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|Tricitrates

CITRATES (Systemic)

Some commonly used brand names are:

In the U.S.—

• Bicitra ⁴
• Citrolith ³
• Oracit ⁴
• Polycitra-K ²
• Polycitra-K Crystals ²
• Polycitra-LC ⁵
• Polycitra Syrup ⁵
• Urocit-K ¹

In Canada—

• Oracit ⁴

Other commonly used names for sodium citrate and citric acid are Albright"s solution and modified Shohl"s solution .

Category

• Alkalizer, systemic—Potassium Citrate and Citric Acid; Sodium Citrate and Citric Acid; Tricitrates
• Alkalizer, urinary—Potassium Citrate; Potassium Citrate and Citric Acid; Potassium Citrate and Sodium Citrate; Sodium Citrate and Citric Acid; Tricitrates
• Antiurolithic, calcium oxalate calculi—Potassium Citrate; Potassium Citrate and Citric Acid
• Antiurolithic, calcium phosphate calculi—Potassium Citrate; Potassium Citrate and Citric Acid
• Antiurolithic, cystine calculi—Potassium Citrate; Potassium Citrate and Citric Acid; Potassium Citrate and Sodium Citrate; Sodium Citrate and Citric Acid; Tricitrates
• Antiurolithic, uric acid calculi—Potassium Citrate; Potassium Citrate and Citric Acid; Potassium Citrate and Sodium Citrate; Sodium Citrate and Citric Acid; Tricitrates
• Buffer, neutralizing—Sodium Citrate and Citric Acid; Tricitrates

Description

Citrates (SIH-trayts) are used to make the urine more alkaline (less acid). This helps prevent certain kinds of kidney stones. Citrates are sometimes used with other medicines to help treat kidney stones that may occur with gout. They are also used to make the blood more alkaline in certain conditions.

Citrates are available only with your doctor"s prescription, in the following dosage forms:

• Oral
• Potassium Citrate
  • Tablets (U.S.)
• Potassium Citrate and Citric Acid
  • Oral solution (U.S.)
  • Crystals for oral solution (U.S.)
• Potassium Citrate and Sodium Citrate
  • Tablets (U.S.)
• Sodium Citrate and Citric Acid
  • Oral solution (U.S. and Canada)
• Tricitrates
  • Oral solution (U.S.)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For citrates, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to potassium citrate or potassium. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Studies on effects in pregnancy have not been done in either humans or animals.

Breast-feeding—Although it is not known whether citrates pass into the breast milk, this medicine has not been reported to cause problems in nursing babies.

Children—Although there is no specific information comparing use of citrates in children with use in other age groups, these medicines are not expected to cause different side effects or problems in children than they do in adults.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of citrates in the elderly with use in other age groups.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking citrates, it is especially important that your health care professional know if you are taking any of the following:

• Amiloride (e.g., Midamor) or
• Benazepril (e.g., Lotensin) or
• Captopril (e.g., Capoten) or
• Digitalis glycosides (heart medicine) or
• Enalapril (e.g., Vasotec) or
• Fosinopril (e.g., Monotril) or
• Heparin (e.g., Panheprin) or
• Lisinopril (e.g., Prinivil; Zestril) or
• Medicines for inflammation or pain (except narcotics) or
• Potassium-containing medicines (other) or
• Quinapril (e.g., Accuprol) or
• Ramipril (e.g., Altase) or
• Salt substitutes, low-salt foods or milk or
• Spironolactone (e.g., Aldactone) or
• Triamterene (e.g., Dyrenium)—Use with potassium-containing citrates may further increase potassium blood levels, possibly leading to serious side effects

• Antacids, especially those containing aluminum or sodium bicarbonate—Use with citrates may increase the risk of kidney stones; also, citrates may increase the amount of aluminum in the blood and cause serious side effects, especially in patients with kidney problems

• Methenamine (e.g., Mandelamine)—Use with citrates may make the methenamine less effective

• Quinidine (e.g., Quinidex)—Use with citrates may cause quinidine to build up in the bloodstream, possibly leading to serious side effects

Other medical problems—The presence of other medical problems may affect the use of citrates. Make sure you tell your doctor if you have any other medical problems, especially:

• Addison"s disease (underactive adrenal glands) or
• Type 2 diabetes mellitus or
• Kidney disease—The potassium in potassium-containing citrates may worsen or cause heart problems in patients with these conditions

• Diarrhea (chronic)—Treatment with citrates may not be effective; a change in dose of citrate may be needed

• Edema (swelling of the feet or lower legs) or
• High blood pressure or
• Toxemia of pregnancy—The sodium in sodium-containing citrates may cause the body to retain (keep) water

• Heart disease—The sodium in sodium-containing citrates may cause the body to retain (keep) water; the potassium in potassium-containing citrates may make heart disease worse

• Intestinal or esophageal blockage—Potassium citrate tablets may cause irritation of the stomach or intestines

• Stomach ulcer or other stomach problems—Potassium citrate-containing products may make these conditions worse

• Urinary tract infection—Citrates may make conditions worse

Proper Use of This Medicine

For patients taking the tablet form of this medicine :

• Swallow the tablets whole. Do not crush, chew, or suck the tablet.
• Take with a full glass (8 ounces) of water.
• If you have trouble swallowing the tablets or they seem to stick in your throat, check with your doctor at once . If this medicine is not completely swallowed and not properly dissolved, it can cause severe irritation.

