Citrate

Commonly used brand name(s):

In the U.S.

• Citra pH
• Cytra-K
• Cytra-K Crystals
• Liqui-DualCitra
• Polycitra-K
• Polycitra-K Crystals
• Urocit-K 10
• Urocit-K 5

In Canada

• Pms-Dicitrate

Available Dosage Forms:

• Tablet
• Solution
• Tablet, Extended Release
• Syrup
• Powder for Suspension

Uses For citrate

Citrates are used to make the urine more alkaline (less acid). This helps prevent certain kinds of kidney stones. Citrates are sometimes used with other medicines to help treat kidney stones that may occur with gout. They are also used to make the blood more alkaline in certain conditions

Citrates are available only with your doctor's prescription.

Before Using citrate

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Although there is no specific information comparing use of citrates in children with use in other age groups, these medicines are not expected to cause different side effects or problems in children than they do in adults.

Geriatric

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of citrates in the elderly with use in other age groups.

Pregnancy

Studies on effects in pregnancy have not been done in either humans or animals.

Breast Feeding

Although it is not known whether citrates pass into the breast milk, citrate has not been reported to cause problems in nursing babies.

Interactions with Medicines

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

• Addison's disease (underactive adrenal glands) or
• Type 2 diabetes mellitus or
• Kidney disease—The potassium in potassium-containing citrates may worsen or cause heart problems in patients with these conditions.

• Diarrhea (chronic)—Treatment with citrates may not be effective; a change in dose of citrate may be needed.

• Edema (swelling of the feet or lower legs) or
• High blood pressure or
• Toxemia of pregnancy—The sodium in sodium-containing citrates may cause the body to retain (keep) water.

• Heart disease—The sodium in sodium-containing citrates may cause the body to retain (keep) water; the potassium in potassium-containing citrates may make heart disease worse.

• Intestinal or esophageal blockage—Potassium citrate tablets may cause irritation of the stomach or intestines.

• Stomach ulcer or other stomach problems—Potassium citrate–containing products may make these conditions worse.

• Urinary tract infection—Citrates may make conditions worse.

Proper Use of citrate

For patients taking the tablet form of citrate:

• Swallow the tablets whole. Do not crush, chew, or suck the tablet.
• Take with a full glass (8 ounces) of water.
• If you have trouble swallowing the tablets or they seem to stick in your throat, check with your doctor at once. If citrate is not completely swallowed and not properly dissolved, it can cause severe irritation.

For patients taking the liquid form of citrate:

• Dilute with a full glass (6 ounces) of water or juice and drink; follow with additional water, if desired.
• Chill, but do not freeze, citrate before taking it, for a better taste.

For patients taking the crystals form of citrate:

• Add the contents of one packet to at least 6 ounces of cool water or juice.
• Stir well to make sure the crystals are completely dissolved.
• Drink all the mixture to be sure you are taking the correct dose. Follow with additional water or juice, if desired.

Take each dose immediately after a meal or within 30 minutes after a meal or bedtime snack. This helps prevent the medicine from causing stomach pain or a laxative effect.

Drink at least a full glass (8 ounces) of water or other liquid (except milk) every hour during the day (about 3 quarts a day), unless otherwise directed by your doctor. This will increase the flow of urine and help prevent kidney stones.

Take citrate only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. This is especially important if you are also taking a diuretic (water pill) or digitalis medicine for your heart.

Dosing

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For potassium citrate
• For oral dosage form (tablets):
  • To make the urine more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 1.08 to 2.16 grams three times a day with meals. Some people may take 1.62 grams four times a day with meals or within thirty minutes after a meal or bedtime snack. Your doctor may change your dose if needed. However, most people usually will not take more than 10.8 grams a day.
    • Children—Dose must be determined by your doctor.

