Adult: As extended-release tab: Mild to moderate hypocitraturia (>150 mg/day urinary citrate): Initially, 15 mEq bid or 10 mEq tid. Max: 100 mEq daily. Severe hypocitraturia (<150 mg/day urinary citrate): Initially, 30 mEq bid or 20 mEq tid. Alternatively, 15 mEq 4 times daily. Max: 100 mEq daily. Treatment recommendations and/or product availability may vary among countries (refer to specific product guidelines).
Renal Impairment
GFR <0.7 mL/kg/min: Contraindicated.
Administration
Should be taken with food. Take w/ meals or w/in 30 min after meals to reduce GI discomfort. ER tab: Swallow whole, do not crush/chew/suck. Granules for oral soln: Dissolve in water. Consult product literature for specific instructions.
Contraindications
Hyperkalaemia or conditions predisposing to hyperkalaemia (e.g. uncontrolled diabetes mellitus, acute dehydration, adrenal insufficiency, extensive tissue breakdown, strenuous physical exercise in unconditioned patients); delayed gastric emptying time, oesophageal compression, intestinal obstruction or stricture; peptic ulcer disease, active UTI. Renal insufficiency (GFR <0.7 mL/kg/min) or chronic renal failure. Patients taking anticholinergic agents. Concomitant use with K-sparing diuretics.
Special Precautions
Patient with CV disease (e.g. heart failure, cardiac arrhythmia). Severe hepatic impairment. Pregnancy and lactation.
Obtain serum electrolytes (K, Na, chloride), bicarbonate, serum creatinine, and CBC every 4 months; urinary citrate and/or pH measurements during initiation or dose change and every 4 months thereafter. Monitor ECG periodically.
Overdosage
Symptoms: Hyperkalaemia which is usually asymptomatic and may be manifested only by increased serum K levels and ECG changes (e.g. QT-interval prolongation, peaking of T-wave, loss of P-wave, depression of S-T segment); metabolic alkalosis; late manifestations include muscle paralysis and CV collapse from cardiac arrest. Management: Closely monitor for arrhythmias and changes in electrolytes. Eliminate K-containing medications, agents with K-sparing properties (e.g. K-sparing diuretics, ARBs, ACE inhibitors, NSAIDs), and foods with high K content (e.g. almonds, milk, salmon, spinach, tuna). May administer IV Ca gluconate if the patient is at no risk or low risk of developing digitalis toxicity. Administer IV dextrose 10% solution containing 10-20 units of crystalline insulin per 1,000 mL at a rate of 300-500 mL/hour. Acidosis may be corrected with IV Na bicarbonate. Haemodialysis or peritoneal dialysis may be performed.
Drug Interactions
May increase the risk of hyperkalaemia with ACE inhibitors, ARBs, aliskiren, and NSAIDs. Increased gastrointestinal irritation with agents that slow gastrointestinal transit time (e.g. anticholinergics). Potentially Fatal: Risk of severe hyperkalaemia with K-sparing diuretics (e.g. triamterene, amiloride, spironolactone).
Action
Description: Mechanism of Action: Potassium citrate acts as an alkalinising agent. It is metabolised to bicarbonate, producing an alkaline load that elevates urinary pH and urinary citrate by augmenting citrate clearance without altering ultrafilterable serum citrate. These changes reduce the potential crystallisation of stone-forming salts (Ca oxalate, Ca phosphate, and uric acid) in the urine. Pharmacokinetics: Metabolism: Metabolised in the liver to bicarbonate.
Chemical Structure
Potassium citrate Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 13344, Potassium Citrate. https://pubchem.ncbi.nlm.nih.gov/compound/Potassium-Citrate. Accessed May 30, 2023.
A12BA02 - potassium citrate ; Belongs to the class of potassium-containing preparations. Used as dietary supplements.
References
Anon. Potassium Citrate. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 02/03/2023.Buckingham R (ed). Bicarbonate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 02/03/2023.Calta Extended-release Tablet (The Cathay YSS Distributors Co., Inc.). MIMS Philippines. http://www.mims.com/philippines. Accessed 25/04/2023.Citrapos Extended-release Tablet (Corbridge Group Phils. Inc.). MIMS Philippines. http://www.mims.com/philippines. Accessed 25/04/2023.Potassium Citrate Tablet, Extended Release (Actavis Pharma, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 02/03/2023.Potassium Citrate. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 02/03/2023.Urocit-K Extended-release Tablets for Oral Use (The International Medical Co Ltd). MIMS Hong Kong. http://www.mims.com/hongkong. Accessed 25/04/2023.
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