sodium citrate/citric acid (Rx)

Brand and Other Names:Albrights Solution, Bicitra, more...Cytra 2, Oracit, Shohls Solution
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

sodium citrate/citric acid (1 mEq sodium equivalent to 1 mEq bicarbonate)

oral solution

  • (500mg/334mg)/5mL
  • (500mg/300mg)/5mL
  • (490mg/640mg)/5mL

Urine Alkalinization, Prevention of Nephrolithiasis

10-30 mL diluted in up to 6 oz water/juice PO PC & HS PRN

Follow with additional water if desired

Dosage Forms & Strengths

sodium citrate/citric acid (1 mEq sodium equivalent to 1 mEq bicarbonate)

oral solution

  • (500mg/334mg)/5mL
  • (500mg/300mg)/5mL
  • (490mg/640mg)/5mL

Urine Alkalinization, Prevention of Nephrolithiasis

<2 years: Based on physician's discretion

≥2 years: 5-15 mL diluted in 30-90 mL of water/juice PO PC & HS PRN

Follow with additional water if desired

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Interactions

Interaction Checker

and sodium citrate/citric acid

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      Serious - Use Alternative

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            Contraindicated (0)

              Serious - Use Alternative (21)

              • atazanavir

                sodium citrate/citric acid will decrease the level or effect of atazanavir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • dapsone

                sodium citrate/citric acid will decrease the level or effect of dapsone by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • dasatinib

                sodium citrate/citric acid will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • demeclocycline

                sodium citrate/citric acid decreases levels of demeclocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • digoxin

                sodium citrate/citric acid will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • doxycycline

                sodium citrate/citric acid decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • eltrombopag

                sodium citrate/citric acid decreases levels of eltrombopag by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Separate by at least 4 hours.

              • fleroxacin

                sodium citrate/citric acid decreases levels of fleroxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • gemifloxacin

                sodium citrate/citric acid decreases levels of gemifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • indinavir

                sodium citrate/citric acid will decrease the level or effect of indinavir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • itraconazole

                sodium citrate/citric acid will decrease the level or effect of itraconazole by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • ketoconazole

                sodium citrate/citric acid will decrease the level or effect of ketoconazole by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • levofloxacin

                sodium citrate/citric acid decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • minocycline

                sodium citrate/citric acid decreases levels of minocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • moxifloxacin

                sodium citrate/citric acid decreases levels of moxifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • nimodipine

                sodium citrate/citric acid will increase the level or effect of nimodipine by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • nisoldipine

                sodium citrate/citric acid will increase the level or effect of nisoldipine by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • nitrendipine

                sodium citrate/citric acid will increase the level or effect of nitrendipine by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • ofloxacin

                sodium citrate/citric acid decreases levels of ofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • oxytetracycline

                sodium citrate/citric acid decreases levels of oxytetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • tetracycline

                sodium citrate/citric acid decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              Monitor Closely (84)

              • acebutolol

                sodium citrate/citric acid decreases levels of acebutolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • alendronate

                sodium citrate/citric acid decreases levels of alendronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • allopurinol

                sodium citrate/citric acid decreases levels of allopurinol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • ampicillin

                sodium citrate/citric acid will decrease the level or effect of ampicillin by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • atenolol

                sodium citrate/citric acid decreases levels of atenolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • azithromycin

                sodium citrate/citric acid decreases levels of azithromycin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • bearberry

                sodium citrate/citric acid will increase the level or effect of bearberry by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

              • benazepril

                sodium citrate/citric acid decreases effects of benazepril by unspecified interaction mechanism. Use Caution/Monitor.

              • benzphetamine

                sodium citrate/citric acid will increase the level or effect of benzphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

              • betaxolol

                sodium citrate/citric acid decreases levels of betaxolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • bisoprolol

                sodium citrate/citric acid decreases levels of bisoprolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • capecitabine

                sodium citrate/citric acid increases levels of capecitabine by enhancing GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • captopril

                sodium citrate/citric acid decreases effects of captopril by unspecified interaction mechanism. Use Caution/Monitor. Sodium citrate/citric acid may decrease absorption of captopril.