• For potassium citrate and citric acid
• For oral dosage form (solution):
  • To make the urine or blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 2 to 3 teaspoonfuls of solution, mixed with water or juice, four times a day, after meals and at bedtime. Your doctor may change the dose if needed.
    • Children—Dose must be determined by your doctor.
  • To make the urine more alkaline (less acidic):
    • Children—At first, 1 to 3 teaspoonfuls of solution, mixed with water or juice, four times a day after meals and at bedtime. Your doctor may change the dose if needed.
• For oral dosage form (crystals for solution):
  • To make the urine or blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 3.3 grams of potassium citrate, mixed with water or juice, four times a day, after meals and at bedtime. Your doctor may change the dose if needed.
    • Children—Use is not recommended.

• For potassium citrate and sodium citrate
• For oral dosage form (tablets):
  • To make the urine more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 1 to 4 tablets after meals and at bedtime.
    • Children—Dose must be determined by your doctor.

• For sodium citrate and citric acid
• For oral dosage form (solution):
  • To make the urine and blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 2 to 6 teaspoonfuls of solution four times a day, after meals and at bedtime. The solution should be mixed in one to three ounces of water. Your doctor may change the dose if needed. However, most people will usually not take more than five ounces a day.
  • To make the blood more alkaline (less acidic):
    • Adults—1 to 2 tablespoonfuls as a single dose. You may mix it in one to two tablespoonfuls of water.
  • To make the contents of the stomach less acidic before surgery:
    • Children—At first, 1 to 3 teaspoonfuls of solution four times a day, after meals and at bedtime. The solution should be mixed in one to three ounces of water. Your doctor may change the dose if needed.

• For tricitrates
• For oral dosage form (solution):
  • To make the urine and blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 1 to 2 tablespoonfuls of solution four times a day, after meals and at bedtime. Your doctor may change the dose if needed.
  • To make the contents of the stomach less acidic before surgery:
    • Adults—1 tablespoonful as a single dose. You should mix the solution in one tablespoonful of water.
  • To make the urine or blood more alkaline (less acidic):
    • Children—At first, 5 to 10 mL four times a day after meals and at bedtime. Your doctor may change the dose if needed.

Missed Dose

If you miss a dose of citrate, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using citrate

It is important that your doctor check your progress at regular visits. This is to make sure the medicine is working properly and to check for unwanted effects.

Do not eat salty foods or use extra table salt on your food while you are taking citrates. This will help prevent kidney stones and unwanted effects.

Check with your doctor before starting any strenuous physical exercise, especially if you are out of condition and are taking any other medication. Exercise and certain medications may increase the amount of potassium in the blood.

For patients taking potassium citrate–containing medicines:

• Do not use salt substitutes and low-salt milk unless told to do so by your doctor. They may contain potassium.
• Check with your doctor at once if you are taking the tablet form and notice black, tarry stools or other signs of stomach or intestinal bleeding.
• Do not be alarmed if you notice what appears to be a whole tablet in the stool after taking potassium citrate tablets. Your body has received the proper amount of medicine from the tablet and has expelled the tablet shell. However, it is a good idea to check with your doctor also.
• If you are on a potassium-rich or potassium-restricted diet, check with your health care professional. Potassium citrate–containing medicines contain a large amount of potassium.

For patients taking sodium citrate–containing medicines:

• If you are on a sodium-restricted diet, check with your health care professional. Sodium citrate–containing medicines contain a large amount of sodium.

citrate Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Stop taking citrate and get emergency help immediately if any of the following effects occur:

Rare

• Abdominal or stomach pain or cramping (severe)
• black, tarry stools
• vomiting (severe), sometimes with blood

Check with your doctor as soon as possible if any of the following side effects occur:

• Confusion
• convulsions (seizures)
• dizziness
• high blood pressure
• irregular or fast heartbeat
• irritability
• mood or mental changes
• muscle pain or twitching
• nervousness or restlessness
• numbness or tingling in hands, feet, or lips
• shortness of breath, difficult breathing, or slow breathing
• swelling of feet or lower legs
• unexplained anxiety
• unpleasant taste
• unusual tiredness or weakness
• weakness or heaviness of legs

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

• Abdominal or stomach soreness or pain (mild)
• diarrhea or loose bowel movements
• nausea or vomiting

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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