Citric acid; potassium citrate; sodium citrate solution is an alkalinizing agent. At recommended doses, it alkalinizes the urine without producing a systemic alkalosis and will not neutralize the gastric juice or disturb digestion. Uses include conditions where long-term maintenance of an alkaline urine is desirable, such as in patients with uric acid and cystine calculi of the urinary tract. It can be used as an adjuvant with uricosuric agents in gout therapy, since urates tend to crystallize out of an acid urine. It is also effective in correcting the acidosis of certain renal tubular disorders. This product is highly concentrated, and when administered after meals and before bedtime, allows one to maintain an alkaline urine pH around the clock, usually without the necessity of a 2 AM dose.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
Route-Specific Administration
Oral Administration
-Administer each dose within 30 minutes after a meal or bedtime snack to minimize side effects (e.g., GI pain or saline laxative effect).
-Instruct the patient to avoid foods high in either potassium (e.g., salt substitutes or low-sodium milk products which contain potassium) or sodium (e.g., tomato juice) during treatment, unless otherwise directed by the prescriber.
-Instruct the patient on the importance of high fluid intake (2-3 liters per day) to prevent urine supersaturation and to assure appropriate urine output.
Oral Liquid Formulations
-Certain products require shaking the bottle prior to measuring the dose of solution to be diluted. Carefully read the product labeling/packaging before measuring the dose.
-Dilute each dose with water before administration. May follow the dose with additional water after swallowing the diluted oral solution mixture, if desired.
-Palatability is enhanced if the product is chilled (not frozen) before administration.
-Oral solutions for dilution contain the equivalent of 1 mEq/mL of potassium ion, 1 mEq/mL of sodium ion, and 2 mEq/mL of bicarbonate ion.
With proper dosing and administration, citric acid; potassium citrate; sodium citrate products are generally well-tolerated in patients who have normal renal function and urinary output. As with other concentrated potassium products, potassium citrate may result in a GI irritant effect, potentially leading to nausea, vomiting, or abdominal pain. A saline laxative effect (e.g., diarrhea) may also occur. Patients who have abnormal renal mechanisms are at greater risk of developing of hyperkalemia or alkalosis, especially in the presence of hypocalcemia. Potassium intoxication causes listlessness, weakness, mental confusion, and tingling of extremities.
The administration of any potassium supplement, including citric acid; potassium citrate; sodium citrate, is contraindicated in a patient who has hyperkalemia. Any further elevation in serum potassium concentration increases the risk of cardiac arrest.
Due to the risk of developing hyperkalemia, citric acid; potassium citrate; sodium citrate is contraindicated in patients with adrenal insufficiency (untreated Addison's disease).
Citric acid; potassium citrate; sodium citrate is contraindicated for use in patients who have renal failure or severe renal impairment with oliguria or azotemia and should be used with caution in patients who have a low urinary output or reduced glomerular filtration rate. As with other alkalinizing agents, use with caution in patients who lack normal renal mechanisms, being careful to avoid the development of hyperkalemia or metabolic alkalosis, especially in the presence of hypocalcemia. Periodically monitor serum electrolytes, particularly serum bicarbonate, throughout the course of therapy in any patient with renal disease. Discontinue treatment if hyperkalemia develops.
Potassium supplements, including citric acid; potassium citrate; sodium citrate, should be used cautiously in patients with severe burns because these patients are prone to hyperkalemia secondary to tissue breakdown and renal insufficiency. Monitor serum electrolytes and renal function throughout therapy, with particularly close monitoring in patients at risk for hyperkalemia; discontinue treatment if hyperkalemia develops.
The potassium salt in citric acid; potassium citrate; sodium citrate increases the risk of developing hyperkalemia in certain patient populations. This risk is particularly high in patients suffering acute dehydration and citric acid; potassium citrate; sodium citrate use should be avoided. Extreme caution is warranted in other at-risk patients, including: those who have systemic metabolic acidosis (e.g., diabetic ketoacidosis); those partaking in strenuous physical exercise (especially unconditioned persons); and in patients receiving salt substitutes, potassium-sparing diuretics (e.g., amiloride, spironolactone, triamterene), ACE inhibitors, or angiotensin II antagonists. Monitor serum electrolytes and renal function throughout therapy, with particularly close monitoring in patients at risk for hyperkalemia; discontinue treatment if hyperkalemia develops.
