Adult: Mild to moderate hypocitraturia (urinary citrate >150 mg daily): As immediate-release tab: Initially, 10 mEq tid. Max: 100 mEq daily. As extended-release tab: Initially, 15 mEq bid or 10 mEq tid. Max: 100 mEq daily. Severe hypocitraturia (urinary citrate <150 mg daily): As immediate-release tab: Initially, 20 mEq tid or 15 mEq 4 times daily. Max: 100 mEq daily. As extended-release tab: Initially, 30 mEq bid or 20 mEq tid. Max: 100 mEq daily.
Renal Impairment
GFR <0.7 mL/kg/min: Contraindicated.
Administration
Should be taken with food. Dilute well w/ water before taking.
Contraindications
Renal insufficiency (GFR <0.7 mL/kg/min); hyperkalaemia or conditions predisposing to hyperkalaemia (e.g. chronic renal failure, uncontrolled DM, acute dehydration, strenuous physical exercise, adrenal insufficiency, extensive tissue breakdown); delayed gastric emptying time, oesophageal compression, intestinal obstruction or stricture, peptic ulcer disease, active UTI.
Special Precautions
Patient w/ conditions which impair K excretion (e.g. severe myocardial damage or heart failure); GI lesions manifested by severe vomiting, abdominal pain or GI bleeding. Pregnancy and lactation.
Monitor serum electrolytes (K, Cl, Na), bicarbonate, serum creatinine and CBC every 4 mth; urinary citrate and/or urinary pH at initiation or dose change and every 4 mth; periodically ECG.
Overdosage
Symptoms: Hyperkalaemia manifested by increased serum K concentration and ECG changes; late manifestations include muscle paralysis and CV collapse from cardiac arrest. Management: Eliminate medications containing K, agents w/ K sparing properties (e.g. K-sparing diuretics, ACE inhibitors, NSAIDs) and food w/ high K content (e.g. almonds, beans, milk, salmon). May give IV Ca gluconate if the patient is at no risk or low risk of developing digitalis toxicity. Administer IV dextrose 10% containing 10-20 U of crystalline insulin per 1,000 mL at a rate of 300-500 mL/hr. Acidosis may be corrected w/ IV Na bicarbonate. May perform haemodialysis or peritoneal dialysis.
Drug Interactions
Risk of severe hyperkalaemia w/ K-sparing diuretics. Increased incidence of GI irritation w/ drugs that slow GI transit time (e.g. anticholinergics).
Action
Description: Potassium citrate is metabolised to bicarbonate, producing an alkaline load which in turn increases urinary pH and raises urinary citrate by augmenting citrate clearance w/o altering ultrafilterable serum citrate. Pharmacokinetics: Metabolism: Metabolised hepatically to bicarbonate.
Chemical Structure
Potassium citrate Source: National Center for Biotechnology Information. PubChem Database. Potassium citrate, CID=13344, https://pubchem.ncbi.nlm.nih.gov/compound/Potassium-citrate (accessed on Jan. 23, 2020)
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