Generic
Potassium Citrate
6 brands available in the market
At a glance
Potassium Citrate is used for the treatment of renal tubular acidosis (RTA) with calcium stones, hypocitraturic calcium oxalate nephrolithiasis, and uric acid lithiasis with or without calcium stones. It alkalinizes urine and citrate binds with urinary calcium, preventing stone formation.
Description
When Potassium Citrate is given orally, metabolism of absorbed citrate produces an alkaline load that increases urinary pH and raises urinary citrate by augmenting citrate clearance. These changes produce urine that is less conducive to crystallization of stone-forming salts (calcium oxalate, calcium phosphate, and uric acid). Citrate complexes with calcium, decreasing calcium ion activity and saturation of calcium oxalate, and inhibits spontaneous nucleation of calcium oxalate and calcium phosphate.
Indications
- Renal tubular acidosis (RTA) with calcium stones
- Hypocitraturic calcium oxalate nephrolithiasis
- Uric acid lithiasis with or without calcium stones
Therapeutic class
Prevention of repeated kidney stone formation
Pharmacological class
Urinary Alkalinizing Agent
Pharmacology
Potassium Citrate administration produces an alkaline load through metabolism of absorbed citrate, increasing urinary pH and citrate. Citrate complexes with calcium, decreasing calcium ion activity and calcium oxalate saturation, and inhibits spontaneous nucleation of calcium oxalate and calcium phosphate. The rise in urinary pH also increases ionization of uric acid to the more soluble urate ion.
Mechanism of action
Prevents stone formation by alkalinizing urine and complexing with calcium.
Dosage
Adult Dose (Oral):
- Severe hypocitraturia (urinary citrate <150 mg/day): 60 mEq/day (30 mEq twice daily or 20 mEq three times daily, with meals or within 30 minutes after)
- Mild-moderate hypocitraturia (urinary citrate >150 mg/day): 30 mEq/day (15 mEq twice daily or 10 mEq three times daily)
- Maintenance: Titrate to achieve urinary citrate 320-640 mg/day & urinary pH 6.0-7.0 (max 100 mEq/day)
Administration
- Take with meals or within 30 minutes after meals
- Swallow tablets whole; do not chew, crush, or break
- Take at the same time each day
Missed dose
If you miss a dose, take it as soon as you remember; skip if it's almost time for next dose; do not double the dose.
Side effects
Side Effects:
- Abdominal discomfort
- Vomiting
- Diarrhea
- Loose bowel movements
- Nausea
- Hyperkalemia
Precautions & warnings
- Hyperkalemia: Contraindicated in chronic renal failure, uncontrolled DM, acute dehydration, adrenal insufficiency, extensive tissue breakdown
- Gastrointestinal lesions: Discontinue if severe vomiting, abdominal pain, or GI bleeding occurs; investigate for bowel perforation or obstruction
Contraindications
- Hyperkalemia or conditions predisposing to hyperkalemia (chronic renal failure, uncontrolled DM, acute dehydration, strenuous exercise in unconditioned individuals, adrenal insufficiency, extensive tissue breakdown)
- Delay or arrest in tablet passage through GI tract (delayed gastric emptying, esophageal compression, intestinal obstruction or stricture)
- Peptic ulcer disease
- Active urinary tract infection
- Renal insufficiency (GFR <0.7 mL/kg/min)
Drug interactions
- Potassium-sparing diuretics: Avoid concomitant use (severe hyperkalemia)
- Anticholinergics (slow GI transit time): Increase gastrointestinal irritation from potassium salts
- Renin-angiotensin-aldosterone inhibitors, NSAIDs: Monitor for hyperkalemia
Food interactions
Take with meals to reduce GI side effects; it is not known whether it is safe to consume alcohol.
Use in pregnancy
Use in Pregnancy: Animal reproduction studies not conducted; use only if clearly needed.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Normal potassium ion content of human milk is about 13 mEq/L; use only if clearly needed.
Pediatric use
Safety and efficacy not established in children.
Geriatric use
Caution required in elderly patients; dose adjustment may be needed.
Renal / hepatic impairment
Renal Impairment: Contraindicated in GFR <0.7 mL/kg/min; avoid in chronic renal failure; consult your doctor.
Hepatic Impairment: Caution in liver disease; consult your doctor.
Overdose effects
Overdose: Hyperkalemia (usually asymptomatic; manifested by EKG changes); treatment: discontinue potassium-containing medications/foods, IV calcium gluconate, IV dextrose + insulin, sodium bicarbonate, hemodialysis/peritoneal dialysis.
Storage conditions
Store below 30°C, away from light and moisture; keep out of reach of children.
Chemical structure
Potassium Citrate