Citric acid; potassium citrate; sodium citrate is contraindicated for use in patients with severe myocardial damage. Because of the sodium salt component, use this product cautiously in patients with heart failure, hypertension, peripheral edema, or pulmonary edema. Because of the potassium salt component, closely monitor patients with cardiac arrhythmias (e.g., atrial fibrillation, atrial flutter, digitalis toxicity (except due to documented hypokalemia), and ventricular arrhythmias including ventricular fibrillation and ventricular tachycardia), including patients receiving digoxin or other antiarrhythmic therapy. Based on a multidisciplinary review of literature and clinical practice trends, the National Council on Potassium in Clinical Practice recommends that serum potassium concentrations >= 4 mEq/L be achieved and maintained in patients with hypertension, heart failure, and cardiac arrhythmias to minimize complications of potassium depletion.
The risk of gastrointestinal injury and a saline laxative effect with oral administration of citric acid; potassium citrate; sodium citrate solution can be minimized with appropriate dilution of the solution and administration after meals. It would be prudent to hold administration in any patient who has diarrhea, to avoid the risk of developing hyperkalemia. Monitor serum electrolytes and renal function throughout therapy, with particularly close monitoring in patients at risk for hyperkalemia; discontinue treatment if hyperkalemia develops.
Conversion of citric acid; potassium citrate; sodium citrate to bicarbonate may be impaired in patients with severe hepatic disease or hepatic failure. Due to the sodium content, use with caution in patients with cirrhosis and associated ascites.
If citric acid; potassium citrate; sodium citrate must be administered to a woman during her pregnancy, closely monitor acid-base status and electrolytes. Use with caution in the presence of toxemia of pregnancy (preeclampsia and eclampsia) due to the sodium content of the solution.
It is not known whether citric acid; potassium citrate; sodium citrate is distributed into breast milk. No specific breast-feeding precautions are provided. Sodium citrate is absorbed and metabolized to sodium bicarbonate. Many potassium products are considered compatible with breast-feeding. The normal potassium ion content of human milk is about 13 mEq/L. Potassium freely passes into and out of breast milk; therefore, the use of potassium citrate in a breast-feeding woman with normal serum potassium concentrations should not adversely affect the breastfed infant. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.
For urinary alkalinization for nephrolithiasis prevention (due to nephrolithiasis or renal calculus with uric acid or cystine salts or during use of uricosuric agents); or for the treatment of chronic metabolic acidosis associated with renal tubular acidosis (RTA) or other renal tubular disorders:
Oral dosage (oral solution with potassium citrate monohydrate 550 mg, sodium citrate dihydrate 500 mg, citric acid monohydrate 334 mg per 5 mL and providing 1 mEq potassium, 1 mEq sodium, and 2 mEq bicarbonate per mL, e.g., Tricitrates or Cytra-3):
Adults: 15 to 30 mL PO 4 times daily, diluted with water and given after meals and at bedtime is the usual dosage range. Monitor urinary pH to adjust and titrate dosage. To maintain a urine pH of 6.5 to 7.4 throughout the day, the usual dosage range is 10 to 15 mL administered 4 times per day. To maintain a urine pH of 7 to 7.6, the usual dosage range is 15 to 20 mL administered 4 times per day.
Infants, Children, and Adolescents: 5 to 15 mL PO 4 times daily, diluted with water and given after meals and at bedtime is a usual dosage range. Monitor urinary pH to adjust and titrate dosage.
Maximum Dosage Limits:
-Adults
120 mL/day PO.
-Geriatric
120 mL/day PO.
-Adolescents
60 mL/day PO.
-Children
60 mL/day PO.
-Infants
60 mL/day PO.
