potassium citrate (Rx)

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

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.

Mechanism of Action

Alkalinizes urine; citrate binds with urinary calcium

Pharmacokinetics

Onset: 1 hr

Duration: 12 hr

Metabolism: Hepatic

Metabolite: Bicarbonate (active)

Excretion: Urine