potassium citrate (Rx)

Brand and Other Names:Urocit K
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet, extended release

  • 5mEq
  • 10mEq
  • 15mEq

Alkalinizing Agent

Mild to Moderate Hypocitraturia

  • Urinary citrate >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 dialy; not to exceed 100 mEq/day

Severe Hypocitraturia

  • Urinary citrate <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 & 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

Safety and efficacy not established

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Interactions

Interaction Checker

and potassium citrate

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            Warnings

            Contraindications

            Hypersensitivity, hyperkalemia, Addison's disease, anuria, uncontrolled DM, acute dehydration, adrenal insufficiency, renal insufficiency (GFR <0.7ml/kg/min)

            Delayed gastric emptying, esophageal compression, GI obstruction, concomitant anticholinergic therapy, peptic ulcer disease, active UTI

            Concomitant K+-sparing agents (e.g., triamterene, spironolactone, amiloride)

            In patients with active urinary tract infection (with either urea-splitting or other organisms, in association with either calcium or struvite stones)

            Cautions

            Use with caution in patients with acid/base alteration (monitor)

            Not for use when experiencing urinary tract infections; the ability of drug to increase urinary citrate may be attenuated by bacterial enzymatic degradation of citrate. Moreover, the rise in urinary pH resulting from therapy might promote further bacterial growth

            Use with caution in patients with cardiovascular disease (higher risk of life-threatening cardiac effects associated with hyper/hypokelemia

            Gastrointestinal lesions

            • Abdominal discomfort, vomiting, diarrhea, loose bowel movements or nausea may occur
            • Solid dosage forms of potassium chlorides have produced stenotic and/or ulcerative lesions of the small bowel and deaths; these lesions are caused by a high local concentration of potassium ions in the region of the dissolving tablets, which injured the bowel
            • Perhaps because wax-matrix preparations are not enteric-coated and release some of their potassium content in the stomach, there have been reports of upper gastrointestinal bleeding associated with these products
            • If there is severe vomiting, abdominal pain, or gastrointestinal bleeding, drug should be discontinued immediately and the possibility of bowel perforation or obstruction investigated

            Hyperkalemia

            • Large doses may cause hyperkalemia and alkalosis, especially in renal impairment
            • Use caution in patients receiving therapy that increases potassium levels (ACE inhibitors, potassium-based salt substitutes, sparing diuretics)
            • Use caution in patients with disorders that may contribute to altered serum potassium and hyperkalemia including untreated Addison's disease, heat cramps, or severe tissue breakdown from trauma or burns)
            • In patients with impaired mechanisms for excreting potassium, administration of drug can produce hyperkalemia and cardiac arrest; potentially fatal hyperkalemia can develop rapidly and be asymptomatic
            • Avoid use in patients with chronic renal failure or any other condition which impairs potassium excretion such as severe myocardial damage or heart failure; closely monitor for signs of hyperkalemia with periodic blood tests and ECGs

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Excreted in breast milk; not recommended

            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

            Onset: 1 hr

            Duration: 12 hr

            Metabolism: Hepatic

            Metabolite: Bicarbonate (active)

            Excretion: Urine

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            Formulary

            FormularyPatient Discounts

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            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.
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            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.