-Neonates
Safety and efficacy have not been established.
Patients with Hepatic Impairment Dosing
Specific guidelines for dosage adjustment in hepatic impairment are not available. Use with caution in patients who have severe hepatic impairment; conversion of citrate salts to bicarbonate may be impaired in patients with hepatic failure. Also use with caution in patients with cirrhosis and associated ascites due to the sodium content.
Patients with Renal Impairment Dosing
Specific guidelines for dosage adjustment in renal impairment are not available. Use is contraindicated in patients who have severe renal impairment with oliguria or azotemia. Use with caution in patients who have low urinary output or a reduced glomerular filtration rate.
*non-FDA-approved indication
Acetaminophen; Aspirin, ASA; Caffeine: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Acetaminophen; Aspirin, ASA; Caffeine: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Acetaminophen; Aspirin: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Acetaminophen; Aspirin; Diphenhydramine: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Acetaminophen; Dextromethorphan; Guaifenesin; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Acetaminophen; Dextromethorphan; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Acetaminophen; Ibuprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Acetaminophen; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Acrivastine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Aliskiren: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and aliskiren are used together. Concomitant use may increase the risk of hyperkalemia.
Aliskiren; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and aliskiren are used together. Concomitant use may increase the risk of hyperkalemia.
Aluminum Hydroxide: (Contraindicated) Avoid coadministration of antacids with citrate salts since increased absorption of aluminum can occur. In addition, some antacids like calcium carbonate, share the potential with the citrate salts for development of metabolic alkalosis, when given in higher dosage. (Major) Avoid coadministration of aluminum hydroxide with citrate salts due to the potential for increased absorption of aluminum. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure.
Aluminum Hydroxide; Magnesium Carbonate: (Contraindicated) Avoid coadministration of antacids with citrate salts since increased absorption of aluminum can occur. In addition, some antacids like calcium carbonate, share the potential with the citrate salts for development of metabolic alkalosis, when given in higher dosage. (Major) Avoid coadministration of aluminum hydroxide with citrate salts due to the potential for increased absorption of aluminum. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure.
Aluminum Hydroxide; Magnesium Hydroxide: (Contraindicated) Avoid coadministration of antacids with citrate salts since increased absorption of aluminum can occur. In addition, some antacids like calcium carbonate, share the potential with the citrate salts for development of metabolic alkalosis, when given in higher dosage. (Major) Avoid coadministration of aluminum hydroxide with citrate salts due to the potential for increased absorption of aluminum. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure.
Aluminum Hydroxide; Magnesium Hydroxide; Simethicone: (Contraindicated) Avoid coadministration of antacids with citrate salts since increased absorption of aluminum can occur. In addition, some antacids like calcium carbonate, share the potential with the citrate salts for development of metabolic alkalosis, when given in higher dosage. (Major) Avoid coadministration of aluminum hydroxide with citrate salts due to the potential for increased absorption of aluminum. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure.
Aluminum Hydroxide; Magnesium Trisilicate: (Contraindicated) Avoid coadministration of antacids with citrate salts since increased absorption of aluminum can occur. In addition, some antacids like calcium carbonate, share the potential with the citrate salts for development of metabolic alkalosis, when given in higher dosage. (Major) Avoid coadministration of aluminum hydroxide with citrate salts due to the potential for increased absorption of aluminum. Patients at increased risk of aluminum accumulation include patients with renal impairment or renal failure.
Amiloride: (Major) The use of potassium supplements in patients treated with amiloride is generally contraindicated. Concomitant use may increase the risk of hyperkalemia. If potassium supplementation is used, monitor serum potassium concentrations closely.
Amiloride; Hydrochlorothiazide, HCTZ: (Major) The use of potassium supplements in patients treated with amiloride is generally contraindicated. Concomitant use may increase the risk of hyperkalemia. If potassium supplementation is used, monitor serum potassium concentrations closely.
