potassium citrate

REMS

Treatment of renal tubular acidosis with calcium stones, hypocitraturic calcium oxalate nephrolithiasis of any etiology, or uric acid lithiasis with or without calcium stones (potassium citrate only).
Treatment/prevention of potassium depletion.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hyperkalemia;
Severe renal impairment, uncontrolled diabetes mellitus, acute dehydration, adrenal insufficiency, or concurrent use of potassium-sparing diuretics (↑ risk of hyperkalemia);
Delayed gastric emptying, esophageal compression, intestinal obstruction, or concurrent use of anticholinergic medications (extended-release tablets);
Peptic ulcer disease;
Untreated Addison’s disease;
Some products may contain tartrazine (FDC yellow dye #5) or alcohol; avoid using in patients with known hypersensitivity or intolerance;
Hyperkalemic familial periodic paralysis.

Use Cautiously in:

Cardiac disease;
Renal impairment;
Diabetes mellitus (liquids may contain sugar);
Hypomagnesemia (may make correction of hypokalemia more difficult);
GI hypomotility, including dysphagia or esophageal compression from left atrial enlargement (tablets);
Patients receiving potassium-sparing drugs.

Adv. Reactions/Side Effects ⬆ ⬇

CV: ARRHYTHMIAS, ECG changes

GI: abdominal pain, diarrhea, flatulence, nausea, vomiting, tablets, capsules onlyGI ulceration, stenotic lesions

Neuro: confusion, paralysis, paresthesia, restlessness, weakness

Interactions ⬆ ⬇

Drug-drug:

Use with potassium-sparing diuretics, ACE inhibitors, angiotensin II receptor antagonists, or NSAIDsmay lead to hyperkalemia.
Anticholinergics may ↑ GI mucosal lesions in patients taking wax-matrix potassium chloride preparations.

Availability ⬆ ⬇

(Generic available)

Potassium Citrate

Extended-release tablets: 540 mg (5 mEq); 1080 mg (10 mEq); 1620 mg (15 mEq)

Potassium Bicarbonate/Potassium Citrate

Tablets for effervescent oral solution: 10 mEq; 20 mEq; 25 mEq

Route/Dosage ⬆ ⬇

Expressed as mEq of potassium. Potassium acetate contains 10.2 mEq/g; potassium bicarbonate contains 10 mEq potassium/g; potassium chloride contains 13.4 mEq potassium/g; potassium citrate contains approximately 10 mEq/g

Normal Daily Requirements

PO (Adults ): 40–80 mEq/day.
PO (Children ): 2–3 mEq/kg/day.
PO (Neonates ): 2–6 mEq/kg/day.

Urinary Alkalinizer (Stone Prevention)

PO (Adults ): Severe hypocitraturia (urinary citrate <150 mg/day): 20 mEq 3 times daily or 30 mEq twice daily; may titrate dose, as needed, based on 24-hr urinary citrate and/or urinary pH measurements (max dose = 100 mEq/day). Mild to moderate hypocitraturia (urinary citrate >150 mg/day): 10 mEq 3 times daily or 15 mEq twice daily; may titrate dose, as needed, based on 24-hr urinary citrate and/or urinary pH measurements (max dose = 100 mEq/day).

Prevention of Hypokalemia During Diuretic Therapy

PO (Adults ): 20–40 mEq/day in 1–2 divided doses; single dose should not exceed 20 mEq.
PO (Neonates , Infants and Children): 1–2 mEq/kg/day in 1–2 divided doses.

Treatment of Hypokalemia

PO (Adults ): 40–100 mEq/day in divided doses.
PO (Neonates , Infants and Children): 2–5 mEq/kg/day in divided doses.

US Brand Names ⬆ ⬇

potassium citrate: Urocit-K,

potassium bicarbonate/potassium citrate: Effer-K

Action ⬆ ⬇

Maintain acid-base balance, isotonicity, and electrophysiologic balance of the cell.
Creates an alkaline environment in urine; it creates an environment less conducive to the crystallization of salts that can lead to stone formation.
Activator in many enzymatic reactions; essential to transmission of nerve impulses; contraction of cardiac, skeletal, and smooth muscle; gastric secretion; renal function; tissue synthesis; and carbohydrate metabolism.

Therapeutic effects:

Replacement of potassium.
Prevention of potassium deficiency.
Reduction in stone formation.

Classifications ⬆ ⬇

Therapeutic Classification: mineral and electrolyte replacements/supplements

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following oral administration.

Distribution: Enters extracellular fluid; then actively transported into cells.

Metabolism/Excretion: Excreted by the kidneys.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(increase in serum potassium concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	1–2 hr	unknown

Patient/Family Teaching ⬆ ⬇

Explain to patient purpose of medication and need to take as directed, especially when concurrent digoxin or diuretics are taken. Advise patient to take effervescent tablets without crushing, chewing, or sucking the tablet. A missed dose should be taken as soon as remembered within 2 hr; if not, return to regular dose schedule. Do not double dose.
Encourage patient to maintain a diet limiting salt intake (avoidance of high-salt foods and of added salt at the table) and maintaining high fluid intake (urine volume should be at least 2 L/day)
Instruct patient to avoid salt substitutes or low-salt milk or food unless approved by health care professional. Advise patient to read all labels to prevent excess potassium intake.
Advise patient regarding sources of dietary potassium (see Food Sources for Specific Nutrients). Encourage compliance with recommended diet.
Instruct patient to report dark, tarry, or bloody stools; weakness; unusual fatigue; or tingling of extremities. Notify health care professional if nausea, vomiting, diarrhea, or stomach discomfort persists. Dose may require adjustment.
Emphasize the importance of regular follow-up exams to monitor serum levels and progress.

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Indications ⬇