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Potassium Citrate

Pronunciation

Pronunciation

(poe TASS ee um SIT rate)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet Extended Release, Oral:

Urocit-K 5: 5 mEq (540 mg)

Urocit-K 10: 10 mEq (1080 mg)

Urocit-K 15: 15 mEq (1620 mg)

Generic: 5 mEq (540 mg), 10 mEq (1080 mg), 15 mEq (1620 mg)

Brand Names: U.S.

  • Urocit-K 10
  • Urocit-K 15
  • Urocit-K 5

Pharmacologic Category

  • Alkalinizing Agent, Oral

Metabolism

Hepatic to bicarbonate

Use: Labeled Indications

Prevention of uric acid nephrolithiasis; prevention of calcium renal stones in patients with hypocitraturia; urinary alkalinizer when sodium citrate is contraindicated

Contraindications

Severe renal insufficiency; patients with hyperkalemia or with conditions predisposing to hyperkalemia (eg, acute dehydration, adrenal insufficiency, uncontrolled diabetes mellitus, tissue breakdown, concurrent use of potassium-sparing agents); patients with delayed gastric emptying, esophageal compression, intestinal obstruction or stricture, or those taking anticholinergic medication; patients with active urinary tract infection

Dosing: Adult

Alkalinizer, bicarbonate precursor: Oral:

Mild-to-moderate hypocitraturia (>150 mg urinary citrate):

Immediate release: 10 mEq 3 times daily; maximum dose: 100 mEq/day

Extended release: 15 mEq 2 times daily or 10 mEq 3 times daily; maximum dose: 100 mEq/day

Severe hypocitraturia (<150 mg/day urinary citrate):

Immediate release: 20 mEq 3 times daily or 15 mEq 4 times daily; maximum dose: 100 mEq/day

Extended release: 30 mEq 2 times daily or 20 mEq 3 times daily; maximum dose: 100 mEq/day

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment

Use is contraindicated in patients with renal insufficiency (GFR <0.7 mL/kg/minute) or chronic renal failure.

Dosing: Hepatic Impairment

No dosage adjustment provided in manufacturer’s labeling.

Administration

Administer with meals or bedtime snack (or within 30 minutes after). Swallow tablets whole with a full glass of water.

Dietary Considerations

Ensure adequate fluid intake; limit salt intake. Take with meals or snack.

Storage

Store in a cool, dry place.

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. Monitor therapy

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

Adverse Reactions

Frequency not defined.

Endocrine & metabolic: Hyperkalemia

Gastrointestinal: Abdominal discomfort, diarrhea, nausea, vomiting

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. Oral liquid preparations (not solid) should be used in patients with esophageal compression or delayed gastric emptying.

• 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.

• Hepatic impairment: Citrate is converted to bicarbonate in the liver; this conversion may be blocked in patients in hepatic failure.

• 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. Contraindicated with severe impairment.

• Severely ill: Citrate is converted to bicarbonate in the liver; this conversion may be blocked in patients who are severely ill or in shock.

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, ACEI, potassium-sparing diuretics, potassium containing salt substitutes).

Monitoring Parameters

Serum electrolytes (potassium, chloride, sodium), bicarbonate, serum creatinine, and CBC every 4 months (more frequently with cardiac/renal disease or acidosis); urinary citrate and/or urinary pH at initiation or dose change and every 4 months; ECG (periodically)

Pregnancy Risk Factor

C

Pregnancy Considerations

Animal reproduction studies have not been conducted.

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 or tablet shell in stool. Have patient report immediately to prescriber signs of high potassium (abnormal heartbeat, confusion, dizziness, passing out, weakness, shortness of breath, numbness or tingling feeling), abdominal edema, severe nausea, severe vomiting, severe abdominal pain, black, tarry, or bloody stools, or vomiting blood (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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