              • carbonyl iron

                sodium citrate/citric acid will decrease the level or effect of carbonyl iron by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • carvedilol

                sodium citrate/citric acid decreases levels of carvedilol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • cefpodoxime

                sodium citrate/citric acid will decrease the level or effect of cefpodoxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • celecoxib

                sodium citrate/citric acid decreases levels of celecoxib by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • celiprolol

                sodium citrate/citric acid decreases levels of celiprolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • chenodiol

                sodium citrate/citric acid decreases levels of chenodiol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • ciprofloxacin

                sodium citrate/citric acid decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. A large proportion of ciprofloxacin is normally excreted unchanged in the urine. When urinary alkalinizing agents such as sodium citrate are used concomitantly, the solubility of ciprofloxacin can be decreased because of alkaline urine. Patients should be monitored for crystalluria and nephrotoxicity.

              • deferoxamine

                deferoxamine decreases levels of sodium citrate/citric acid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron; its affinity for other minerals is unknown.

              • dextroamphetamine

                sodium citrate/citric acid will increase the level or effect of dextroamphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

              • enalapril

                sodium citrate/citric acid decreases effects of enalapril by unspecified interaction mechanism. Use Caution/Monitor.

              • ephedrine

                sodium citrate/citric acid will increase the level or effect of ephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

              • erythromycin base

                sodium citrate/citric acid increases levels of erythromycin base by unknown mechanism. Use Caution/Monitor.

              • erythromycin ethylsuccinate

                sodium citrate/citric acid increases levels of erythromycin ethylsuccinate by unknown mechanism. Use Caution/Monitor.

              • erythromycin lactobionate

                sodium citrate/citric acid increases levels of erythromycin lactobionate by unknown mechanism. Use Caution/Monitor.

              • erythromycin stearate

                sodium citrate/citric acid increases levels of erythromycin stearate by unknown mechanism. Use Caution/Monitor.

              • esmolol

                sodium citrate/citric acid decreases levels of esmolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • etidronate

                sodium citrate/citric acid decreases levels of etidronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • ferric maltol

                sodium citrate/citric acid will decrease the level or effect of ferric maltol by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • ferrous fumarate

                sodium citrate/citric acid will decrease the level or effect of ferrous fumarate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • ferrous gluconate

                sodium citrate/citric acid will decrease the level or effect of ferrous gluconate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • ferrous sulfate

                sodium citrate/citric acid will decrease the level or effect of ferrous sulfate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • flecainide

                sodium citrate/citric acid will increase the level or effect of flecainide by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

              • fosamprenavir

                sodium citrate/citric acid will decrease the level or effect of fosamprenavir by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • fosinopril

                sodium citrate/citric acid decreases effects of fosinopril by unspecified interaction mechanism. Use Caution/Monitor.

              • gabapentin

                sodium citrate/citric acid decreases levels of gabapentin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • gabapentin enacarbil

                sodium citrate/citric acid decreases levels of gabapentin enacarbil by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • glipizide

                sodium citrate/citric acid will increase the level or effect of glipizide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • glyburide

                sodium citrate/citric acid will increase the level or effect of glyburide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • ibandronate

                sodium citrate/citric acid decreases levels of ibandronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • imidapril

                sodium citrate/citric acid decreases effects of imidapril by unspecified interaction mechanism. Use Caution/Monitor.

              • iron dextran complex

                sodium citrate/citric acid will decrease the level or effect of iron dextran complex by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • iron sucrose

                sodium citrate/citric acid will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • isoniazid

                sodium citrate/citric acid decreases levels of isoniazid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • itraconazole

                sodium citrate/citric acid decreases levels of itraconazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • ketoconazole

                sodium citrate/citric acid decreases levels of ketoconazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • labetalol

                sodium citrate/citric acid decreases levels of labetalol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • lactulose

                sodium citrate/citric acid decreases effects of lactulose by pharmacodynamic antagonism. Use Caution/Monitor.

              • lisinopril

                sodium citrate/citric acid decreases effects of lisinopril by unspecified interaction mechanism. Use Caution/Monitor.

              • memantine

                sodium citrate/citric acid will increase the level or effect of memantine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

              • methscopolamine

                sodium citrate/citric acid decreases levels of methscopolamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • metoprolol

                sodium citrate/citric acid decreases levels of metoprolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • mexiletine

                sodium citrate/citric acid will increase the level or effect of mexiletine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

              • moexipril

                sodium citrate/citric acid decreases effects of moexipril by unspecified interaction mechanism. Use Caution/Monitor.

