Potassium citrate

UROCIT-K

What it isPotassium salt that alkalinizes urine and complexes calcium; hypocitraturic calcium stones and uric-acid stones.

Why this oneUnlike sodium alkali, it supplies citrate without a sodium load and can also correct hypokalemia.

What limits itHyperkalemia limits use in kidney disease or with RAAS blockers; monitor potassium and avoid when GI transit is impaired.

FDA label

FDA dosing	Population	Start	Target	Max
Severe hypocitraturia (urinary citrate <150 mg/day)	Adults	60 mEq/day: 30 mEq BID or 20 mEq TID, with/within 30 min after meals or bedtime snack	Urinary citrate >320 mg/day (goal ~640), urine pH 6.0-7.0	100 mEq/day
Mild-moderate hypocitraturia (urinary citrate >150 mg/day)	Adults	30 mEq/day: 15 mEq BID or 10 mEq TID, with/within 30 min after meals or bedtime snack	Urinary citrate >320 mg/day (goal ~640), urine pH 6.0-7.0	100 mEq/day

Renal Contraindicated if GFR <0.7 mL/kg/min (soft-tissue calcification, hyperkalemia); avoid in chronic renal failure

Hepatic Undefined

Doses >100 mEq/day not studied — avoid

Take with meals or within 30 min after meals or a bedtime snack
Add to a regimen limiting salt intake with high fluid intake (urine volume ≥2 L/day)
Adjust dose by 24-h urinary citrate and/or pH; recheck every 4 months
Monitor serum electrolytes, creatinine, and CBC every 4 months (more often if cardiac/renal disease or acidosis); periodic ECGs
Discontinue if hyperkalemia, significant creatinine rise, or significant fall in Hct/Hgb
Intact wax matrices may appear in stool (expected)

Hyperkalemia or conditions predisposing to it (chronic renal failure, uncontrolled diabetes, acute dehydration, strenuous exercise in unconditioned individuals, adrenal insufficiency, extensive tissue breakdown, potassium-sparing agents) — risk of cardiac arrest
Arrest/delay of tablet passage through the GI tract: delayed gastric emptying, esophageal compression, intestinal obstruction or stricture, or anticholinergic use
Peptic ulcer disease (ulcerogenic potential)
Active urinary tract infection (bacterial citrate degradation attenuates effect; higher pH may promote bacterial growth)
Renal insufficiency (GFR <0.7 mL/kg/min)

Hyperkalemia and cardiac arrest in patients with impaired potassium excretion — can develop rapidly and be asymptomatic; avoid in chronic renal failure, severe myocardial damage, or heart failure; monitor with periodic blood tests and ECGs
GI lesions — solid potassium dosage forms have caused stenotic/ulcerative small-bowel lesions, upper GI bleeding, and deaths (~1 per 100,000 patient-years); stop immediately and investigate perforation/obstruction if severe vomiting, abdominal pain, or GI bleeding

Pregnancy Animal reproduction studies not conducted; give only if clearly needed

Lactation Human milk potassium is ~13 mEq/L; effect of Urocit-K unknown — use only if clearly needed

NO BOXED WARNINGS

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