For patients taking the liquid form of this medicine :

• Dilute with a full glass (6 ounces) of water or juice and drink; follow with additional water, if desired.
• Chill, but do not freeze, this medicine before taking it, for a better taste.

For patients taking the crystals form of this medicine :

• Add the contents of one packet to at least 6 ounces of cool water or juice.
• Stir well to make sure the crystals are completely dissolved.
• Drink all the mixture to be sure you are taking the correct dose. Follow with additional water or juice, if desired.

Take each dose immediately after a meal or within 30 minutes after a meal or bedtime snack . This helps prevent the medicine from causing stomach pain or a laxative effect.

Drink at least a full glass (8 ounces) of water or other liquid (except milk) every hour during the day (about 3 quarts a day), unless otherwise directed by your doctor . This will increase the flow of urine and help prevent kidney stones.

Take this medicine only as directed by your doctor . Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. This is especially important if you are also taking a diuretic (water pill) or digitalis medicine for your heart .

Dosing—The dose of these single or combination medicines will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets that you take or of teaspoonfuls or ounces of solution that you drink depends on the strength of the single or combination medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking this single or combination medicine .

• For potassium citrate
• For oral dosage form (tablets):
  • To make the urine more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 1.08 to 2.16 grams three times a day with meals. Some people may take 1.62 grams four times a day with meals or within thirty minutes after a meal or bedtime snack. Your doctor may change your dose if needed. However, most people usually will not take more than 10.8 grams a day.
    • Children—Dose must be determined by your doctor.

• For potassium citrate and citric acid
• For oral dosage form (solution):
  • To make the urine or blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 2 to 3 teaspoonfuls of solution, mixed with water or juice, four times a day, after meals and at bedtime. Your doctor may change the dose if needed.
  • To make the urine more alkaline (less acidic):
    • Children—At first, 1 to 3 teaspoonfuls of solution, mixed with water or juice, four times a day after meals and at bedtime. Your doctor may change the dose if needed.
• For oral dosage form (crystals for solution):
  • To make the urine or blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 3.3 grams of potassium citrate, mixed with water or juice, four times a day, after meals and at bedtime. Your doctor may change the dose if needed.
    • Children—Use is not recommended.

• For potassium citrate and sodium citrate
• For oral dosage form (tablets):
  • To make the urine more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 1 to 4 tablets after meals and at bedtime.
    • Children—Dose must be determined by your doctor.

• For sodium citrate and citric acid
• For oral dosage form (solution):
  • To make the urine and blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 2 to 6 teaspoonfuls of solution four times a day, after meals and at bedtime. The solution should be mixed in one to three ounces of water. Your doctor may change the dose if needed. However, most people will usually not take more than five ounces a day.
  • To make the contents of the stomach less acidic before surgery:
    • Adults—1 to 2 tablespoonfuls as a single dose. You may mix it in one to two tablespoonfuls of water.
  • To make the blood more alkaline (less acidic):
    • Children—At first, 1 to 3 teaspoonfuls of solution four times a day, after meals and at bedtime. The solution should be mixed in one to three ounces of water. Your doctor may change the dose if needed.

• For tricitrates
• For oral dosage form (solution):
  • To make the urine and blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 1 to 2 tablespoonfuls of solution four times a day, after meals and at bedtime. Your doctor may change the dose if needed.
  • To make the contents of the stomach less acidic before surgery:
    • Adults—1 tablespoonful as a single dose. You should mix the solution in one tablespoonful of water.
  • To make the urine or blood more alkaline (less acidic):
    • Children—At first, 5 to 10 mL four times a day after meals and at bedtime. Your doctor may change the dose if needed.

Missed dose—If you miss a dose of this medicine, take it as soon as possible if remembered within 2 hours. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Keep the liquid form of this medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

It is important that your doctor check your progress at regular visits. This is to make sure the medicine is working properly and to check for unwanted effects.

Do not eat salty foods or use extra table salt on your food while you are taking citrates. This will help prevent kidney stones and unwanted effects.

Check with your doctor before starting any strenuous physical exercise, especially if you are out of condition and are taking any other medication. Exercise and certain medications may increase the amount of potassium in the blood.

For patients taking potassium citrate-containing medicines :

• Do not use salt substitutes and low-salt milk unless told to do so by your doctor. They may contain potassium.
• Check with your doctor at once if you are taking the tablet form and notice black, tarry stools or other signs of stomach or intestinal bleeding .
• Do not be alarmed if you notice what appears to be a whole tablet in the stool after taking potassium citrate tablets. Your body has received the proper amount of medicine from the tablet and has expelled the tablet shell. However, it is a good idea to check with your doctor also.
• If you are on a potassium-rich or potassium-restricted diet, check with your health care professional. Potassium citrate-containing medicines contain a large amount of potassium.

For patients taking sodium citrate-containing medicines :

• If you are on a sodium-restricted diet, check with your health care professional. Sodium citrate-containing medicines contain a large amount of sodium.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Stop taking this medicine and check with your doctor immediately if any of the following side effects occur :

Also, check with your doctor as soon as possible if any of the following side effects occur:

Confusion; convulsions (seizures); dizziness; high blood pressure; irregular or fast heartbeat; irritability; mood or mental changes; muscle pain or twitching; nervousness or restlessness; numbness or tingling in hands, feet, or lips; shortness of breath, difficult breathing, or slow breathing; swelling of feet or lower legs; unexplained anxiety; unpleasant taste; unusual tiredness or weakness; weakness or heaviness of legs

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Revised: 08/29/1994

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