ill or in shock.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer's labeling.
• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP ["Inactive" 1997]; Zar 2007).
Other warnings/precautions:
• Administration: Dilute with water to minimize GI injury; administer after meals to minimize saline laxative effect.
Some dosage forms may contain propylene glycol; in neonates, large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Powder: Each packet contains 30 mEq potassium and delivers equivalent of 30 mEq of bicarbonate.
Solution: Each 5 mL contains 10 mEq potassium and delivers equivalent of 10 mEq bicarbonate.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Powder for solution, oral:
Cytra-K: Potassium citrate monohydrate 3300 mg and citric acid monohydrate 1002 mg per packet (100s) [sugar free; fruit-punch flavor; each packet contains potassium 30 mEq equivalent to bicarbonate 30 mEq]
Solution, oral:
Cytra-K: Potassium citrate monohydrate 1100 mg and citric acid monohydrate 334 mg per 5 mL (480 mL) [ethanol free, sugar free; contains propylene glycol; cherry flavor; contains potassium 2 mEq/mL equivalent to bicarbonate 2 mEq /mL]
Generic: Potassium citrate monohydrate 1100 mg and citric acid monohydrate 334 mg per 5 mL (473 mL)
Yes
Solution (Potassium Citrate-Citric Acid Oral)
1100-334 mg/5 mL (per mL): $0.11 - $0.76
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral: Administer after meals (to avoid laxative effect) and at bedtime. Administer additional water or juice after the dose, if needed.
Oral: Dose should be diluted prior to administration to minimize injury due to high concentration of potassium; administer after meals and at bedtime to prevent saline laxative effect; may follow dose with additional water if necessary; dose may be chilled to improve palatability.
Gout (adjuvant): As an adjuvant to uricosurics in gout therapy.
Renal tubular acidosis: Treatment of acidosis in certain renal tubular disorders.
Urine alkalinizer: Alkalinizing agent in conditions where long-term maintenance of alkaline urine is desirable.
Polycitra may be confused with Bicitra
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Aliskiren: Potassium Salts may enhance the hyperkalemic effect of Aliskiren. Risk C: Monitor therapy
Alpha-/Beta-Agonists (Indirect-Acting): Alkalinizing Agents may increase the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). Risk C: Monitor therapy
Aluminum Hydroxide: Citric Acid Derivatives may increase the absorption of Aluminum Hydroxide. Risk C: Monitor therapy
Amantadine: Alkalinizing Agents may increase the serum concentration of Amantadine. Risk C: Monitor therapy
AMILoride: Potassium Salts may enhance the hyperkalemic effect of AMILoride. Management: Amiloride and potassium supplements should not be used except in severe or refractory cases of hypokalemia. If coadministered, monitor serum potassium closely as rapid increases in potassium are possible. Risk D: Consider therapy modification
Amphetamines: Alkalinizing Agents may decrease the excretion of Amphetamines. Management: Consider alternatives to using amphetamines and alkalinizing agents in combination. If these agents must be used together, patients should be monitored closely for excessive amphetamine effects. Risk D: Consider therapy modification
Angiotensin II Receptor Blockers: Potassium Salts may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy
Angiotensin-Converting Enzyme Inhibitors: Potassium Salts may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy
Anticholinergic Agents: May enhance the ulcerogenic effect of Potassium Citrate. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium citrate. Risk X: Avoid combination
Drospirenone-Containing Products: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Eplerenone: May enhance the hyperkalemic effect of Potassium Salts. Management: This combination is contraindicated in patients receiving eplerenone for treatment of hypertension. Potassium supplements may be needed to treat/prevent hypokalemia in select patients with heart failure receiving eplerenone and high dose loop diuretics. Risk D: Consider therapy modification
Finerenone: Potassium Salts may enhance the hyperkalemic effect of Finerenone. Risk C: Monitor therapy
Flecainide: Alkalinizing Agents may decrease the excretion of Flecainide. Risk C: Monitor therapy
Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Mecamylamine: Alkalinizing Agents may increase the serum concentration of Mecamylamine. Risk C: Monitor therapy
Memantine: Alkalinizing Agents may increase the serum concentration of Memantine. Risk C: Monitor therapy
Nicorandil: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Nonsteroidal Anti-Inflammatory Agents: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
QuiNINE: Alkalinizing Agents may increase the serum concentration of QuiNINE. Risk C: Monitor therapy
Spironolactone: Potassium Salts may enhance the hyperkalemic effect of Spironolactone. Risk X: Avoid combination
Triamterene: Potassium Salts may enhance the hyperkalemic effect of Triamterene. Risk X: Avoid combination
Refer to potassium citrate monograph for information.
Refer to potassium citrate monograph for information.
Take after meals to minimize laxative effect.
Serum creatinine, BUN, LFTs, serum potassium, serum bicarbonate, urinary pH.
Note: Reference ranges may vary depending on the laboratory
Urinary pH: 4.6-8.0
Metabolism: ≥95% via hepatic oxidation to bicarbonate; may be impaired in patients with hepatic failure, in shock, or who are severely ill; citric acid is metabolized to CO2 and H2O
Excretion: Urine (< 5% unchanged)
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
