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ALIMENTARY TRACT AND METABOLISM › MINERAL SUPPLEMENTS › POTASSIUM › Potassium
potassium citrate
A12BA02
Forms & Strengths
- Extended-release tablets: 5 mEq (540 mg)
- Extended-release tablets: 10 mEq (1080 mg)
- Extended-release tablets: 15 mEq (1620 mg)
- Oral crystals/powder packets: 30 mEq/packet
- Oral crystals/powder packets: 50 mEq/packet
Adult Dosing
- Renal tubular acidosis: 20 mEq T.I.D. or 60 mEq daily in divided doses
- Hypocitraturic calcium oxalate nephrolithiasis: Initial 20 mEq T.I.D. with meals or within 30 minutes after meals
- Uric acid lithiasis with or without calcium stones: Initial 15 mEq T.I.D. with meals or within 30 minutes after meals
- Titrate dose based on urinary citrate excretion and 24-hour urinary pH (target pH 6.0 to 7.0)
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
- Renal tubular acidosis (off-label): Initial 1 mEq/kg/day to 3 mEq/kg/day in divided doses
- Titrate dose carefully based on clinical response and urinary pH
Indications
- Management of renal tubular acidosis with calcium stones
- Hypocitraturic calcium oxalate nephrolithiasis of any etiology
- Uric acid lithiasis with or without calcium stones
Mechanism of Action
- Potassium citrate is a systemic alkalinizer
- Metabolized to potassium bicarbonate, increasing serum and urinary bicarbonate levels
- Raises urinary pH and increases urinary citrate excretion by decreasing the renal tubular reabsorption of citrate
- Binds to calcium in urine and inhibits the crystallization of calcium oxalate and calcium phosphate
- Alkalinization of urine prevents the precipitation of uric acid crystals
Contraindications
- Conditions predisposing to hyperkalemia (e.g., chronic renal failure, uncontrolled diabetes mellitus, acute dehydration, strenuous physical exercise in unconditioned individuals)
- Delayed gastric emptying, esophageal compression, or intestinal obstruction (risk of GI mucosal ulceration from wax-matrix tablets)
- Concurrent use of potassium-sparing diuretics
- Active urinary tract infection with urea-splitting organisms
- Severe myocardial damage or heart failure
Adverse Reactions
- Nausea, vomiting, diarrhea, or abdominal discomfort
- Gastrointestinal lesions, ulceration, or bleeding from extended-release wax-matrix tablets
- Hyperkalemia
- Metabolic alkalosis (with excessive dosing)
Drug Interactions
- Potassium-sparing diuretics (e.g., triamterene, spironolactone, amiloride): concomitant use may cause severe hyperkalemia
- Anticholinergic agents: slow gastrointestinal motility, increasing the risk of GI mucosal irritation or ulceration from solid potassium dosage forms
- Cardiac glycosides (digitalis): hyperkalemia may reduce the cardiac effects of digitalis
- Renin-angiotensin-aldosterone system (RAAS) inhibitors (e.g., ACE inhibitors, ARBs, aliskiren): increased risk of hyperkalemia
Curated Content: Needs Vetting Before Put to Clinical Use