              • mycophenolate

                sodium citrate/citric acid will decrease the level or effect of mycophenolate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • nadolol

                sodium citrate/citric acid decreases levels of nadolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • nebivolol

                sodium citrate/citric acid decreases levels of nebivolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • nitrofurantoin

                sodium citrate/citric acid decreases levels of nitrofurantoin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • omadacycline

                sodium citrate/citric acid will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

              • pamidronate

                sodium citrate/citric acid decreases levels of pamidronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • penbutolol

                sodium citrate/citric acid decreases levels of penbutolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • penicillamine

                sodium citrate/citric acid decreases levels of penicillamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • perindopril

                sodium citrate/citric acid decreases effects of perindopril by unspecified interaction mechanism. Use Caution/Monitor.

              • pindolol

                sodium citrate/citric acid decreases levels of pindolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • polysaccharide iron

                sodium citrate/citric acid will decrease the level or effect of polysaccharide iron by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • posaconazole

                sodium citrate/citric acid will decrease the level or effect of posaconazole by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • propranolol

                sodium citrate/citric acid decreases levels of propranolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • pseudoephedrine

                sodium citrate/citric acid will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

              • quinapril

                sodium citrate/citric acid decreases effects of quinapril by unspecified interaction mechanism. Use Caution/Monitor.

              • quinidine

                sodium citrate/citric acid will increase the level or effect of quinidine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor. Elevated quinidine plasma levels, possibly with cardiac conduction disturbances and arrhythmias, may occur.

              • ramipril

                sodium citrate/citric acid decreases effects of ramipril by unspecified interaction mechanism. Use Caution/Monitor.

              • risedronate

                sodium citrate/citric acid decreases levels of risedronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • rose hips

                sodium citrate/citric acid will decrease the level or effect of rose hips by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • rosuvastatin

                sodium citrate/citric acid decreases levels of rosuvastatin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • sarecycline

                sodium citrate/citric acid will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

              • sotalol

                sodium citrate/citric acid decreases levels of sotalol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • tiludronate

                sodium citrate/citric acid decreases levels of tiludronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • timolol

                sodium citrate/citric acid decreases levels of timolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • tolbutamide

                sodium citrate/citric acid will increase the level or effect of tolbutamide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • trandolapril

                sodium citrate/citric acid decreases effects of trandolapril by unspecified interaction mechanism. Use Caution/Monitor.

              • ursodiol

                sodium citrate/citric acid decreases effects of ursodiol by pharmacodynamic antagonism. Use Caution/Monitor.

              • zoledronic acid

                sodium citrate/citric acid decreases levels of zoledronic acid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              Minor (15)

              • aspirin

                sodium citrate/citric acid, aspirin. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • aspirin rectal

                sodium citrate/citric acid, aspirin rectal. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • aspirin/citric acid/sodium bicarbonate

                sodium citrate/citric acid, aspirin/citric acid/sodium bicarbonate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • balsalazide

                sodium citrate/citric acid, balsalazide. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • blessed thistle

                blessed thistle decreases effects of sodium citrate/citric acid by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction.

              • choline magnesium trisalicylate

                sodium citrate/citric acid, choline magnesium trisalicylate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • chromium

                sodium citrate/citric acid decreases levels of chromium by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Separate by 2 hours.

              • devil's claw

                devil's claw decreases effects of sodium citrate/citric acid by pharmacodynamic antagonism. Minor/Significance Unknown.

              • diflunisal

                sodium citrate/citric acid, diflunisal. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • mesalamine

                sodium citrate/citric acid, mesalamine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • salicylates (non-asa)

                sodium citrate/citric acid, salicylates (non-asa). Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • salsalate

                sodium citrate/citric acid, salsalate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • strontium ranelate

                sodium citrate/citric acid decreases levels of strontium ranelate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Separate by 2 hr when possible.

              • sulfasalazine

                sodium citrate/citric acid, sulfasalazine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • willow bark

                sodium citrate/citric acid, willow bark. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

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              Adverse Effects

              Frequency Not Defined

              Diarrhea

              Nausea

              Tetany

              Metabolic alkalosis

              Vomiting

              Stomach pain

              Fluid retention

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              Warnings

              Contraindications

              Hypersensitivity to drug or component of the formulation

              Severe renal impairment, oliguria, anuria, azotemia, acute dehydration, untreated Addison disease, adynamia episodica hereditaria, heat cramp, hyperkalemia, severe myocardial damage, sodium-restricted diet

