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ALIMENTARY TRACT AND METABOLISM › DIGESTIVES, INCL. ENZYMES › DIGESTIVES, INCL. ENZYMES › Acid preparations
citric acid
A09AB04
Forms & Strengths
- Oral solution: citric acid anhydrous 334 mg / sodium citrate 500 mg per 5 mL
- Effervescent granules/tablets: various combinations with sodium bicarbonate and potassium citrate
- Topical/irrigation solutions: various concentrations for urinary tract or wound use
Adult Dosing
- Metabolic acidosis / urinary alkalinization: 10 to 30 mL (containing 2 to 6 g sodium citrate and corresponding citric acid) diluted in water after meals and at bedtime
- Kidney stone prevention (uric acid / cystine calculi): Titrated to maintain urinary pH between 6.0 and 7.0
Pediatric Dosing
- Metabolic acidosis / urinary alkalinization: 1 to 3 mL/kg/day divided into 4 doses, diluted in water or juice
- Safety and efficacy in neonates not established for systemic alkalinizing formulations
Indications
- Management of chronic metabolic acidosis requiring systemic alkalinization
- Prevention of calcium renal stones with hypocitraturia
- Prevention of uric acid and cystine nephrolithiasis
- Excipient and acidulant in pharmaceutical formulations
Mechanism of Action
- Metabolized systemically to bicarbonate, increasing urinary pH and neutralizing metabolic acidosis
- Increases urinary citrate excretion by complexing with calcium, thereby reducing urinary saturation of calcium salts and preventing crystal precipitation
Contraindications
- Severe renal impairment (glomerular filtration rate < 0.7 mL/kg/min or oliguria/anuria)
- Acute dehydration or heat cramps
- Untreated Addison's disease
- Hypernatremia or severe myocardial damage where sodium load is hazardous (for sodium citrate/citric acid combinations)
- Active urinary tract infection with urea-splitting organisms
Adverse Reactions
- Gastrointestinal: Diarrhea, nausea, vomiting, abdominal discomfort, flatulence
- Metabolic: Fluid overload, hypernatremia, metabolic alkalosis, hypocalcemia tetany
- Renal: Precipitation of calcium phosphate stones if urinary pH becomes excessively alkaline
Drug Interactions
- Potassium-sparing diuretics: Concurrent use increases risk of severe hyperkalemia (if potassium citrate formulation used)
- Lithium: Alkalinization of urine increases renal clearance of lithium, decreasing its serum concentration
- Fluoroquinolones and macrolides: Alkalinization may alter urinary excretion or dissolution profiles
- Aluminum-containing antacids: Citrate complexes with aluminum, significantly increasing gastrointestinal absorption of aluminum
Curated Content: Needs Vetting Before Put to Clinical Use