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Potassium Bicarbonate and Potassium Citrate

Pronunciation

(poe TASS ee um bye KAR bun ate & poe TASS ee um SIT rate)

Index Terms

  • Potassium Bicarbonate and Potassium Citrate (Effervescent)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Tablet Effervescent, Oral:

Effer-K: 10 mEq

Effer-K: 10 mEq [contains fd&c red #40; cherry-vanilla flavor]

Effer-K: 20 mEq

Effer-K: 20 mEq [scored; contains fd&c red #40, fd&c yellow #6 (sunset yellow); orange cream flavor]

Effer-K: 25 mEq [lime flavor]

Effer-K: 25 mEq [contains fd&c red #40, fd&c red #40 aluminum lake, saccharin; cherry berry flavor]

Effer-K: 25 mEq [contains fd&c yellow #10 (quinoline yellow), fd&c yellow #10 aluminum lake, saccharin; lemon citrus flavor]

Effer-K: 25 mEq [contains fd&c yellow #6 (sunset yellow), fd&c yellow #6 aluminum lake, saccharin; orange flavor]

Effer-K: 25 mEq [contains saccharin; unflavored flavor]

K-Effervescent: 25 mEq [orange flavor]

K-Prime: 25 mEq [contains fd&c yellow #6 (sunset yellow), fd&c yellow #6 aluminum lake, saccharin; orange flavor]

K-Vescent: 25 mEq [orange flavor]

Klor-Con/EF: 25 mEq [DSC] [contains fd&c yellow #6 (sunset yellow), fd&c yellow #6 aluminum lake, saccharin]

Klor-Con/EF: 25 mEq [DSC] [contains fd&c yellow #6 (sunset yellow), fd&c yellow #6 aluminum lake, saccharin; orange flavor]

Klor-Con/EF: 25 mEq [sugar free; contains fd&c yellow #6 (sunset yellow), fd&c yellow #6 aluminum lake, saccharin]

Klor-Con/EF: 25 mEq [sugar free; contains fd&c yellow #6 (sunset yellow), fd&c yellow #6 aluminum lake, saccharin; orange flavor]

Generic: 25 mEq

Brand Names: U.S.

  • Effer - K
  • K - Effervescent
  • K - Prime
  • K - Vescent
  • Klor - Con / EF

Pharmacologic Category

  • Electrolyte Supplement, Oral

Pharmacology

Potassium is needed for the conduction of nerve impulses in heart, brain, and skeletal muscle; contraction of cardiac, skeletal and smooth muscles; maintenance of normal renal function

Absorption

Well absorbed from upper GI tract

Distribution

Enters cells via active transport from extracellular fluid

Excretion

Primarily urine; skin and feces (small amounts); most intestinal potassium reabsorbed

Use: Labeled Indications

Treatment or prevention of hypokalemia, particularly when it is necessary to avoid chloride or the acid/base status requires bicarbonate

Contraindications

Hyperkalemia; concomitant use of potassium-sparing diuretics or potassium supplements

Dosing: Adult

Note: Doses expressed as mEq of potassium.

Normal daily requirement: 40-100 mEq/day or 1-2 mEq/kg/day (off-label dose; Mirtallo, 2004)

Hypokalemia: Oral:

Prevention: 10-80 mEq/day in 1-4 divided doses

Treatment: 40-100 mEq/day in 2-4 divided doses. Note: For asymptomatic mild hypokalemia, generally recommended to limit doses to 20-25 mEq/dose to avoid GI discomfort.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment

No dosage adjustment provided in manufacturer’s labeling. However, patients with chronic renal failure require serum potassium monitoring and appropriate dosage adjustment.

Dosing: Hepatic Impairment

No dosage adjustment provided in manufacturer’s labeling.

Administration

Dissolve tablet completely in 3-4 ounces of cold water or juice. May further dilute if GI adverse effects occur.

Storage

Store at controlled room temperature 15°C to 30°C (59°F to 86°F)

Drug Interactions

ACE Inhibitors: Potassium Salts may enhance the hyperkalemic effect of ACE Inhibitors. Monitor therapy

Aliskiren: Potassium Salts may enhance the hyperkalemic effect of Aliskiren. Monitor therapy

Aluminum Hydroxide: Citric Acid Derivatives may increase the absorption of Aluminum Hydroxide. Consider therapy modification

Angiotensin II Receptor Blockers: Potassium Salts may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Monitor therapy

Eplerenone: May enhance the hyperkalemic effect of Potassium Salts. Management: This combination is contraindicated in patients receiving eplerenone for treatment of hypertension. Consider therapy modification

Heparin: May enhance the hyperkalemic effect of Potassium Salts. Monitor therapy

Heparin (Low Molecular Weight): May enhance the hyperkalemic effect of Potassium Salts. Monitor therapy

Nicorandil: May enhance the hyperkalemic effect of Potassium Salts. Monitor therapy

Potassium-Sparing Diuretics: Potassium Salts may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Consider therapy modification

Test Interactions

Decreased ammonia

Adverse Reactions

Frequency not defined.

Gastrointestinal: Abdominal pain, diarrhea, nausea, vomiting

Endocrine & metabolic: Hyperkalemia and associated manifestations (eg, cardiac arrhythmias, etc)

Warnings/Precautions

Concerns related to adverse effects:

• GI effects: May cause GI upset (eg, nausea, vomiting, diarrhea, abdominal pain, discomfort) and lead to GI ulceration, bleeding, perforation and/or obstruction.

• Hyperkalemia: Close monitoring of serum potassium concentrations is needed to avoid hyperkalemia; severe hyperkalemia may lead to muscle weakness/paralysis and cardiac conduction abnormalities (eg, heart block, ventricular arrhythmias, asystole).

Disease-related concerns:

• Acid/base disorders: Use with caution in patients with acid/base alterations; changes in serum potassium concentrations can occur during acid/base correction, monitor closely.

• Cardiovascular disease: Use with caution in patients with cardiovascular disease (eg, heart failure, cardiac arrhythmias); patients may be more susceptible to life-threatening cardiac effects associated with hyper/hypokalemia.

• Metabolic acidosis: Patients with hypokalemia accompanied by metabolic acidosis should be treated with an alkalinizing potassium salt.

• Potassium-altering conditions/disorders: Use with caution in patients with disorders or conditions likely to contribute to altered serum potassium and hyperkalemia (eg, untreated Addison's disease, heat cramps, severe tissue breakdown from trauma or burns).

• Renal impairment: Use with caution in patients with renal impairment; monitor serum potassium concentrations closely. Avoid with severe impairment.

Concurrent drug therapy issues:

• Digitalis: Use with caution in digitalized patients; may be more susceptible to potentially life-threatening cardiac effects with rapid changes in serum potassium concentrations.

• Potassium-altering therapies: Use with caution in patients receiving concomitant medications or therapies that increase potassium (eg, ACE inhibitors, potassium-sparing diuretics, potassium-containing salt substitutes).

Monitoring Parameters

Serum potassium, magnesium (to facilitate potassium repletion), and bicarbonate

Pregnancy Risk Factor

C

Pregnancy Considerations

Animal reproduction studies have not been conducted with this combination. See individual agents.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience diarrhea. Have patient report immediately to prescriber signs of high potassium (abnormal heartbeat, confusion, dizziness, passing out, weakness, shortness of breath, numbness or tingling feeling), severe nausea, severe vomiting, abdominal edema, black, tarry, or bloody stools, vomiting blood, or severe abdominal pain (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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