Aminosalicylate sodium, Aminosalicylic acid: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Amlodipine; Benazepril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Amlodipine; Celecoxib: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Amlodipine; Olmesartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Amlodipine; Valsartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Amphetamine: (Moderate) Monitor for an increase in the incidence and severity of amphetamine-related adverse effects during concomitant use of urinary alkalinizing agents. Increasing urine pH may increase amphetamine exposure by reducing urinary excretion of amphetamine. A urine pH more than 7.5 has been observed to increase the half-life of amphetamine from 8 to 10.5 hours to 16 to 31 hours when compared to a pH less than 6. Additionally, a urine pH more than 8 has been observed to reduce the amount of amphetamine excreted in the urine over 16 hours to less than 3% of the original dose; a 5-fold reduction compared to controls.
Amphetamine; Dextroamphetamine: (Moderate) Monitor for an increase in the incidence and severity of amphetamine-related adverse effects during concomitant use of urinary alkalinizing agents. Increasing urine pH may increase amphetamine exposure by reducing urinary excretion of amphetamine. A urine pH more than 7.5 has been observed to increase the half-life of amphetamine from 8 to 10.5 hours to 16 to 31 hours when compared to a pH less than 6. Additionally, a urine pH more than 8 has been observed to reduce the amount of amphetamine excreted in the urine over 16 hours to less than 3% of the original dose; a 5-fold reduction compared to controls.
Amphetamines: (Moderate) Monitor for an increase in the incidence and severity of amphetamine-related adverse effects during concomitant use of urinary alkalinizing agents. Increasing urine pH may increase amphetamine exposure by reducing urinary excretion of amphetamine. A urine pH more than 7.5 has been observed to increase the half-life of amphetamine from 8 to 10.5 hours to 16 to 31 hours when compared to a pH less than 6. Additionally, a urine pH more than 8 has been observed to reduce the amount of amphetamine excreted in the urine over 16 hours to less than 3% of the original dose; a 5-fold reduction compared to controls.
Angiotensin II receptor antagonists: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Angiotensin-converting enzyme inhibitors: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Antacids: (Contraindicated) Avoid coadministration of antacids with citrate salts since increased absorption of aluminum can occur. In addition, some antacids like calcium carbonate, share the potential with the citrate salts for development of metabolic alkalosis, when given in higher dosage.
Aspirin, ASA: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Butalbital; Caffeine: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Caffeine: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Caffeine; Orphenadrine: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Carisoprodol; Codeine: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Dipyridamole: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Omeprazole: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Aspirin, ASA; Oxycodone: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Atropine; Difenoxin: (Moderate) Drugs that decrease GI motility, like diphenoxylate/difenoxin, may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. Immediate release potassium formulations may be preferred in patients requiring diphenoxylate/difenoxin therapy.
Azilsartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Azilsartan; Chlorthalidone: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Benazepril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Benazepril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Major) Avoid the administration of Alkalinizing agents to patients who are being treated with methenamine, as an acidic urine is required for methenamine therapeutic efficacy. Alkalinized urine decreases methenamine efficacy by increasing the amount of non-ionized drug available for renal tubular reabsorption and inhibits the conversion of methenamine to formaldehyde, which is the active bacteriostatic form. (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Benzphetamine: (Major) Urinary alkalinizers, such as potassium citrate diminish the urinary excretion of benzphetamine. These medications increase the proportion of non-ionized amphetamines, resulting in increased renal tubular reabsorption of these compounds. The half-life and therapeutic actions of benzphetamine will be prolonged in the presence of potassium citrate. This combination should be avoided. (Moderate) Monitor for an increase in the incidence and severity of amphetamine-related adverse effects during concomitant use of urinary alkalinizing agents. Increasing urine pH may increase amphetamine exposure by reducing urinary excretion of amphetamine. A urine pH more than 7.5 has been observed to increase the half-life of amphetamine from 8 to 10.5 hours to 16 to 31 hours when compared to a pH less than 6. Additionally, a urine pH more than 8 has been observed to reduce the amount of amphetamine excreted in the urine over 16 hours to less than 3% of the original dose; a 5-fold reduction compared to controls.
