Nephrology

5415 CITRATE AND CITRIC ACID SOLUTIONS

  • Citrate and Citric Acid Solutions

    Patients receiving sodium-restricted diet (sodium salts); severe renal impairment with oliguria, azotemia, or anuria; untreated Addison's disease, acute dehydration, heat cramps, severe myocardial damage, hyperkalaemia (potassium salts).

    Warnings

    Conversion to bicarbonate may be impaired in patients with hepatic failure or in shock.

    Adverse Reactions

    Endocrine and metabolic:   Metabolic alkalosis, hypernatraemia (if sodium salt used), hypocalcaemia; hyperkalaemia (if product containing potassium used).

    Gastrointestinal:   Laxative effect.

    Drug Interactions

    Chlorpropamide, lithium, methenamine, methotrexate, salicylates, and tetracycline increase urinary excretion with alkaline urine.

    Anorexiants, flecainide, mecamylamine, quinidine, and sympathomimetics decrease urinary excretion with alkaline urine.

    Mechanism of Action

    Citrate salts are oxidized in the body to form bicarbonate.

    Usual Dosage

    Oral (dilute in water or juice):

    Infants and Children: 2-3 mEq/kg/day in divided doses 3-4 times/day or 5-15 mL with water after meals and at bedtime.

    Adults: 15-30 mL with water after meals and at bedtime.

    Dosage Forms

    Solution, oral:

    Bicitra: Sodium citrate 500 mg and citric acid 334 mg/5 ml (1 mEq sodium and 1 mEq bicarbonate equivalent per ml) (15 ml unit dose, 480 ml).

    Oracit: Sodium citrate 490 mg and citric acid 640 mg/5 ml (1 mEq sodium and 1 mEq bicarbonate equivalent per ml).

    Polycitra: Sodium citrate 500 mg and citric acid 334 mg/5 ml (1 mEq potassium, 1 mEq sodium, 2 mEq bicarbonate equivalent per ml).

    Polycitra-LC: Potassium citrate monohydrate 550 mg, sodium citrate dihydrate 500 mg, citric acid monohydrate 334 mg/5 ml (1 mEq potassium, 1 mEq sodium).

    Polycitra K: Crystals and solution:  Potassium citrate monohydrate 1100 mg, citric acid monohydrate 334 mg/5 ml (2 mEq potassium and 2 mEq bicarbonate equivalent per ml).