potassium citrate

Potassium citrate is a medication used in the management of kidney conditions that promote formation of kidney stones (nephrolithiasis), including renal tubular acidosis and low citrate excretion in the urine (hypocitraturia).

Renal tubular acidosis is a condition of excessive urine acidity caused when the kidneys are unable to remove the acid wastes from the blood as efficiently as they should, which can lead to the formation of calcium oxalate stones in the kidneys. Inadequate citrate in the urine is another risk factor for kidney stone formation.

Kidney stones tend to form in an acidic environment, and reduction in urinary acidity prevents the crystallization of stone-forming salts including calcium oxalate, calcium phosphate and uric acid. Potassium citrate increases urinary citrate and pH levels, making the urine more alkaline and less conducive to crystallization of urinary salts. Potassium citrate also increases urinary potassium, and in some patients, causes a transient decrease in urinary calcium.

Potassium citrate works in multiple ways to prevent kidney stones. Increased citrate in the urine forms complexes with calcium, and reduces calcium ion activity and calcium oxalate saturation. Citrate also inhibits the spontaneous nucleation of calcium oxalate and calcium phosphate. The increase in pH also decreases calcium ion activity, promoting citrate complexation with calcium. The higher alkalinity increases the ionization of uric acid to the more soluble urate ion.

The FDA-approved uses of potassium citrate include:

• Renal tubular acidosis with calcium stones
• Hypocitraturic calcium oxalate nephrolithiasis from any cause
• Uric acid lithiasis with or without calcium stones

• Do not use in patients with hypersensitivity to any of the components in the potassium citrate formulation.
• Do not use potassium citrate in patients with high blood potassium levels (hyperkalemia) or predisposition for hyperkalemia, further increase in potassium levels can lead to cardiac arrest. Conditions that predispose an individual for hyperkalemia include:
  • Chronic kidney failure
  • Kidney insufficiency
  • Uncontrolled diabetes mellitus
  • Adrenal insufficiency
  • Extensive tissue breakdown from injury or trauma
  • Acute dehydration
  • Strenuous exercise in unconditioned individuals
• Do not administer potassium citrate concurrently with potassium-sparing medications such as triamterene, spironolactone or amiloride.
• Do not administer potassium citrate to patients who have conditions that may delay the passage of the tablet through the gastrointestinal system, including:
  • Esophageal compression
  • Delayed gastric emptying
  • Gastrointestinal obstruction or stricture
  • Concomitant anticholinergic treatment
• Do not use potassium citrate in patients with urinary tract infection, the bacterial enzyme may degrade citrate. The increased pH may promote bacterial growth.
• Do not use it in patients with peptic ulcer disease, potassium citrate may exacerbate the condition.
• Patients with cardiovascular diseases such as heart failure or cardiac arrhythmia are at a higher risk for life-threatening cardiac effects from hyperkalemia. Use potassium citrate with caution and monitor closely with ECGs and blood tests.
• There have been reports of ulcerative lesions in the gastrointestinal passage caused by local concentration of potassium ions in the region of dissolving tablets. Discontinue the drug immediately if the patient develops severe vomiting, abdominal pain or gastrointestinal bleeding and investigate the possibility of bowel obstruction or perforation.
• Use with caution in patients with acid-base disorders, and impaired liver or kidney function.
• Closely monitor potassium levels in patients taking concomitant non-steroidal anti-inflammatory drugs (NSAIDs), NSAIDs may cause potassium retention.

Common side effects of potassium citrate include:

• High blood potassium levels (hyperkalemia)
• Abdominal discomfort
• Nausea
• Vomiting
• Diarrhea

Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:

• Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
• Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
• Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
• Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Tablet, Extended Release

• 5 mEq
• 10 mEq
• 15 mEq

Adult:

Alkalinizing Agent

Mild to Moderate Hypocitraturia

• Urinary citrate more than 150 mg/day
• Immediate release: 10 mEq 3 times daily; not to exceed 100 mEq/day
• Extended release: 15 mEq 2 times daily or 10 mEq 3 times daily; not to exceed 100 mEq/day

Severe Hypocitraturia

• Urinary citrate less than 150 mg/day
• Immediate release: 20 mEq 3 times daily or 15 mEq 4 times daily; not to exceed 100 mEq/day
• Extended release: 30 mEq 2 times daily or 20 mEq 3 times daily; not to exceed 100 mEq/day

Maintenance

• Titrate dose to achieve urinary citrate 320-640 mg/day and urinary pH 6.0-7.0 (maximum dose 100 mEq/day)

Dosing considerations

• Administer dose with meals or within 30 minutes after meals or bedtime snack
• Twenty-four-hour urinary citrate and/or urinary pH measurements should be used to determine adequacy of initial dosage and to evaluate the effectiveness of any dosage change

Pediatric:

• Safety and efficacy not established

• Potassium citrate can increase blood potassium to dangerously high levels (hyperkalemia). Hyperkalemia may be asymptomatic except for high concentration of potassium in blood and ECG changes, but can lead to muscle paralysis, cardiovascular collapse and cardiac arrest.
• Patients with potassium citrate overdose should be monitored closely for electrolyte imbalance and irregular heart rhythm. Overdose may be treated with:
  • Discontinuation of potassium-containing and potassium-sparing medications
  • Elimination of foods containing potassium
  • Intravenous fluids and appropriate medications
  • Hemodialysis or peritoneal dialysis

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Potassium citrate has no known severe interactions with other drugs.
• Serious Interactions of potassium citrate include:
  • dextroamphetamine transdermal
  • drospirenone
  • potassium acid phosphate
  • potassium chloride
  • potassium phosphates, IV
  • spironolactone
  • triamterene
• Potassium citrate has moderate interactions with at least 101 different drugs.
• Potassium citrate has mild interactions with at least 26 different drugs.

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

• It is not known if potassium citrate can affect reproductive capacity in women of pregnancy potential, or cause fetal harm if administered to a pregnant woman. Potassium citrate should be used during pregnancy only if clearly needed.
• It is not known if potassium citrate affects the normal potassium ion content of breast milk. Potassium citrate should be administered to a nursing mother only if clearly needed.

• Take potassium citrate tablet exactly as prescribed. Do not crush, chew or suck.
• You may require regular blood tests and ECGs while on potassium citrate, follow up with your doctor.
• Notify your physician immediately if you notice tarry stools or other signs of gastrointestinal bleeding.
• Store safely out of reach of children.
• In case of overdose, seek medical help immediately or contact Poison Control.