Bismuth Subsalicylate: (Moderate) Urinary alkalinizing agents may increase the excretion of salicylates by increasing renal clearance. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Bismuth Subsalicylate; Metronidazole; Tetracycline: (Moderate) Urinary alkalinizing agents may increase the excretion of salicylates by increasing renal clearance. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Brompheniramine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Brompheniramine; Pseudoephedrine; Dextromethorphan: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Bupivacaine; Meloxicam: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Butalbital; Aspirin; Caffeine; Codeine: (Moderate) Concurrent administration of high doses of alkalinizing agents may increase urine pH and decrease serum salicylate levels by decreasing renal tubular reabsorption of salicylic acid. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Candesartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Candesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Captopril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Captopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Celecoxib: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Celecoxib; Tramadol: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Cetirizine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Chlophedianol; Dexchlorpheniramine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Chlorpheniramine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Choline Salicylate; Magnesium Salicylate: (Moderate) Urinary alkalinizing agents may increase the excretion of salicylates by increasing renal clearance. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Codeine; Guaifenesin; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Cyclosporine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and cyclosporine are used together. Concomitant use may increase the risk of hyperkalemia.
Desloratadine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Dexbrompheniramine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Dextroamphetamine: (Moderate) Monitor for an increase in the incidence and severity of amphetamine-related adverse effects during concomitant use of urinary alkalinizing agents. Increasing urine pH may increase amphetamine exposure by reducing urinary excretion of amphetamine. A urine pH more than 7.5 has been observed to increase the half-life of amphetamine from 8 to 10.5 hours to 16 to 31 hours when compared to a pH less than 6. Additionally, a urine pH more than 8 has been observed to reduce the amount of amphetamine excreted in the urine over 16 hours to less than 3% of the original dose; a 5-fold reduction compared to controls.
Dextromethorphan; Guaifenesin; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Dextromethorphan; Quinidine: (Major) Alkalinizing agents such as potassium citrate can increase renal tubular reabsorption of quinidine by alkalinizing the urine; higher quinidine serum concentrations and quinidine toxicity are possible. (Major) Urinary alkalinization increases the renal tubular reabsorption of quinidine, resulting in higher quinidine serum concentrations which may lead to toxicity. Avoid citric acid; potassium citrate; sodium citrate administration to any patient receiving treatment with quinidine.
Diclofenac: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Diclofenac; Misoprostol: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Diflunisal: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Digoxin: (Minor) Potassium levels should be monitored closely in patients receiving digoxin and potassium supplementation. Both hypokalemia and hyperkalemia increase the risk of digoxin toxicity. Some patients at increased risk are patients with renal impairment, patients on diuretics, and patients who are on potassium-sparing medications concurrently. Monitor renal function, potassium concentrations, and digoxin concentrations and clinical response during concurrent treatment.
Diphenhydramine; Ibuprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Diphenhydramine; Naproxen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Diphenoxylate; Atropine: (Moderate) Drugs that decrease GI motility, like diphenoxylate/difenoxin, may increase the risk of GI irritation from sustained-release solid oral dosage forms of potassium salts. Immediate release potassium formulations may be preferred in patients requiring diphenoxylate/difenoxin therapy.
Donepezil; Memantine: (Moderate) Increases in urinary pH may decrease elimination of memantine, resulting in drug accumulation and potential toxicity. (Moderate) Urinary alkalinizing agents may decrease the elimination of memantine, resulting in drug accumulation and potential toxicity. The clearance of memantine is reduced by about 80% under alkaline urine conditions at pH 8. Memantine should be used with caution with drugs known to increase urinary pH.
Drospirenone: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone.
Drospirenone; Estetrol: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone.
Drospirenone; Estradiol: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone.
Drospirenone; Ethinyl Estradiol: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone.
Drospirenone; Ethinyl Estradiol; Levomefolate: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and drospirenone are used together. Concomitant use may increase the risk of hyperkalemia. Drospirenone has anti-mineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to 25 mg of spironolactone.
