Renacidin (citric acid/glucono-delta-lactone/magnesium carbonate) dosing, indications, interactions, adverse effects, and more

Sections

Sections citric acid/glucono-delta-lactone/magnesium carbonate
Dosing & Uses
Adverse Effects
Warnings
Pregnancy
Pharmacology
Images
Patient Handout
Formulary

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

citric acid/glucono-delta-lactone/magnesium carbonate

renal irrigation solution

(1980.6mg/59.4mg/980.4mg)/30mL single-use plastic bottle

Renal Calculi

Indicated for local irrigation for dissolution of renal calculi composed of apatite (a calcium carbonate-phosphate compound) or struvite (magnesium ammonium phosphates) in patients who are not candidates for surgical removal

Also indicated as adjunctive therapy to dissolve residual apatite or struvite calculi and fragments after surgery or to achieve partial dissolution of renal calculi to facilitate surgical removal

Instilled via nephrostomy tube to permit calculus lavage; use second catheter for drainage if calculi obstruct ureter

Infuse NS at 60 mL/hr and increase until elevated pressure, pain, or maximum flow rate of 120 mL/hr reached

Start flow of infusion at maximum rate achieved with NS

Bladder Calculi

Indicated or dissolution of bladder calculi of the struvite or apatite variety by local intermittent irrigation through a urethral catheter or cystostomy catheter as an alternative or adjunct to surgical procedures

30 mL instilled through a urinary catheter into the bladder and the catheter is clamped for 30-60 minutes, release clamp and drain bladder

Repeat 4-6 times daily

Urinary Catheter Incrustation

Indicated for intermittent irrigation to prevent or minimize incrustations of indwelling urinary tract catheters

Instill 30 mL of the solution through the catheter and then clamp catheter for 10 minutes, after which the clamp is removed to allow drainage of the bladder

Repeat 3 times daily

Safety and efficacy not established

>10%

Flank pain, transient (>50%)

Fever (20-40%)

Urothelial ulceration with or without edema (13%)

Frequency Not Defined

Urinary tract infection

Back pain

Dysuria

Transient hematuria

Nausea

Hypermagnesemia

Hyperphosphatemia

Elevated serum creatinine

Candidiasis

Bladder irritability

Septicemia

Ileus

Vomiting

Thrombophlebitis

Contraindications

Hypersensitivity

Urinary tract infections (urea-splitting bacteria reside within struvite and apatite stones); dissolution therapy in the presence of an infected urinary tract may lead to sepsis and death

Treatment (dissolution) of calcium oxalate, uric acid, cysteine calculi

Cautions

Obtain urine specimen and culture prior to initiating chemolytic therapy and treat with appropriate antibiotic therapy if infection evident

Demonstrable urinary tract extravasation

An infected stone can serve as a continual source for infection and, therefore, antibiotic therapy should be continued throughout the course of dissolution therapy

Discontinue immediately if the patient develops fever, urinary tract infection, signs and symptoms consistent with urinary tract infection, or persistent flank pain.

Discontinue if hypermagnesemia or elevated serum creatinine develops

Sterile urine must be present prior to initiating therapy

Concurrent use of magnesium containing medications may contribute to production of hypermagnesemia

Maintain patency of the irrigating catheter; calculus fragments and debris may obstruct the outflow catheter

Intrapelvic pressures must be maintained at or below 25cm of water

Patients with indwelling urethral or cystostomy catheters frequently have vesicoureteral reflux; cystogram prior to initiation irrigation is essential for such patients; if reflux demonstrated, all precautions recommended for renal pelvis irrigation must be taken

Monitor serum creatinine, phosphate, and magnesium every several days

Urine specimens should be collected for culture and antibacterial sensitivity q3Days or less and at the first sign of fever

Pregnancy & Lactation

Pregnancy Category: C; generally avoided in pregnancy

Lactation: Magnesium is known to be excreted in human milk; unknown whether Renacidin components distributed in breast milk, caution advised

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.

Mechanism of Action

Action on susceptible apatite calculi results from an exchange of magnesium from the irrigating solution for calcium contained in the stone matrix; resulting magnesium salts formed are soluble in the glucono-citrate irrigating solution, thereby resulting in the calculus dissolution

Struvite calculi are composed mainly of magnesium ammonium phosphates which are solubilized by Renacidin Irrigation due to its acidic pH (ie, 3.85)

BRAND	FORM.	UNIT PRICE	PILL IMAGE
Renacidin irrigation -	1980.6 mg-59.4 mg-980.4mg/30mL solution

Patient Handout

NO MONOGRAPH AVAILABLE AT THIS TIME

USES: Consult your pharmacist.

HOW TO USE: Consult your pharmacist.

SIDE EFFECTS: Consult your 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: Consult your pharmacist.

DRUG INTERACTIONS: Consult your pharmacist.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.

NOTES: No monograph available at this time.

MISSED DOSE: Consult your pharmacist.

STORAGE: Consult your pharmacist.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.

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.

Formulary

FormularyPatient Discounts

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View the formulary and any restrictions for each plan.
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Compare formulary status to other drugs in the same class.
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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.

View explanations for tiers and restrictions

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.

Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

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