              Cautions

              Use with caution in toxemia of pregnancy

              Contains sodium; use caution in patients with peripheral or pulmonary edema, severe renal impairment, hypertension, or heart failure

              Conversion to bicarbonate may be impaired; use caution in shock, severely ill, or hepatic failure

              Do not dilute in tomato juice

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              Pregnancy & Lactation

              Pregnancy Category: C

              Lactation: consult physician

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Alkalinizes urine; citrate binds with urinary calcium

              Pharmacokinetics

              Metabolism: Oxidized to sodium bicarbonate

              Excretion: Urine

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Cytra-2 oral
              -
              500-334 mg/5 mL solution
              Oracit oral
              -
              490-640 mg/5 mL solution
              Oracit oral
              -
              490-640 mg/5 mL solution
              Oracit oral
              -
              490-640 mg/5 mL solution
              sodium citrate-citric acid oral
              -
              500-334 mg/5 mL solution
              sodium citrate-citric acid oral
              -
              500-334 mg/5 mL solution

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              sodium citrate-citric acid oral

              CITRIC ACID/SODIUM CITRATE - ORAL

              (SIT-rik AS-id/SOE-dee-um SI-trate)

              COMMON BRAND NAME(S): Bicitra, Cytra-2, Oracit, Shohl's

              USES: This medication is used to make the urine less acidic. Urine that is less acidic helps the kidneys get rid of uric acid, helping to prevent gout and certain types of kidney stones (urate). This medication can also prevent and treat certain metabolic problems (acidosis) caused by kidney disease.Citric acid and citrate salts (which contain potassium and sodium) belong to a class of drugs known as urinary alkalinizers. Because some conditions require you to limit your intake of potassium and sodium, your doctor's choice of product may depend on how much potassium and sodium you can take.

              HOW TO USE: Shake the container well before each dose. Take this medication by mouth, usually 4 times a day or as directed by your doctor. To help prevent diarrhea and stomach upset, take each dose after a meal, and mix your prescribed dose of medication in a full glass (4 to 8 ounces or 120 to 240 milliliters) of cold water or juice just before taking, or take as directed by your doctor. Drink the entire mixture slowly. Ask your doctor or pharmacist for further instructions.The liquid form of this medication must be mixed with at least 4 ounces (120 milliliters) of water or juice before taking.Refrigerating the mixture before drinking may improve the taste. Drink more water or juice after taking this medication unless otherwise directed by your doctor.Dosage is based on your medical condition and response to treatment.Take this medication as prescribed. Do not increase your dose or take this more often without your doctor's approval. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.While taking this medication, you may need to test the pH (acidity) of your urine using special paper. The pH will help determine the proper dose. Consult your doctor or pharmacist for more information.

              SIDE EFFECTS: Nausea, vomiting, diarrhea, and stomach pain may occur. Mixing the medication with water or juice, taking it after meals, and drinking more fluids will help prevent these side effects. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if any of these unlikely but serious side effects occur: swelling of the hands/ankles/feet, tingling/numbness of the hands/feet, weakness.Tell your doctor right away if any of these rare but very serious side effects occur: fast/slow/irregular heartbeat, mental/mood changes (e.g., confusion, restlessness), muscle spasms, seizures.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: severe kidney disease (for example, if you are unable to make urine), a sodium-restricted diet, high sodium levels.Before using this medication, tell your doctor or pharmacist your medical history, especially of: a certain breathing problem (pulmonary edema), low calcium levels, high blood pressure, heart problems (e.g., irregular heartbeat, heart failure), kidney disease, swollen ankles/legs/feet due to retaining water (peripheral edema).Liquid forms of this product may contain sugar. Caution is advised if you have diabetes. Ask your doctor or pharmacist about using this product safely.Because this medication contains salt (sodium), tell your doctor if you are on a salt-restricted diet.During pregnancy, this medication should be used only when clearly needed. This medication may worsen high blood pressure during pregnancy (toxemia of pregnancy). Discuss the risks and benefits with your doctor.It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.This drug should not be used with the following medications because very serious interactions may occur: antacids that contain aluminum.If you are currently using any of these medications listed above, tell your doctor or pharmacist before starting this medication.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: aspirin and other salicylates (e.g., salsalate), lithium, quinidine.If your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: muscle spasms, seizures.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (e.g., sodium levels) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature between 68 and 77 degrees F (20 and 25 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets. Do not freeze. Protect from heat.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised March 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.