Enalapril, Enalaprilat: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Ephedrine: (Moderate) The renal elimination of ephedrine susceptible to changes in urinary pH. Potassium citrate is a urinary alkalinizing agent. Concomitant administration of ephedrine with urinary alkalinizers may increase the likelihood of adverse reactions.
Ephedrine; Guaifenesin: (Moderate) The renal elimination of ephedrine susceptible to changes in urinary pH. Potassium citrate is a urinary alkalinizing agent. Concomitant administration of ephedrine with urinary alkalinizers may increase the likelihood of adverse reactions.
Eplerenone: (Contraindicated) The use of potassium supplements in patients receiving eplerenone for the treatment of hypertension is contraindicated. Concomitant use may increase the risk of hyperkalemia. Minimize the risk of hyperkalemia with proper patient selection and monitoring.
Eprosartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Eprosartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Etodolac: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Fenoprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Fexofenadine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Finerenone: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and finerenone are used together. Concomitant use may increase the risk of hyperkalemia.
Flecainide: (Moderate) Urinary alkalinization can decrease the renal clearance of flecainide, resulting in an increased elimination half-life and AUC for flecainide.
Flurbiprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Fosinopril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Guaifenesin; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Hydrochlorothiazide, HCTZ; Moexipril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Hydrocodone; Ibuprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: (Major) Avoid the administration of Alkalinizing agents to patients who are being treated with methenamine, as an acidic urine is required for methenamine therapeutic efficacy. Alkalinized urine decreases methenamine efficacy by increasing the amount of non-ionized drug available for renal tubular reabsorption and inhibits the conversion of methenamine to formaldehyde, which is the active bacteriostatic form. (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Ibuprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Ibuprofen; Famotidine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Ibuprofen; Oxycodone: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Ibuprofen; Pseudoephedrine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Indomethacin: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Irbesartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Irbesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Ketoprofen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Ketorolac: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Lisdexamfetamine: (Major) Urinary alkalinizers, such as potassium citrate, diminish the urinary excretion of amphetamines. These drug combinations should be avoided, especially in amphetamine overdose situations. (Moderate) Monitor for an increase in the incidence and severity of amphetamine-related adverse effects during concomitant use of urinary alkalinizing agents. Increasing urine pH may increase amphetamine exposure by reducing urinary excretion of amphetamine. A urine pH more than 7.5 has been observed to increase the half-life of amphetamine from 8 to 10.5 hours to 16 to 31 hours when compared to a pH less than 6. Additionally, a urine pH more than 8 has been observed to reduce the amount of amphetamine excreted in the urine over 16 hours to less than 3% of the original dose; a 5-fold reduction compared to controls.
Lisinopril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Lisinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Lithium: (Major) Avoid the administration of Alkalinizing agents to patients who are being treated with lithium, especially patients who are stabilized on lithium, as urinary alkalinization increases the renal clearance of lithium. If coadministration can not be avoided, monitor lithium serum concentrations and patient clinical response very closely. Also of note, lithium clearance is increased if hypernatremia occurs.
Loratadine; Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Losartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Losartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Magnesium Hydroxide: (Contraindicated) Avoid coadministration of antacids with citrate salts since increased absorption of aluminum can occur. In addition, some antacids like calcium carbonate, share the potential with the citrate salts for development of metabolic alkalosis, when given in higher dosage.
Magnesium Salicylate: (Moderate) Urinary alkalinizing agents may increase the excretion of salicylates by increasing renal clearance. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Magnesium Salts: (Contraindicated) Avoid coadministration of antacids with citrate salts since increased absorption of aluminum can occur. In addition, some antacids like calcium carbonate, share the potential with the citrate salts for development of metabolic alkalosis, when given in higher dosage.
Meclofenamate Sodium: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Mefenamic Acid: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Meloxicam: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Memantine: (Moderate) Increases in urinary pH may decrease elimination of memantine, resulting in drug accumulation and potential toxicity. (Moderate) Urinary alkalinizing agents may decrease the elimination of memantine, resulting in drug accumulation and potential toxicity. The clearance of memantine is reduced by about 80% under alkaline urine conditions at pH 8. Memantine should be used with caution with drugs known to increase urinary pH.
