Sodium bicarbonate
NaHCO₃
Pronunciation: SOE-dee-um bye-KAR-bon-ayt
What it isAlkalinizing agent; metabolic acidosis, urinary alkalinization and sodium channel blocker overdose.
Why this oneThe antidote for tricyclic and other sodium channel blocker cardiotoxicity, working by both pH and sodium load.
What limits itHypernatremia, volume overload and hypokalemia. Paradoxical intracellular acidosis if ventilation is inadequate.
Sodium bicarbonate prescription history
Animated chart of estimated U.S. prescriptions per year, All Rx meds (1914–2026). Sodium bicarbonate enters in 1900 (estimated).
FDA-approved for
- metabolic acidosis
- antacid (OTC)
Off-label
- urinary alkalinization in salicylate overdose
- serum alkalinization in tricyclic overdose
Principal riskHypernatremia, volume overload and hypokalemia
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityUsually well tolerated at replacement doses; excessive dosing can cause agent-specific metabolic or organ toxicity.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Antacid (acid indigestion/upset stomach) | Adults | 1 × 325 mg tablet dissolved in water PRN | 24 × 325 mg tablets/24h (adults up to 60 years of age); 12 tablets/24h (60 years of age or older); max dose ≤2 weeks unless physician-supervised |
Renal Undefined
Hepatic Undefined
Counts apply only to this 325 mg tablet: max 24 tablets/24h (adults up to 60 years of age) or 12 tablets (60 years of age or older); not >2 weeks at max dose; avoid on sodium-restricted diet unless directed (89 mg sodium/tablet).
Instructions
- Dissolve tablet completely in a glass of water before drinking
- Do not take when overly full from food or drink
- Not recommended for children
Available strengths
- tab 325, 391, 648, 650, 782, 977.5, 978, 2860/65 mg
- powder 2.6 g/2.6 g
- powder 2.616 g/2.616 g
- powder 1 g/g
- powder 22.8/77.8 mg/100 mg
- powder 700/2300 mg/3000 mg
- powder 315, 616, 1000 mg/g
- sol 5, 8.4 g/100 mL
- + 15 other marketed forms not shown
Cautions
- Do not take until the tablet is completely dissolved
- Do not take when overly full from food or drink
- Consult a doctor if severe stomach pain occurs after taking
Pregnancy Undefined
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | brand $/unit | CostPlus | |
|---|---|---|---|---|---|
| 325 mg | tab | per unit | $0.01/ea | — | not offered |
| 391 mg | tab | per unit | $0.45/ea | — | not offered |
| 648 mg | tab | per unit | — | not offered | |
| 650 mg | tab | per unit | $0.01/ea | — | not offered |
| 782 mg | tab | per unit | $0.52/ea | — | not offered |
| 977.5 mg | tab | per unit | $0.36/ea | — | not offered |
| 978 mg | tab | per unit | — | $0.86/ea | not offered |
| 2860/65 mg | tab | per unit | — | not offered |
Available combined with: PEG 3350/ electrolytes (GOLYTELY)
Generic entry2005
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Memory aids: interaction avatars
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Self-check
- How does bicarbonate counter sodium-channel-blocker cardiotoxicity?
Through pH and sodium load. - What can occur if ventilation is inadequate during bicarbonate treatment?
Paradoxical intracellular acidosis.