sodium citrate and citric acid

REMS

Management of chronic metabolic acidosis associated with chronic renal insufficiency or renal tubular acidosis.
Alkalinization of urine.
Prevention of cystine and urate urinary calculi.
Prevention of aspiration pneumonitis during surgical procedures.
Used as a neutralizing buffer.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Severe renal impairment;
Severe sodium restriction;
HF, untreated hypertension, edema, or toxemia of pregnancy.

Use Cautiously in:

OB: Safety not established

Adv. Reactions/Side Effects ⬆ ⬇

F and E: fluid overload, hypernatremia (severe renal impairment), hypocalcemia, metabolic alkalosis (large doses only)

GI: diarrhea

MS: tetany

Interactions ⬆ ⬇

Drug-drug:

May partially antagonize the effects of antihypertensives.
Urinary alkalinization may result in ↓ salicylate or barbiturate levels or ↑ levels of quinidine, flecainide, or amphetamines.

Availability ⬆ ⬇

Oral solution: sodium citrate 490 mg and citric acid 640 mg/5 mL; sodium citrate 500 mg and citric acid 300 mg/5 mL; sodium citrate 500 mg and citric acid 334 mg/5 mL

Route/Dosage ⬆ ⬇

Adjust dosage according to urine pH. Contains 1 mEq sodium and 1 mEq bicarbonate/mL solution

Alkalinizer

PO (Adults ): 10–30 mL solution diluted in water 4 times daily.
PO (Children ): 5–15 mL solution diluted in water 4 times daily.

Antiurolithic

PO (Adults ): 10–30 mL solution diluted in water 4 times daily.

Neutralizing Buffer

PO (Adults ): 15–30 mL solution diluted in 15–30 mL of water.

US Brand Names ⬆ ⬇

~~Bicitra,~~ Oracit, Shohl’s Solution modified

Action ⬆ ⬇

Converted to bicarbonate in the body, resulting in increased blood pH.
As bicarbonate is renally excreted, urine is also alkalinized, increasing the solubility of cystine and uric acid.
Neutralizes gastric acid.

Therapeutic effects:

Provision of bicarbonate in metabolic acidosis.
Alkalinization of the urine.
Prevention of cystine and urate urinary calculi.
Prevention of aspiration pneumonitis.

Classifications ⬆ ⬇

Therapeutic Classification: antiurolithics, mineral and electrolyte replacements/supplements

Pharmacologic Classification: alkalinizing agents

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following oral administration.

Distribution: Rapidly and widely distributed.

Metabolism/Excretion: Rapidly oxidized to bicarbonate, which is excreted primarily by the kidneys. Small amounts (<5%) excreted unchanged by the lungs.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(effects on serum pH)

ROUTE	ONSET	PEAK	DURATION
PO	rapid (min–hr)	unknown	4–6 hr

Patient/Family Teaching ⬆ ⬇

Instruct patient to take as directed. Missed doses should be taken within 2 hr. Do not double doses.
Instruct patients receiving chronic sodium citrate on correct method of monitoring urine pH, maintenance of alkaline urine, and the need to increase fluid intake to 3000 mL/day. When treatment is discontinued, pH begins to fall toward pretreatment levels.
Advise patients receiving long-term therapy on need to avoid salty foods.

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Indications ⬇