Methamphetamine: (Major) As potassium citrate is a urinary alkalinizer, use will diminish the urinary excretion of and increase the half-life of amphetamines. The interaction of amphetamines with urinary alkalinizers is well documented. Avoid concurrent use, especially in amphetamine overdose situations. (Moderate) Monitor for an increase in the incidence and severity of amphetamine-related adverse effects during concomitant use of urinary alkalinizing agents. Increasing urine pH may increase amphetamine exposure by reducing urinary excretion of amphetamine. A urine pH more than 7.5 has been observed to increase the half-life of amphetamine from 8 to 10.5 hours to 16 to 31 hours when compared to a pH less than 6. Additionally, a urine pH more than 8 has been observed to reduce the amount of amphetamine excreted in the urine over 16 hours to less than 3% of the original dose; a 5-fold reduction compared to controls.
Methenamine: (Major) Avoid the administration of Alkalinizing agents to patients who are being treated with methenamine, as an acidic urine is required for methenamine therapeutic efficacy. Alkalinized urine decreases methenamine efficacy by increasing the amount of non-ionized drug available for renal tubular reabsorption and inhibits the conversion of methenamine to formaldehyde, which is the active bacteriostatic form. (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended.
Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine: (Major) Avoid the administration of Alkalinizing agents to patients who are being treated with methenamine, as an acidic urine is required for methenamine therapeutic efficacy. Alkalinized urine decreases methenamine efficacy by increasing the amount of non-ionized drug available for renal tubular reabsorption and inhibits the conversion of methenamine to formaldehyde, which is the active bacteriostatic form. (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended.
Methenamine; Sodium Salicylate: (Major) Avoid the administration of Alkalinizing agents to patients who are being treated with methenamine, as an acidic urine is required for methenamine therapeutic efficacy. Alkalinized urine decreases methenamine efficacy by increasing the amount of non-ionized drug available for renal tubular reabsorption and inhibits the conversion of methenamine to formaldehyde, which is the active bacteriostatic form. (Major) The therapeutic action of methenamine requires an acidic urine. Alkalinizing agents, such as citrate salts, can alkalinize the urine, thereby decreasing the effectiveness of methenamine by increasing the amount of non-ionized drug available for renal tubular reabsorption. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form; concurrent use of methenamine and urinary alkalizers is not recommended. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Moexipril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Nabumetone: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Naproxen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Naproxen; Esomeprazole: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Naproxen; Pseudoephedrine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia. (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Nebivolol; Valsartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Nonsteroidal antiinflammatory drugs: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Olmesartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Olmesartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Oxaprozin: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Penicillin G: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and high doses of penicillin G potassium are used together. Concomitant use may increase the risk for hyperkalemia. Penicillin G potassium contains 1.7 mEq of potassium per million units of penicillin G activity.
Perindopril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Perindopril; Amlodipine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Piroxicam: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Pseudoephedrine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Pseudoephedrine; Triprolidine: (Minor) Pseudoephedrine renal elimination is susceptible to changes in urinary pH. Urinary alkalinizers allow for increased tubular reabsorption of pseudoephedrine. Concomitant administration of pseudoephedrine with urinary alkalinizers may increase the likelihood of pseudoephedrine adverse reactions.
Quinapril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Quinapril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Quinidine: (Major) Alkalinizing agents such as potassium citrate can increase renal tubular reabsorption of quinidine by alkalinizing the urine; higher quinidine serum concentrations and quinidine toxicity are possible. (Major) Urinary alkalinization increases the renal tubular reabsorption of quinidine, resulting in higher quinidine serum concentrations which may lead to toxicity. Avoid citric acid; potassium citrate; sodium citrate administration to any patient receiving treatment with quinidine.
Quinine: (Moderate) Use caution if using citric acid and quinine concomitantly. Urinary alkalinizing agents may increase plasma quinine concentrations because quinine is reabsorbed when the urine is alkaline. (Moderate) Use caution if using potassium citrate and quinine concomitantly. Urinary alkalinizing agents may increase plasma quinine concentrations because quinine is reabsorbed when the urine is alkaline.
Ramipril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Sacubitril; Valsartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Salicylates: (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Salsalate: (Moderate) Urinary alkalinizing agents may increase the excretion of salicylates by increasing renal clearance. (Moderate) Urinary alkalinizing agents, like potassium citrate, increase the excretion of salicylates by increasing renal clearance.
Sodium Polystyrene Sulfonate: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
Sparsentan: (Moderate) Monitor potassium during concomitant use of sparsentan and potassium. Concomitant use increases the risk for hyperkalemia.
Spironolactone: (Major) The use of potassium supplements in patients receiving spironolactone may increase the risk for hyperkalemia. Potassium supplements should generally be avoided in heart failure patients receiving spironolactone. Monitor serum potassium concentrations closely if concomitant use is necessary.
Spironolactone; Hydrochlorothiazide, HCTZ: (Major) The use of potassium supplements in patients receiving spironolactone may increase the risk for hyperkalemia. Potassium supplements should generally be avoided in heart failure patients receiving spironolactone. Monitor serum potassium concentrations closely if concomitant use is necessary.
Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and trimethoprim are used together. Concomitant use may increase the risk of hyperkalemia.
Sulindac: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Sumatriptan; Naproxen: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Tacrolimus: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and tacrolimus are used together. Concomitant use may increase the risk of hyperkalemia.
Telmisartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Telmisartan; Amlodipine: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Telmisartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Tolmetin: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and nonsteroidal anti-inflammatory drugs (NSAIDs) are used together. Concomitant use may increase the risk of hyperkalemia.
Trandolapril: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Trandolapril; Verapamil: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin-converting enzyme inhibitors (ACE inhibitors) are used together. Concomitant use may increase the risk of hyperkalemia.
Triamterene: (Major) The use of potassium supplements in patients treated with triamterene is generally contraindicated. Concomitant use may increase the risk of hyperkalemia. If potassium supplementation is used, monitor serum potassium concentrations closely.
Triamterene; Hydrochlorothiazide, HCTZ: (Major) The use of potassium supplements in patients treated with triamterene is generally contraindicated. Concomitant use may increase the risk of hyperkalemia. If potassium supplementation is used, monitor serum potassium concentrations closely.
Trimethoprim: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and trimethoprim are used together. Concomitant use may increase the risk of hyperkalemia.
Valsartan: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum potassium concentrations closely if potassium supplements and angiotensin II receptor antagonists are used together. Concomitant use may increase the risk of hyperkalemia.
Following absorption, potassium citrate and sodium citrate are metabolized to potassium bicarbonate and sodium bicarbonate, which raise the blood and urine pH. Citric acid is a temporary neutralizing buffer. Citric acid; potassium citrate; sodium citrate is used as a urinary alkalinizer to prevent uric acid or cystine calculi of the urinary tract. As a urinary alkalinizer, the generated bicarbonates increase urinary pH by promoting the urinary excretion of free bicarbonate ions. Urine alkalinization raises the solubility of cystine in the urine and also ionizes uric acid to a more soluble urate ion. In 5 patients with uric acid lithiasis, sodium citrate and potassium citrate were equally effective in preventing uric acid stone formation due to their alkalinizing effect. However, in contrast to potassium citrate which decreases urinary calcium, sodium citrate does not significantly decrease urinary calcium. The combination may also be effective in correcting the acidosis of certain renal tubular disorders, as the resulting bicarbonates that form after absorption buffer excess hydrogen ion concentrations and raise blood pH.
Citric acid; potassium citrate; sodium citrate solution is administered orally. Citric acid acts as a temporary buffer. Potassium citrate and sodium citrate are absorbed and metabolized to potassium bicarbonate and sodium bicarbonate. Oxidation is virtually complete so that less than 5% of the citrates are excreted in the urine unchanged.